Interferon beta does not slow progression

[thelegendlc]

I see many comments from members here that the interferon beta (DMT) drugs slow the progression of MS. However, an article published in the Journal of the American Medical Association (JAMA) on July 12th 2012 indicates that the interferon beta drugs do not slow progression.It was a study conducted in Canada. The evidence is that these DMT drugs (Avonex and Betaseron) reduce the frequency and severity of flares. However, they do not slow the progression of the disease. Google "interferon beta and JAMA" and check it out.

[Marco]

Thank you for posting this. I'll give you my twocents, that is probably worth about a nickel.

I believe the test population was limited to 100 patients
with relatively active disease. For example: over 10% of the patients were having 1.5 relapses/year. The latest average was 1 relapse every 13/months with
permanent deficits occurring in 50% of relapses. From a practical standpoint, MS patients with moderate to high-activity MS should probably not be on interferon therapy.

The information does show interferons provided a significant reduction in relapse rate and T2 white matter lesions. Looking deeper, there is a relationship between progression and relapse rate, or the impact pf relapse rate on disability scores. So if interferons reduce the number of lesions (preventing damage) and the relapse rate (preventing damage and deficits), they do impact progression.

The need for follow up studies is absolutely necessary.

• Follow up studies should test patients with milder forms of the disease (EDSS scores 2.0 and below), like other drugs are tested against.
  
• They also need to determine what patients are TH1 and TH17 patients.
  
• They also need to look at nonresponders vs responders vs superresponders.
  
• They also need to conduct the study over a multi-year period to accommodate for a potential of 3 relapses (on average 39 months)

So while the abbreviated sample indicated that interferon may not slow progression in a statistically significant way, additional testing is necessary before anyone should emphatically state that interferons do not slow progression.

If in your lifetime you had 40 vs 60 relapses do you believe you would have less progression or more progression?

Again, I really appreciate your post and hope you will respond to mine so we can all learn together. I'm not saying I am right by any stretch of the imagination. I just see the data from a different perspective.

[Tawanda]

Burning out on DMTs in general...

After 10+ years of the MonSter I am less and less jazzed about any and all of our available DMTs. Perhaps the only real thing they provide is HOPE, but I believe that having HOPE does benefit us medically and that the reverse, being HOPELESS can actually cause actual physical harm. If you could put HOPE in an Rx, perhaps we'd all be better off.

[Mamabug]

Thank you, Legend, for posting your information. I always prefer not to bury my head in the sand.

And, thank you, also, Marco, for adding a new perspective to it. It's nice to know that the situation may not be bleak.

I am on Copaxone, not on an interferon. For me, whether or not my Copaxone would delay progression, it does reduce the fx and sx of flares, and would still remain worth the inconvenience for those reasons.

[BigA]

So this is an interesting topic and occupied much of my thoughts for several years. Retrospective studies are difficult. this study was in the Canadian health care system. Not everyone got drugs during the time they looked at. That means that doctors only tended to prescribe for patients with serious disease. You can find old timers in our community who had the disease long before there were any drugs and then started taking them, maybe 10 or 15 years after diagnosis. So if you measure people who were treated and only the serious cases were treated, you create selection bias.

Of course they tried to filter this out. Maybe they were successful - I don't know. However there is one study which for me, proved they have beneficial effect:



Researchers went back and followed up patients from one of the original trials of interferon β-1b. They were able to track down 98.4% of the original 372 participants. 81 had died in the intervening years. All they looked at was cause of death. As a group, those who received the Interferon had a lower death rate from all causes. If you started even just 2 years earlier, you had a better chance of not being dead 20 years later.

Summary: http://www.ncbi.nlm.nih.gov/pubmed/23204140
Full Paper: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3533062/

we observed that the HR for death was significantly reduced by 46.8% in the IFNβ-1b 250µg group and by 46.0% in the IFNβ-1b 50 µg group compared to placebo. This nearly identical effect size in the two independently randomised groups provided strong supportive evidence that the observed survival benefit was not due to chance (ie, from a type I error). Although it was still possible that the observed benefit reflected an unusually high death rate in the placebo arm, this too seemed unlikely given the virtual overlap of placebo-group mortality with natural history studies18