Sunday, 29 May 2011

MS and survival - long-term betaferon treatment improves survival

I had to give a talk yesterday, at the European Neurological Society (ENS) Meeting in Lisbon, on how to handle the complexity that the emergence of new DMTs are creating. I was trying to make the argument for early aggressive treatment and the expert patient, i.e. to involve the patient as much as possible in the decsion making process so as to ensure long-term adherence to therapy and to manage expectations (what will the impact of the treatment be on my disease and on my life). One point I stressed is that MS causes disability in the majority of people with the disease given sufficient time and that the average life expectancy is reduced by about ~10 years.

In support of this strategy is the recently presented 21-year follow-up of the orginal cohort of patients treated with interferon-beta-1b in the pivotal Betseron/Betaferon study. The follow-up showed that treatment with IFNbeta-1b reduced the risk of death by 47% compared to patients receiving placebo for 3 years and then being offered treatment with IFNbeta-1b; in otherwords a delay in treatment by 3 years signficantly affected your chance of being alive at 21 years. We only need to treat 8 patients with IFNbeta-1b to prevent 1 death due to MS 21 years later.  There is one caveat to these data; IFNbeta has many actions in the body and the improvement in survival may be due to other mechanisms independent of MS. For example, IFNbeta may improve survival by preventing cancers or possibly heart disease.The latter could not be answered in this study as there were too few subjects.

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" Don't you find these data interesting? I do. The data provide a strong argument for treating early and long."

CoI: I have received personal compensation from Bayer-Schering for consultancy work and Bayer-Schering has supported a clinical study in our group in the past.

4 comments:

  1. "average life expectancy is reduced by about ~10 years"

    As a patient I don't find this data "interesting". Nor the statement that "MS causes disability in the majority of people".

    Why bother saving for a pension?

    You said at the MS Research day that MS wasn't terminal. I have to disagree - it's just over along timeframe.

    The fact that it makes most disabled, and takes away a big chunk of your life at the end re-inforces the need for proper funding to get some really effective treatments.

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  2. Not all is lost! You have to realise that the survival data was collected in the pre-DMT era. The Betaferon/Betaseron data shows that treating early and long has a long-term impact; this is very good news. I also believe that with more effective DMTs the impact will be greater.

    You also have to realise that this data refers to the average effect; a lot of PwMS do better than average.

    I disagree that MS is a terminal illness; the latter typically refers to diseases or illnesses of much shorter duration. Any disease that lasts decades can't be called terminal; if it could then life itself could be considered a terminal disease.

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  3. I find this really interesting. I was put onto Betaferon within 10 months of my first symptoms and only 3 months after my official diagnosis. I have relapsing/remitting MS and I do count myself very lucky, both in being given betaferon so early (It was in 1999 in the UK) and in the lack of progression of the disease despite a number of relapses since then.
    I am currently on a break at the advice of the hospital as I hadn't had a relapse for 28 months. After 13 years of taking the medication I was scared I would feel awful but after some initial withdrawal symptoms I feel really good.
    My question is this: Could long term use of betaferon reduce the virulence of the disease?

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  4. Re: "Could long term use of betaferon reduce the virulence of the disease?"

    Possibly. We have no data to support this. If IFNbeta works as an anti-viral it may. Unfortunately, we still don't know which mechanism of action or responsible for the effectiveness of IFNbeta in MS.

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