Beta-interferon in CIS 8-year follow-up

Early treatment delays cognitive progression. #MSBlog #MSResearch

"What do long-term extension studies tell us? They give us insights that are not necessarily obvious in the short 2-year pivotal trial. The one that stands out in this 8-year open-label extension study is that CISers treated immediately with IFNbeta had better cognitive outcomes at 8 years compared to MSers who had a delayed start on treatment. This is a very strong argument for early treatment. Treat early to delay the progression of cognitive impairment in MS. I have made the point in the past that in early MS cognitive impairment is the main driver of early disability in MSers; long before physical disability. If IFNbeta, which on average is only moderately effective, can have an impact on cognition if used early what impact will the more effective therapies have? Unfortunately, we don't have this data to hand, but all the efficacy data suggests they would have a major impact."
"Have you aligned all your ducks? 

1. EARLY TREATMENT
2. HIGHLY-EFFECTIVE TREATMENT
3. INDUCTION THERAPY


Epub: Edan et al. Long-term impact of interferon beta-1b in patients with CIS: 8-year follow-up of BENEFIT. J Neurol Neurosurg Psychiatry. 2013 Nov 11. doi: 10.1136/jnnp-2013-306222.

OBJECTIVE: To examine the long-term impact of early treatment initiation of interferon beta-1b (IFNB1b, Betaferon/Betaseron) in CISers with a first event suggestive of MS.

METHODS: In the original placebo-controlled phase of BENEFIT, CISers were randomised to IFNB1b 250 μg or placebo subcutaneously every other day. After 2 years or diagnosis of clinically definite MS (CDMS), all CISers/MSers were offered open-label IFNB1b treatment for a maximum duration of 5 years. Thereafter, CISers/MSers were enrolled in an observational extension study for up to 8.7 years.

RESULTS: Of the initial 468 CISers, 284 (60.7%; IFNB1b: 178 (61.0% of the original arm), placebo: 106 (60.2% of original arm)) were enrolled in the extension study. 94.2% were receiving IFNB1b. CISers originally randomised to IFNB1b had a reduced risk of developing CDMS by 32.2% over the 8-year observation period (HR 0.678; 95% CI 0.525 to 0.875; p=0.0030), a longer median time to CDMS by 1345 days (95% CI 389 to 2301), and a lower annualised relapse rate (0.196 (95% CI 0.176 to 0.218) versus 0.255 (95% CI 0.226 to 0.287), p=0.0012), with differences mainly emerging in the first year of the study. Cognitive outcomes remained higher in the early treated CISers. EDSS remained low over time with a median of 1.5 in both arms.

CONCLUSIONS: These 8-year results provide further evidence supporting early initiation of treatment with IFNB1b in CISers with a first event suggestive of MS.

CoI: multiple

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