“I was invited to give a clinical talk on MS at a regional neuroscience centre in the South-East of England this week; Hurstwood Park. I spoke on the paradigm shift in treatment goals and discussed three aims of treatment: (1) early treatment, (2) highly-effective treatment and (3) the advantages that a true induction therapy offers over a maintenance therapy. I went through the scientific rationale of treat-2-target of NEDA (no evident disease activity) and why we need to adopt a zero tolerance strategy. I think most people at the meeting thought I was an outlier. I may be an outlier in the UK, but would sit firmly in the middle of the pack if I worked in the USA. Being an outlier is one thing, but neurologists need to ask themselves question what would they want if they had MS or a loved one of theirs had the disease. Would they be happy to live with a sub-optimal treatment response and have smouldering MS? Smouldering MS shreds your brain and sets you up for getting progressive disease. I think the most compelling data to support a more aggressive approach to MS treatment is recent brain atrophy data. Brain atrophy is the best integrator of end organ damage and if you can normalise brain atrophy rates in MSers you are giving that individual the best chance of remaining healthy and of ageing normally. We forget that MSers are as susceptible age-related cognitive decline as the general population. What protects us from the latter is brain health. Why shouldn’t MSers have brain health? It is interesting that the only drugs that normalise brain atrophy rates in year two are the most effective ones; i.e. natalizumab and alemtuzumab, with fingolimod close behind. I exclude year 1 atrophy rates as they are all over the place and susceptible to the phenomenon of pseudoatrophy. This is why we have to rebaseline MSers on DMTs with MRI to reset the clock for comparison.”
Patti et al. Interferon-beta-1a treatment has a positive effect on quality of life of relapsing-remitting multiple sclerosis: Results from a longitudinal study. J Neurol Sci. 2013 Dec 26. pii: S0022-510X(13)03077-3.
PURPOSE: The impact of interferon beta (IFNβ) therapy on a patient’s quality of life (QoL) has not been completely clarified. This multicenter, independent, observational and longitudinal study was aimed to evaluate the impact of different pharmaceutical formulations of IFNβ-1a on QoL in MSers affected by relapsing-remitting multiple sclerosis (RRMS).
METHODS: The multiple sclerosis quality of life-54 questionnaire was used to assess patients’ QoL.
RESULTS: 394 (66%) MSers completed the two-year study; 152 were treated with IFNβ-1a i.m. weekly injected (group a), 152 with IFNβ-1a 44μg s.c. injected three times a week (group b) and 90 were untreated (group c). After two years, a significant increase was found in the physical health composite score (Δ=+3.1 in group a, Δ=+3 in group b, p<0.05 in both), mental health composite score (Δ=+4.7 in group a, Δ=+5.5 in group b, p<0.001 in both), in eight MSQoL sub-items of group a and in seven sub-items in group b. Conversely, the untreated group showed a slight decrease in seven domains. The variable “therapy with DMDs” was associated with improved QoL.
CONCLUSION: QoL of RRMS could be improved by IFNβ-1a treatment, despite natural history data which seem to demonstrate that QoL could get worse over the time.