Too Soon for 'Treat-All' Approach to Multiple Sclerosis?
By Daniel J. DeNoon
WebMD Medical News
Reviewed by Louise Chang, MD
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.
The 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 disability.
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 sclerosis."
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 treat-all approach."
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 treatment."
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.
Discuss this and other MS topics with others on WebMD's Multiple Sclerosis Support Group message board.
SOURCES: Kappos, L. The Lancet, Aug. 4, 2007; vol 370: pp 389-397. Pittock, S.J. The Lancet, Aug. 4, 2007; vol 370: pp 363-364. Pittock, S.J. Annals of Neurology, August 2004; vol 56: pp 303-306. News release, Mayo Clinic, Rochester. Mark S. Freedman, MD, FRCPC, director, MS research center, and professor of neurology, University of Ottawa, Ontario, Canada. Robert Fox, MD, medical director, Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic.
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