MS disability progression: Drug impact

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  • Published: Aug 1, 2012
  • Author: David Bradley
  • Channels: MRI Spectroscopy
thumbnail image: MS disability progression: Drug impact

Disability

For many years beta-interferons, a type of protein involved in the immune response, have been prescribed to sufferers of multiple sclerosis (MS). 

For almost two decades beta-interferons, a type of protein involved in the immune response, have been prescribed to patients with multiple sclerosis (MS). However, a new study indicates that they may actually have no measurable impact on the long-term disability progression in the disease.

MS also known as "disseminated sclerosis" or "encephalomyelitis disseminata" is a potentially debilitating disease that involves an inflammatory damage in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged. The loss of the myelin insulating sheath, called "demyelination", and scarring cause a wide range of signs and symptoms including loss of sensitivity, tingling, pins needles, numbness, muscle weakness and spasms, difficulty moving, with coordination and balance and speech and digestive problems. The disease commonly hits young adults, particularly women and is thought to afflict up to 150 per 100,000 people depending on the country, and ethnicity. Beta-interferons have been approved as one of the first line "disease-modifying treatments" for MS for several years.

Now, researchers at the University of British Columbia (UBC) Hospital MS Clinic and Brain Research Centre at Vancouver Coastal Health Research Institute and UBC have reported important findings regarding the benefits of beta-interferons on disability progression in patients with the relapsing-remitting form of MS, the most common form of the disease. According to the work by Helen Tremlett, Afsaneh Shirani, Joel Oger and colleagues there is no strong evidence of a significant association between using beta-interferons in MS and staving off long-term disability progression.

The researchers examined health records of 2656 anonymized patients for the period 1985 to 2008 in a retrospective cohort study. The patient groups included those with MS who were treated with beta-interferons as well as patients who were not treated with the drugs. The perhaps disappointing but thought-provoking finding is that despite many years of research and development into these drugs it appears that, at least as far as this one measure of impact goes, they do not warrant routine use in all MS patients if the main aim is to significantly reduce progression of disability.

The relapsing-remitting form of MS is usually characterized by "flare-ups" (relapses) in which old symptoms might reappear or worsen or even new symptoms arise. Such periods are then usually followed by remission. This form of MS is seen in about 85% of patients.

Clinical trials have demonstrated that beta-interferons reduce the frequency of relapses as well as the emergence of new lesions as visualized on patients' MRI scans. It might be that the reason the team found no relationship between long-term disability and these drugs is that the relapses may not be directly responsible for such long-term disability in all patients; there might be other mechanisms that researchers are yet to identify that lead to progression of the disease in MS patients.

"What this study provides is additional information to patients and clinicians about the longer term effect of this class of drugs," explains Tremlett. "We know that this class of drugs is very helpful in reducing relapses, which can be important to patients. We do not recommend that patients stop taking these medications, but these findings provide evidence, allowing more realistic expectations as to the anticipated benefits associated with drug treatment from the disability perspective."

New therapeutic clues needed

The team concedes that despite their finding, it still might be that some patients gain long-term benefit from beta-interferons. The researchers are now working towards identifying the type of patients who might respond well to these drugs. However, the work does suggest the search for novel treatments with greater efficacy in this aspect of MS might now be sought. Beta-interferons do not seem to be a panacea for sufferers but this work points to the need for therapy tailored more directly to individual patients. The use of MRI in monitoring such patients and their response to treatmentmight ultimately help toward revealing clues to alternative mechanisms that lead to the cycles of relapse and remission and long-term disability.

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Article by David Bradley

The views represented in this article are solely those of the author and do not necessarily represent those of John Wiley and Sons, Ltd.

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