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Drug slows onset of MS, study finds
Patients who had early signs of the disease were given Avonex. It costs $10,000 a year, though.
By Shankar Vedantam
INQUIRER STAFF WRITER
Aggressively treating patients with very early signs of multiple sclerosis - well before the crippling nerve disease is usually diagnosed - can delay the onslaught of the disease and mute its damage.
A study, conducted in 50 centers across the United States and Canada, including in Philadelphia, found results so dramatic that researchers stopped the trial midway and called for early drug intervention for all patients at risk for MS.
"This is huge," said Steven Galetta, a professor of neurology at the University of Pennsylvania, one of the centers that studied the impact of early treatment with the drug Interferon beta-1A. "It has profound implications regarding those patients at high risk for MS."
"The earlier you treat MS, the better off you are," he said.
The study is to be published tomorrow in the New England Journal of Medicine.
The study was sponsored by Cambridge, Mass.-based Biogen Inc., a biotechnology firm that sells the drug Avonex, used in the trial. Avonex is commonly used for MS patients but has not been prescribed so early.
Multiple sclerosis affects about 350,000 people in the United States, according to the National Multiple Sclerosis Society. Women are two to three times more likely to be affected than men.
The disease is characterized by symptoms such as blurred or weakened vision, weakness in the fingers and toes, numbness and imbalance. It sometimes progresses to the point where patients are partially paralyzed and wheelchair-dependent.
Scientists have found that symptoms are caused by the destruction of the myelin sheath that covers nerve fibers – akin to the breakdown of the insulation of a telephone wire. This disrupts the transmission of messages within the nervous system and increases the risk of damage to the underlying nerves.
Piecing together a diagnosis of MS from early symptoms can be difficult since they are common to other conditions and sometimes go away. Doctors have so far relied on multiple outbursts - or relapses - and MRI brain scans to make a diagnosis and begin treatment.
The new study and other research indicates that waiting to treat MS may be harmful. Long before physical symptoms develop, the brains of MS patients appear to undergo a steady, stealthy assault.
And for each flare-up in physical symptoms, said doctors, there may be a dozen silent attacks in the brain. These attacks can cause lapses in concentration, memory, attention and judgment as well as physical disabilities.
The study recruited 383 patients who had reported a single outburst of symptoms. An MRI scan established that they were at risk for MS. One half received weekly injections of interferon beta-1A, a drug currently used to treat fully diagnosed MS, while the rest received a dummy injection or placebo.
After three years of follow-up, scientists found that 44 percent fewer patients in the drug group had developed a second outburst of symptoms compared with those in the placebo group. Since the second outburst is the traditional point at which a diagnosis of MS is made, the scientists concluded that their treatment had substantially delayed the disease.
Even more impressive, according to the researchers, treated patients saw 90 percent fewer brain lesions in certain MRI scans, a crucial benefit, given that such damage to the brain is irreversible.
Eventually half the patients in the placebo group went on to develop MS, compared with just over a third in the group that got the drug.
Lawrence Jacobs, professor of neurology at the State University of New York in Buffalo and the lead investigator of the study, said the results boded well for long-term prognosis.
"It's very good to increase the length of time between the first and second relapse and reduce the number of lesions," he said.
Two difficulties can prevent the implementation of the study results: A year's supply of Avonex can cost $10,000, raising questions about access to care. Second, with the inherent difficulty in diagnosis, patients need to take early symptoms seriously and consult a neurologist, Jacobs said.
The most common early signs to watch for, he said, are lost vision in
one eye, pain with eye movements, double vision, coordination problems,
and an electric shock-like sensation down the spine when the chin is pressed
against the chest.
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Shankar Vedantam's e-mail address is svedantam@phillynews.com
