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EARLY TREATMENT IS CRUCIAL FOR MULTIPLE SCLEROSIS, NEW STUDY SHOWS

Early treatment with the drug beta interferon can slow and perhaps stop the development of multiple sclerosis in people at high risk of the disease, says a new study in the New England Journal of Medicine.

The research at 50 medical centers around the nation, led by Buffalo physician Dr. Lawrence D. Jacobs, also suggests that many individuals with such neurological conditions as numbness in limbs or inflammation of the optic nerve may have smoldering brain lesions that lead to multiple sclerosis.

As a result, the researchers strongly urged physicians to use brain MRIs to identify patients at high risk of the debilitating disease so they can be treated early.

"Early treatment retards (central nervous system) atrophy and slows cognitive decline. It has a massive effect on the activity of brain lesions," said Jacobs, head of the neurology department at Buffalo General Hospital and chief of the Baird Multiple Sclerosis Research Center at Millard Fillmore Hospital.

In the late 1970s, Jacobs became the first American multiple sclerosis researcher to test one form of beta interferon, a naturally occurring substance in the body believed to play an important role in the body's immune system.

Multiple sclerosis is a chronic inflammatory disease of the central nervous system that slowly disrupts nerve impulses, causing weakness, loss of coordination, vision and speech problems and, in severe cases, paralysis.

The disease is often characterized by a pattern of exacerbations and remissions. Some people experience mild symptoms. More common are severe attacks followed by periods of recovery. Still others progress to a serious stage in which they may need a wheelchair.

There are about 350,000 multiple sclerosis patients in the United States -- 2,500 of them in Western New York, where the disease occurs at twice the national rate.

In the U.S., multiple sclerosis occurs more frequently in areas located above the 37th parallel, including Western New York, than in areas below it.

The basic rule for diagnosing multiple sclerosis is two attacks at least one month apart and more than one area of damage to myelin, the sheath that surrounds and protects nerve fibers. The bioengineered form of beta interferon marketed as Avonex by Biogen Inc. is one of three new agents for treating patients who fall into this category.

The latest study of 383 patients showed that Avonex, which was approved by the FDA in 1996, also appears to offer significant benefit to patients who have a single key symptom associated with nerve damage, such as numbness in a limb or optic nerve problems.

To date, there have been no well-accepted guidelines to treat these patients, who are at risk for multiple sclerosis but don't fit the definition for the disease.

Avonex reduced the rate of development of multiple sclerosis by 44 percent in these patients after three years on the drug. In addition, the size of brain lesions in the treated patients were 91 percent lower than the untreated patients.

"The study is an important extension of what we know -- that treatment can slow progression of the disease -- in a new population of patients. It's not a cure, but we like to think the treatment can lead to better outcomes down the road," said Dr. Stephen Reingold, vice president for research programs at the National Multiple Sclerosis Society.

It is not yet clear if the benefits of beta inteferon continue long-term or if they will apply to patients with the progressive form of the disease, but researchers remain hopeful based on the study.

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