Caution Urged in Early MS Treatment
Too Soon for 'Treat-All' Approach to Multiple Sclerosis?
Aug. 2, 2007 -- A new study shows that early treatment for multiple
sclerosis cuts the risk of disability. But some experts say it's too soon to
take a "treat-all approach" to MS.
international BENEFIT study tested a current trend -- giving MS treatments
to patients at the first sign of what might be MS. The study showed that early
treatment with Betaseron, one of three forms of beta-interferon approved for
MS, cut the three-year risk of
disability by 41% compared with delayed treatment.
However, patients who got early
treatment only reduced their overall three-year risk of disability by 14%.
The final report on the study appears in the Aug. 4 issue of The
Lancet. Accompanying the study is an editorial by Mayo Clinic MS expert
Sean J. Pittock, MD.
The benefits seen in the BENEFIT study were "modest," Pittock
writes. He notes that 12 patients would have to be treated with Betaseron --
beginning at the first sign of MS -- to protect one patient from worsening
Pittock notes that the BENEFIT trial does show, for the first time, that
early beta-interferon treatment has a "beneficial effect on accumulation of
confirmed disability in patients with a first event suggestive of multiple
But he warns against over-optimistic interpretation of the findings.
"The results should be interpreted with care because the magnitude of
benefit, although statistically significant, is clinically small," Pittock
writes. The study findings "should not be misconstrued as evidence for a
In a 2004 study, Pittock and colleagues found that some patients have
"benign MS" that does not progress to ever greater levels of
disability. Pittock and colleagues suggested that this argues against
aggressive, early treatment for all MS patients.
Pittock and colleagues, however, may be bucking a trend. The new findings
mean it's time to start treatment when you've had a single MS-like event, says
BENEFIT researcher Mark S. Freedman, MD, FRCPC, director of the MS research
center at the University of Ottawa, Ontario, Canada.
"The first paradigm shift came at the end of the '90s, when we learned
that waiting for an MS relapse is too late and we started treating MS at the
time of diagnosis," Freedman told WebMD in May. "Now we see you have to
start when you think you have MS. This is the new paradigm shift in MS
Robert Fox, MD, medical director of Cleveland Clinic's Mellen Center for
Multiple Sclerosis Treatment and Research, agrees with Freedman.
"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 told WebMD in May.
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