Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 76 (1 Suppl 1), S14-25

Treatment Effects of Immunomodulatory Therapies at Different Stages of Multiple Sclerosis in Short-Term Trials


Treatment Effects of Immunomodulatory Therapies at Different Stages of Multiple Sclerosis in Short-Term Trials

David Bates. Neurology.


Intervention with interferon-β (IFNβ) therapy counters early inflammatory damage to myelin and protects axons; such therapy might demonstrate greater efficacy earlier in the disease course compared with later when permanent damage has already occurred. Clinical trials conducted in patients with clinically isolated syndrome (CIS) show clinical benefits of early treatment of multiple sclerosis (MS), as evidenced by delayed conversion to clinically definite multiple sclerosis and reduced disability 3 years later; however, statistical significance is lost at 5 years. Moreover, in the CIS trials, patients who began treatment later in the course of MS did not benefit as much as those who began treatment earlier. In the treatment of relapsing-remitting multiple sclerosis (RRMS), immunomodulatory drug (IMD) therapy markedly reduced relapse rates and the burden of disease, as assessed by MRI. IFNβ therapy has demonstrated greater benefits in RRMS than in secondary progressive multiple sclerosis (SPMS). The SPMS trials consistently show reduction in relapse rates and accumulation of new MRI lesions, but have conflicting results for time to disability progression, which is the primary outcome measure in SPMS trials. Current evidence suggests that IFNβ therapy may be more effective in the early stages of SPMS, characterized by relapsing episodes and MRI evidence of greater brain lesion disease activity. Thus, intervention with IFNβ therapy is appropriate for all stages of MS except PPMS or non-relapsing SPMS. Intervention with glatiramer acetate is appropriate for RRMS. The balance of evidence indicates that early therapy is essential to delay the accumulation of irreversible neurologic damage and consequent disability.

Similar articles

  • [Immunomodulatory Therapy in Multiple Sclerosis]
    T Csépány et al. Ideggyogy Sz 57 (11-12), 401-16. PMID 15662768. - Review
    During the past decade, several disease-modifying agents have been established and have become available for the treatment of multiple sclerosis. The disease-modifying ag …
  • Clinically Isolated Syndromes: Predicting and Delaying Multiple Sclerosis
    BW Thrower. Neurology 68 (24 Suppl 4), S12-5. PMID 17562845. - Review
    Multiple sclerosis (MS) represents a spectrum of demyelination that depends on disease duration and clinical categorization. Most patients present with the relapsing-remi …
  • Management of Worsening Multiple Sclerosis With Mitoxantrone: A Review
    EJ Fox. Clin Ther 28 (4), 461-74. PMID 16750460. - Review
    In the available clinical trials, mitoxantrone provided effective treatment for worsening RRMS or SPMS. When mitoxantrone is used as recommended, the risks of substantial …
  • Early Treatment
    G Comi. Neurol Sci 27 Suppl 1, S8-12. PMID 16708191. - Review
    Class I clinical trials demonstrated that immunomodulatory treatments (interferon-beta and glatiramer acetate) reduce the disease activity and the accumulation of disabil …
  • Shifting the Paradigm Toward Earlier Treatment of Multiple Sclerosis With Interferon Beta
    G Comi. Clin Ther 31 (6), 1142-57. PMID 19695384. - Review
    The evidence that axonal damage begins in the early stages of MS, before symptoms are evident, provides a rationale for early intervention with immunomodulatory agents. I …
See all similar articles

Cited by 30 PubMed Central articles

See all "Cited by" articles

Publication types

MeSH terms