May 17, 2001 -- If you're a fan of TV's The West Wing, you know that the first lady, who happens to be a medical doctor, has been giving the president interferon beta injections. Her covert attempts to keep his multiple sclerosis in check are right on target, according to the latest research. In a new study, patients who began taking the drug immediately after their first attack of MS symptoms were significantly less likely to have another.
In MS, the outer linings of nerve cells, called myelin sheaths, become hardened and scarred, forming lesions that interfere with signal transmission. This causes a variety of problems including weakness, double vision, dizziness, and strange pins-and-needle sensations.
Most people with MS have their first attack in early adulthood, and symptoms are often so mild, they're barely noticed. With each subsequent attack, however, more damage is done, and the disease can eventually become incapacitating.
"We have demonstrated that a very low dose of interferon beta, given within three months of the first attack of multiple sclerosis, is able to reduce by 24% the probability of having a second attack," says study leader Giancarlo Comi, MD, a professor of neurology at IRCCS Ospedale S. Raffaele in Milan, Italy.
Comi's team randomly assigned more than 300 patients with suspected MS -- they'd had just one episode of MS-like symptoms -- to receive a single interferon beta injection or a placebo injection every week for two years.
All patients underwent a complete examination every six months and had an MRI scan to check for the telltale lesions every 12 months.
At the end of the study, far fewer interferon patients than placebo patients had experienced a second attack or showed MS lesions on MRI. But "even in those patients who did have a second attack, the time between the first and second attacks was doubled by the drug," Comi tells WebMD.
"When we planned this study, the idea was that if we begin treatment as soon as possible after the first attack, then the disease would respond better than if we waited," he says. "There is no doubt that this study confirms that hypothesis."
What's more, says Comi, "we used a very low dose of interferon beta, much lower than what we normally use to treat advanced disease. This indicates that in the early phase, multiple sclerosis is more responsive to interferon beta than it is later, and treatment should begin as early as possible."
But right now in the U.S. and Europe, insurance will cover the therapy only after a patient has suffered two attacks and shows MRI evidence of lesions, as those are the criteria for a clinical diagnosis of MS.
"Sometimes, however, the second attack occurs three, five, or even 10 years after the first, and by that time, the disease could have already progressed," says Comi.
New guidelines, due out in July, "will put pressure on the pharmaceutical houses," says Jerry S. Wolinsky, MD, professor of neurology at the University of Texas Health Science Center at Houston. "Experts now believe that many patients who present with their first attack and multiple lesions definitely do have MS and should get on with treatment. The ground rules will be changing. They have to."
Wolinsky, who was not involved in the study, provided objective commentary for WebMD.
According to him, the findings are "tantalizing, but by no means definitive," and significant questions remain. For one thing, Wolinsky tells WebMD, "there is no way to know from this study whether continuing the low doses of interferon beta will actually prevent significant accumulated disability" over time.