A long-term study shows treatments with interferon when multiple sclerosis is first suspected — even before a definite diagnosis — can result in less disease activity or progression.
A long-term study following multiple sclerosis (MS) patients taking the drug interferon beta-1b suggests the earlier therapy is started, the greater the benefit.
The results of the BENEFIT 11 study were published last week in Neurology.
In MS, the immune system mistakenly sees myelin, the protective covering of nerve cells, as an enemy to be destroyed. When a person has an MS attack the nerves are damaged and can result in a whole slate of symptoms that depend on the location of the inflammation.
The symptoms can be mild or dramatic. They can range from numbness and tingling to paralysis, cognitive issues, bowel and bladder problems, and even blindness.
Starting Early Is Key
For this study, researchers examined people who had suffered from clinically isolated syndrome (CIS), which is a singular neurological event resulting in symptoms similar to those seen in MS.
While the patients may appear to have the disease, doctors cannot give a definite diagnosis until after a person has at least two attacks. Each attack must result in lesions, or patches of inflammation, in different spots on the brain or spinal cord. Patients who have CIS have yet to meet this requirement and not all of them will go on to be diagnosed with MS.
Many will, however, so CIS is seen as a possible precursor to MS. By including these patients in this study, researchers were trying to catch MS in its earliest stage to see if treating with interferon beta-1b before the disease had time to do damage could make a difference in long-term outcomes.
Over the Long Haul
The original study randomly assigned participants to receive either interferon beta-1b or a placebo. After either a second neurological event or two years, all patients were given interferon beta-1b.
Researchers followed 278 patients over an 11-year period and found that people with CIS who received interferon beta-1b had a lower relapse rate and a longer time from first episode to receiving a definite MS diagnosis.
Early in relapsing MS, the body has the ability to heal damaged myelin to near perfect condition. Because of this, symptoms a patient suffers during an attack may disappear after the episode is over. But scar tissue accumulates over time. This scar tissue does not transmit nerve impulses as effectively as the original myelin. As a result, symptoms can remain and disability can accumulate.
For that reason, beginning treatment early — and taking it as prescribed — is crucial.
There are currently 12 disease-modifying therapies (DMTs) approved by the Food and Drug Administration (FDA) to treat MS. Each of these medications comes with possible side effects and varying levels of effectiveness.
According to a consensus paper published by the Multiple Sclerosis Coalition, “Early successful control of disease activity — including the reduction of clinical and sub-clinical attacks and the delay of the progressive phase of the disease — appears to play a key role in preventing accumulation of disability, prolonging the ability of people with MS to remain active and engaged, and protecting quality of life.”
Interferon beta-1b came on the market in 1993 as the first FDA-approved DMT for MS. It has been sold under the brand name Betaseron since that time. In 2014, the drug got a makeover. This version of the drug, called Extavia, only has to be injected twice a month.