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Several studies have shown that after a first neurologic episode highly suggestive of multiple sclerosis (MS), treatment with interferon-β delays occurrence of a second episode at a different location (i.e., clinically definite MS). In one such study, industry-funded investigators randomized patients to begin interferon-β or placebo within 60 days of a first suggestive clinical event and to continue treatment for 2 years or until progression to clinically definite MS, whichever occurred first. Upon completion of the study, 378 patients accepted open-label interferon-β and continued regular clinical assessments, allowing the researchers to compare progression of disease and disability between patients who received early and delayed treatment.
After a total follow-up of 3 years, risk for progression to clinically definite MS was significantly lower in the early-treatment group than in the delayed-treatment group (37% vs. 51%). Most patients in both groups remained at a low level of disability, but risk for progression on a standardized 10-point MS disability score was significantly lower in the early-treatment group (16% vs. 24%).
Kappos L et al. Effect of early versus delayed interferon beta-1b treatment on disability after a first clinical event suggestive of multiple sclerosis: A 3-year follow-up analysis of the BENEFIT study. Lancet 2007 Aug 4; 370:389-97.
Pittock SJ. Interferon beta in multiple sclerosis: How much BENEFIT? Lancet 2007 Aug 4; 370:363-4.
Comment
Although these data seem to support treatment with interferon-β after an initial episode suggestive of multiple sclerosis, an editorialist advises caution, noting that the absolute differences in disability scores were small, and the number needed to treat (12) to prevent one patient from progressing to increased disability was large. This study will continue for 2 more years and may yet provide more robust results.