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Predicting beta-interferon failure in relapsing-remitting multiple sclerosis

Department of Neurology, St Vincent's University Hospital, Dublin, Ireland

C. Walsh

Department of Statistics, University of Dublin, Dublin, Ireland

G. Antonelli

Section of Virology, Department of Experimental Medicine and Pathology, University 'La Sapienza', Rome, Italy

M. Hutchinson

Department of Neurology, St Vincent's University Hospital, Dublin, Ireland,mhutchin{at}iol.ie

Proposed beta-interferon (IFNß) treatment failure criteria for patients with relapsing-remitting multiple sclerosis (RRMS) have not been validated in clinical practice. This study aimed to establish (a) whether IFNß attenuated accumulation of fixed disability in comparison to a cohort of matched historical control subjects from the Sylvia Lawry centre for MS research, and (b) whether relapse-based treatment failure criteria or clinical and demographic variables had predictive value for the accumulation of fixed disability. Of the 175 IFNß-treated RRMS patients, 60 (34%) developed accumulation of fixed disability over a median of five years follow-up, which was significantly less than the rate of accumulation of fixed disability in the control group (P<0.0001). Any relapse in the treatment period predicted accumulation of fixed disability with a sensitivity of 80% and specificity of 43%; patients totally relapse free were less likely to develop accumulation of fixed disability (P <0.002). Multivariate analysis confirmed that a greater risk of accumulation of fixed disability was conferred by a higher Expanded Disability Status Scale (EDSS) score starting IFNß (P=0.02), and by failure of IFNß to completely suppress relapses (P=0.004). In conclusion, IFNß therapy reduced the accumulation of fixed disability in a cohort of RRMS patients, followed for a median of five years. Higher baseline EDSS and failure of complete relapse suppression were associated with a significantly greater likelihood of accumulation of fixed disability. Multiple Sclerosis 2007; 13: 336-342. http://msj.sagepub.com

Key Words: beta-interferon • historical controls • multiple sclerosis • progression • relapse • treatment failure

This version was published on April 1, 2007

Multiple Sclerosis, Vol. 13, No. 3, 336-342 (2007)
DOI: 10.1177/1352458506071309


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