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Should Multiple Sclerosis Drug Be Given Earlier?

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Sept. 26, 2000 -- Avonex is a medication shown to be effective in treating multiple sclerosis (MS). However, current guidelines say that a person should only be treated when a diagnosis of MS is certain. This means that some patients -- who have symptoms that are highly suggestive of the illness -- will not receive the medications that seem to slow the disease.

Now, research reported in the Sept. 28 issue of TheNew England Journal of Medicine suggests that the drug may be helpful in patients at the first sign of MS and may prevent them from having additional attacks which could eventually cause irreversible damage to the brain or spinal cord.

MS attacks nerves throughout the brain, eyes, and spinal cord, giving rise to devastating symptoms such as blindness and paralysis. Normally, many nerves are coated with myelin, an insulating substance that allows them to communicate with each other more rapidly. In MS, the myelin coating of some nerves breaks down, interrupting communication between nerves and causing the characteristic symptoms. The symptoms can mysteriously disappear as rapidly as they appeared, so that the disease may be marked by episodes of disability and then remissions, when patients are relatively free of symptoms. With each attack, recovery may be less complete, until damage is irreversible.

In the new study, Avonex slowed progression by half in those who received the drug earlier than most patients, lead author Lawrence D. Jacobs, MD, tells WebMD. "This treatment is being considered by more and more physicians. Certainly it's an option that should be discussed with the patient," says Jacobs, a professor of neurology at State University of New York at Buffalo.

Routine use of brain scans after the first MS attack may help identify those patients most likely to get worse, and those most likely to benefit from being given the drug earlier, Jacobs explains.

"It is convincing that there is a difference with treatment," Brian G. Weinshenker, MD, tells WebMD. "The question is whether this justifies starting patients on an expensive treatment [when they] might do just as well without it."

"I'm reluctant to start therapy in these patients, based on the findings of this study," says Weinshenker, a professor of neurology at the Mayo Clinic in Rochester, Minn., and author of an accompanying review article. "After a first attack, some patients may never develop [actual] MS."

"I personally would not advise patients to have [Avonex] before onset of definite MS," Florian Deisenhammer, MD, tells WebMD. He is a professor of neurology at the University of Innsbruck in Austria and was not involved in the study.

The fluctuating symptoms in MS make it extremely difficult to test the effects of drugs, as patients may get better with or without treatment, Weinshenker explains. The best way to tell whether patients are getting better because of a drug or in spite of it is through rigorous studies.

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