This Article Full Text (OnlineFirst PDF) All Versions of this Article: 1352458508093892v1 14/9/1234    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Freedman, M S Articles by Forrestal, F G Search for Related Content PubMed PubMed Citation Articles by Freedman, M S Articles by Forrestal, F G Social Bookmarking                         What's this?

Canadian treatment optimization recommendations (TOR) as a predictor of disease breakthrough in patients with multiple sclerosis treated with interferon -1a: analysis of the PRISMS study

¹ Department of Medicine (Neurology), University of Ottawa, Ottawa, Ontario, Canada
² Merck Serono International S.A., Geneva, Switzerland (an affiliate of Merck KGaA, Darmstadt, Germany)

^* To whom correspondence should be addressed.

	Abstract

Background

Early intervention with an effective disease-modifying drug (DMD) offers the best chance of limiting the inflammatory process that contributes to irreversible axonal damage correlating with disability in multiple sclerosis (MS). It is equally important to ascertain fairly quickly whether patients are responding positively to the choice of therapy to allow time for either a treatment modification or a switch in treatment, a process we termed "treatment optimization". Various treatment optimization recommendations (TOR) have been proposed to help decide when a patient taking an MS DMD might be showing a sub-optimal response. We have applied the clinical scheme proposed by the Canadian TOR to the patients involved in the Prevention of Relapses and disability by Interferon Subcutaneously in MS 4-year (PRISMS-4) study, who received interferon -1a treatment for 4 years, with the TOR applied retrospectively at year 1.

Objective

The aim of this investigation was to examine whether these TOR were able to predict which patients would go on to develop disease breakthrough (defined as any relapses or disease progression), indicative of a sub-optimal response over the ensuing 3 years of study and therefore might have benefited from a change in treatment.

Results

We found 39% of patients receiving therapy experienced either a medium or high level of concern of breakthrough after a year of treatment, and 89% of these patients went on to develop further breakthrough over years 2–4. Although 67% of the 61% of patients having no or low-level concern after a year of treatment also experienced further disease breakthrough, it was significantly less than the medium or high group.

Conclusion

This study shows that the Canadian TOR may be an important tool for early treatment optimization.

Key Words: disease-modifying drugs, early treatment, multiple sclerosis, treatment optimization

First published on July 16, 2008, doi:10.1177/1352458508093892

Multiple Sclerosis 2008;14:1234.

A more recent version of this article appeared on November 1, 2008


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				J Rio, J Castillo, A Rovira, M Tintore, J Sastre-Garriga, A Horga, C Nos, M Comabella, X Aymerich, and X Montalban Measures in the first year of therapy predict the response to interferon {beta} in MS Multiple Sclerosis, July 1, 2009; 15(7): 848 - 853. [Abstract] [PDF]

				M Hutchinson Predicting and preventing the future: actively managing multiple sclerosis Practical Neurology, June 1, 2009; 9(3): 133 - 143. [Abstract] [Full Text] [PDF]