STUDY: Association Between Use of Interferon Beta and Progression of Disability in MS

[ActiveMSers]

It is interesting that this study differs so much from the 2012 Italian study (not referenced), which found in a similarly large sample size that "DMDs significantly reduce the risk of multiple sclerosis progression" and that "the risk of secondary progression was significantly lower in patients treated with DMDs." (Link: http://www.ncbi.nlm.nih.gov/pubmed/22653657). One reason may be the length of the two studies. The below JAMA study looked at 4/5 years of data; the Italian study looked at at least 10+ years. Perhaps both studies are correct; say disability is not that different in the first five years (on or off interferon), but over time, DMDs more heavily influence disease progression. Or maybe it's time to more seriously consider interferon alternatives like Tysabri, Gilenya and Copaxone. - Dave

Association Between Use of Interferon Beta and Progression of Disability in Patients With Relapsing-Remitting Multiple Sclerosis

Afsaneh Shirani, MD; Yinshan Zhao, PhD; Mohammad Ehsanul Karim, MSc; Charity Evans, PhD; Elaine Kingwell, PhD; Mia L. van der Kop, MSc; Joel Oger, MD, FRCPC; Paul Gustafson, PhD; John Petkau, PhD; Helen Tremlett, PhD
[+] Author Affiliations
JAMA. 2012;308(3):247-256. doi:10.1001/jama.2012.7625 Text Size: A A A
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ABSTRACT

Interferon beta is widely prescribed to treat multiple sclerosis (MS); however, its relationship with disability progression has yet to be established.

Objective To investigate the association between interferon beta exposure and disability progression in patients with relapsing-remitting MS.

Design, Setting, and Patients Retrospective cohort study based on prospectively collected data (1985-2008) from British Columbia, Canada. Patients with relapsing-remitting MS treated with interferon beta (n = 868) were compared with untreated contemporary (n = 829) and historical (n = 959) cohorts.

Main Outcome Measures The main outcome measure was time from interferon beta treatment eligibility (baseline) to a confirmed and sustained score of 6 (requiring a cane to walk 100 m; confirmed at >150 days with no measurable improvement) on the Expanded Disability Status Scale (EDSS) (range, 0-10, with higher scores indicating higher disability). A multivariable Cox regression model with interferon beta treatment included as a time-varying covariate was used to assess the hazard of disease progression associated with interferon beta treatment. Analyses also included propensity score adjustment to address confounding by indication.

Results The median active follow-up times (first to last EDSS measurement) were as follows: for the interferon beta–treated cohort, 5.1 years (interquartile range [IQR], 3.0-7.0 years); for the contemporary control cohort, 4.0 years (IQR, 2.1-6.4 years); and for the historical control cohort, 10.8 years (IQR, 6.3-14.7 years). The observed outcome rates for reaching a sustained EDSS score of 6 were 10.8%, 5.3%, and 23.1% in the 3 cohorts, respectively. After adjustment for potential baseline confounders (sex, age, disease duration, and EDSS score), exposure to interferon beta was not associated with a statistically significant difference in the hazard of reaching an EDSS score of 6 when either the contemporary control cohort (hazard ratio, 1.30; 95% CI, 0.92-1.83; P = .14) or the historical control cohort (hazard ratio, 0.77; 95% CI, 0.58-1.02; P = .07) were considered. Further adjustment for comorbidities and socioeconomic status, where possible, did not change interpretations, and propensity score adjustment did not substantially change the results.

Conclusion Among patients with relapsing-remitting MS, administration of interferon beta was not associated with a reduction in progression of disability.

Full article: http://jama.jamanetwork.com/article....icleid=1217239

[life well lived]

I was at an MS dinner sponsored by Active Source. The neuro giving the talk there presented some stats I strongly suspect are false, like when she said 99.9% of MS patients have a second flare. However, if that were true, there would be no such thing as a diagnosis of "probable MS" and people wouldn't complain about being in MS limbo. Still, she did also say the front line DMD's like Avonex allow for 40% of patients to be progression free over the first 2 years. I had always heard almost a third of patients never have another flare.

This makes me question whether the difference in flare rates is even worth taking the front line drugs. It almost seems like if one is going to treat the MS, one should go with Tysabri or one of the other 2 oral pills which seem to have more success delaying symptom progression. I know Tysabri has some risks, but if JC negative? Why allow for years of progression? cost?

I also question why insurance doesn't require some of the tests available which seem to suggest some DMD will not work like
http://www.emedicinehealth.com/scrip...iclekey=114946
which could indicate some drugs may make the course of MS worse.

Finally, we already acknowledge the lesions shown on an MRI aren't well correlated with disease symptoms which seems to suggest we don't fully understand the importance of what we see or our mapping of brain function ignores our bodies ability reroute signals in order to maintain function. In any event, the results of this study seem to indicate we need to rely more on subjective symptom measurements when determining the efficacy of MS treatments. It's messier than the nice quantitative methods of counting the number and size of lesions to determine a drug's efficacy, but this article and a ton of anecdotal evidence point to the flaws of the easier approach.