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Review: Treatment of early multiple sclerosis: the value of treatment initiation after a first clinical episode

Department of Neurology, University of California, San Francisco, CA, USA, douglas.goodin{at}ucsf.edu

D. Bates

Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Trust, Newcastle, UK

Multiple sclerosis is a chronic, demyelinating disorder of the central nervous system. It is characterised by progressive neurological disability, which is likely to occur as a result of permanent axonal damage. Such damage may be reflected by brain atrophy, which can be identified early in the course of the disease. Patients who present with an initial episode of inflammatory demyelination, commonly referred to as a clinically isolated syndrome, are at high risk of developing clinically definite multiple sclerosis, especially if their magnetic resonance imaging studies suggest the presence of multi-focal disease. Treatment with disease-modifying therapies at the initial episode of demyelination may postpone this development. In this review we present an overview of evidence supporting early treatment initiation. We focus on three large placebo-controlled trials of interferon beta therapy: Controlled High-Risk Avonex^® Multiple Sclerosis Prevention Study, Early Treatment of Multiple Sclerosis and Betaferon ^® in Newly Emerging Multiple Sclerosis for Initial Treatment. Results from these early treatment studies are presented, and the impact of using interferon beta treatment in the early stages of disease is discussed with the aim of considering optimal therapeutic strategies to improve long-term patient outcome.

Key Words: multiple sclerosis • clinically isolated syndrome • early treatment • delayed treatment • interferon beta 1b • interferon beta 1a

This version was published on October 1, 2009

Multiple Sclerosis, Vol. 15, No. 10, 1175-1182 (2009)
DOI: 10.1177/1352458509107007


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