Multiple Sclerosis Forum Report

14th Meeting of the European Neurological Society, Barcelona, Spain

Publication date: 2004-08-06

Perspectives in the Optimal Management of Multiple Sclerosis

This report was reviewed for medical and scientific accuracy by Andrew R. Pachner, MD, Professor, Department of Neurology and Neurosciences, University of Medicine & Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey.

Expert Commentary

Andrew R. Pachner, MD, Professor, Department of Neurology and Neurosciences, University of Medicine & Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey

Data presented at the 14th Meeting of the European Neurological Society provide further insight into current issues surrounding the optimal treatment and management of multiple sclerosis (MS). The topics discussed at this year's meeting included selection criteria for determining the optimal immunomodulatory agent in treating MS, how to interpret and clinically manage the development of neutralizing antibodies induced by interferon beta therapy, and potential treatment options for those patients who experience disease progression despite best treatment practices.

Over the past decade, the development of biologic therapies has had a dramatic effect on the treat- ment of MS. Results of the Quality Assessment in Multiple Sclerosis Therapy Study (QUASIMS), a large, retrospective, comparative study reported at this meeting, indicate that the available interferon beta agents (intramuscular interferon beta-1a [Avonex], subcutaneous interferon beta-1a [Rebif], and subcutaneous interferon beta-1b [Betaseron in the US and Betaferon outside the US]) offer comparable efficacy in preventing relapse and delaying disease progression.¹

Recently, neutralizing antibodies have become recognized as a potential confounding factor to achieving successful long-term outcomes in patients with MS. The development of neutralizing antibodies to interferon beta may severely negate the therapeutic benefits of interferon beta. This Multiple Sclerosis Forum Report™ contains important information regarding the development of neutralizing antibodies and identifies potential clinical strategies for management of this problem.

Additionally, new data were presented on the chemotherapeutic agent mitoxantrone (Novantrone). For patients with difficult-to-treat or challenging MS, mitoxantrone has shown promising activity that may result in stabilization of MS disease. However, this potential is offset by the dose-limiting cardiotoxicity of mitoxantrone. Nonetheless, several investigators reported their experience in using mitoxantrone safely and effectively in patients with MS.

These issues constitute the focus of this Multiple Sclerosis Forum Report™. I hope you find this information useful and beneficial for your patients in developing long-term management strategies for MS.

Comparable Efficacy of Interferon Beta Agents

Direct Comparison Study of the Effect of Beta-interferons in Iranian Patients with Multiple Sclerosis: Results of a 6-year Therapy.
Hossein Pakdaman, MD, Professor of Neurology, Shahid Beheshti University, Tehran, Iran and President of the Iranian Neurological Association

According to Hossein Pakdaman, MD, Professor of Neurology, Shahid Beheshti University, Tehran, Iran, and President of the Iranian Neurological Association, the incidence of MS in Iran has been rapidly increasing. Current estimates place the number of individuals with MS at 40,000 - among a population of 75 million. Dr. Pakdaman reported the results of a long-term study evaluating Avonex, Rebif, and Betaseron in the treatment of clinically definite MS.

This single-blind (physician), direct comparison study evaluated 214 patients with clinically definite MS who received treatment with intramuscular Avonex 30 mg once weekly (n = 72), subcutaneous Rebif 22 mcg three times weekly (n = 83), or subcutaneous Betaseron 8 MIU every other day (n = 59).² The three treatment arms were matched according to age, gender, age at diagnosis, and mean Expanded Disability Status Scale (EDSS) score. The primary out