RATIONALE FOR EARLY TREATMENT WITH INTERFERON BETA-1A IN RELAPSING-REMITTING MULTIPLE-SCLEROSIS

Disease-modifying therapies are now available for the treatment of rel apsing-remitting multiple sclerosis (RR-MS). These drugs have transfor med the management of RR-MS from simply treating symptomatic disease t o providing effective but incomplete prophylaxis against further disea se activity. Our ability to modify disease activity is limited to redu cing exacerbations and delaying progression of disability. No interven tion has yet been shown to reverse disability once it is established. To prevent disability, therapy should be initiated early in the course of the illness. The rationale for early treatment is as follows: (1) a high percentage of patients with clinically definite RR-MS progress from isolated attacks to neurologic impairment and then to disability within a short time; (2) survival in MS is directly related to disabil ity, so delaying the onset of disability could be expected to influenc e survival; (3) interferon (IFN) beta-la has been shown to slow the pr ogression of disability when given to RR-MS patients with impairment o r mild disability; and (4) magnetic resonance imaging studies indicate that MS patients frequently have evidence of central nervous system i nflammation without overt clinical symptoms, and it has been postulate d that treatment of subclinical disease as identified by magnetic reso nance imaging may improve long-term outcome. IFN-beta reduces the numb er of new T-2-weighted lesions, as well as the number and volume of ga dolinium-enhanced lesions. Aggressive early treatment with IFN beta-la is recommended, particularly for patients with risk factors suggestin g an unfavorable prognosis.