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Super-Early MS Treatment Best

Permanent Disability Delayed by Betaseron After First MS-Like Event
By
WebMD Health News
Reviewed by Louise Chang, MD

June 1, 2007 -- Treat a disease even before it's diagnosed? Yes, if the disease is multiple sclerosis, new research shows.

An MS diagnosis is complex and often depends on more than one attack of neurological symptoms such as limb weakness or blurred vision. Doctors tend to take a year or more to make the diagnosis, and only then make treatment decisions.

Now a new study shows that it's not enough to treat multiple sclerosis as soon as it's diagnosed. The time to start treatment is when you've had a single MS-like event, says Mark S. Freedman, MD, FRCPC, director of the MS research center at the University of Ottawa in Ontario, Canada.

"The first paradigm shift came at the end of the 1990s, when we learned that waiting for MS to progress was too late, and we started treating MS earlier -- usually soon after confirming the diagnosis," Freedman tells WebMD. "Now we see you have to start when you think you have MS. This is the new paradigm shift in MS treatment."

That "startling" conclusion comes from compelling data Freedman reported today at the Consortium of Multiple Sclerosis Centers annual meeting in Washington. Freedman also reported some of the data at last month's meeting of the American Academy of Neurology in Boston.

Freedman and colleagues at 98 MS treatment centers in 20 nations studied 468 patients who had a first episode of what doctors call "clinically isolated syndrome" suggestive of MS. Half were treated right away with Betaseron, one of three beta-interferon drugs currently approved for MS treatment. The other half got inactive placebo injections and only got the real drug when a second attack confirmed their MS diagnosis.

After just two years, Freedman says, 85% of the patients initially treated with placebo would have met the new criteria for MS diagnosis -- and after three years, 24% showed signs of "sustained progression" -- even though most of them had already switched to Betaseron a year or more earlier. Only 16% of the patients given immediate treatment had sustained progression.

"Permanent damage happens very early in MS, much earlier than we had anticipated," Freedman says. "That year to year-and-a-half delay in treatment translates into an accumulation of disability. It was startling to see that at just year three of the study."

Rx: Super-Early MS Treatment

This means a sea change in MS treatment, says Robert Fox, MD, medical director of Cleveland Clinic's Mellen Center for Multiple Sclerosis Treatment and Research.

"We have finally shown that treating MS super early can have a significant impact on the development of disability, which is what patients are most worried about," Fox tells WebMD.

"This isn't just early treatment -- early treatment is when a patient has had a second episode. Early treatment now turns out to be late," Fox says. "This is the first study to show we need to treat super early, after only a single attack with the diagnosis of MS not confirmed."

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