From the American Academy of Neurology 59th Annual Meeting: BENEFIT: Better outcomes demonstrated with early versus late initiation of interferon beta-1b for MS

Key Points

Immediate initiation of interferon beta-1b in patients with a first event suggestive of multiple sclerosis (MS) significantly reduces the risk of permanent neurologic impairment compared with delayed initiation, according to Mark S. Freedman, MD, professor of neurology, University of Ottawa, Ontario, Canada.

"Initiation of interferon beta-1b early after the first demyelinating event delays and reduces the risk for recurrent disease activity leading to a diagnosis of MS," Dr Freedman said at the American Academy of Neurology 59th Annual Meeting, April 28 to May 5, 2007, in Boston, Massachusetts.

The standard disease management approach for MS has involved delaying treatment until after a patient has >1 clinical attack suggestive of MS, rather than initiating treatment after the first attack, which gives physicians greater assurance of a definite diagnosis of MS. The new data, from phase 2 of the Betaseron in Newly Emerging Multiple Sclerosis For Initial Treatment (BENEFIT) study, counter this philosophy, Dr Freedman said.

Phase 2 was a prospectively planned follow-up period designed to assess the impact of immediate versus delayed treatment with interferon beta-1b on the long-term course of the disease (total observation time, 5 years). All patients who reached the end of the placebo-controlled study were offered interferon beta-1b. At the end of 3 years, 73% of patients were taking interferon beta-1b after the first event suggestive of MS.

Neurologic impairment was measured using the Expanded Disability Status Scale (EDSS). Confirmed EDSS progression over 3 years occurred in 34% of patients randomized to delayed treatment compared with 18% of patients randomized to immediate treatment, corresponding to a 40% relative risk reduction (P=.0218). At 3 years, immediate treatment was associated with a 41% lower likelihood of progression to clinically definite MS compared with delayed treatment (P=.0011), confirming the findings of the placebo-controlled phase.

Early treatment also had a significant effect on the development of gadolinium-enhancing lesions and was associated with a greater reduction in the relapse rate compared with delayed treatment, Dr Freedman said.