Shifting the Paradigm Toward Earlier Treatment of Multiple Sclerosis With Interferon Beta

Background: Axonal damage Occurs early ill the Course Of Multiple sclerosis (MS). Among untreated patients, 85%, to 94% with a first clinically isolated syndrome (CIS) suggestive of MS and positive findings on magnetic resonance imaging (MRI) are at risk for developing MS. Objectives: This article reviews the current literature concerning early diagnosis of MS, the rationale for early immunomodulatory treatment of patients with a CIS and MRI evidence of central nervous system lesions, and the efficacy of early treatment with Interferon beta (IFN-beta). Methods: MEDLINE was searched from 1990 through the end of 2008 for papers Published in English concerning the treatment of MS. Search terms Included IFN-beta, early treatment, CIS, and multiple Sclerosis, and limits were set to return results related to human clinical trials in adults. Results: Three pivotal randomized controlled trials were identified, 2 involving IFN-beta-1a (30 mu g IM once weekly and 22 mu g SC once weekly) and 1 involving IFN-beta-1b (250 mu g SC qod). In these trials, treatment with IFN-beta effectively reduced the risk of developing MS by Lip to 50%, in patients with a CIS. Furthermore, compared with delayed treatment, early treatment was associated with a reduced risk of disease progression: a 40%, reduction In risk for confirmed disability progression at 3 years and a 41% reduction In risk of MS at 3 years. Conclusions: The evidence that axonal damage begins in the early stages of MS, before symptoms are evident, provides a rationale for early intervention with immunomodulatory agents. Ill 3 pivotal clinical trials, IFN-beta effectively reduced the risk of developing clinically definite MS in CIS patients with a first demyelinating event and positive brain MRI. (Clin Ther. 2009;)]:1142-1157) (C) 2009 Excerpta Medica Inc.