Tuesday, 14 May 2013

16-years of interferon treatment aids cognition

Early treatment with interferon-beta has a positive impact on cognition at 16 years. #MSBlog #MSResearch

Epub: Lacy et al.The effects of long-term interferon- beta-1b treatment on cognitive functioning in multiple sclerosis: a 16-year longitudinal study. Mult Scler. 2013.

BACKGROUND: MS is a progressive disease of the central nervous system that affects cognition. Short-term treatment with interferon-beta-1b (IFN-beta-1b) has been shown to have beneficial effects on cognition.

OBJECTIVE: The objective of this paper is to evaluate the effects of IFN-beta-1b on cognitive functioning in MSers over the course of 16 years.

METHODS: Sixteen subjects with relapsing-remitting MS participated in the study. Nine of these subjects received IFN-b-1b, while seven received placebo treatment in the pivotal MS trial. After five years, all subjects were switched to IFN-beta-1b treatment. At two and four years into the study, all subjects underwent a brief neuropsychological test battery, magnetic resonance imaging (MRI), and neurologic ratings; measures were repeated at 16 years.

RESULTS: Across the total cohort, cognitive functioning remained relatively stable over the course of 16 years. The placebo/IFN-beta-b group exhibited increased visual memory performance relative to the IFN-beta-1b treatment group, but had a greater decline in verbal memory. Initial MRI lesion load demonstrated a significant, negative correlation with overall cognitive performance at 16 years (p = 0.00).

CONCLUSION: They conclude that IFN-beta-1b has beneficial effects on long-term cognition outcomes in MS.


"A small but interesting study. Interferon has a positive effect on cognition; i.e. it delays its progression. Delaying interferon therapy by 2 years has a negative impact; those who were on placebo for at least 2 years did worse than those on active treatment. If interferon has an effect like this imagine the potential of the newer more effective therapies on cognitive function?"

"These results are consistent with a body of other evidence showing that delaying the use of DMTs has a negative impact on MSers. Time to adopt early treatment?"

7 comments:

  1. Funny, how about the at least 50% of MSers that discontinues to use IFN beta because of severe side effects?

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    1. It is not the interferon that is necessarily that important in this post, but the observation that a DMT has an impact on cognition. If interferon does this what can we expect from DMF, fingolimod, natalizumab, cladribine, alemtuzumab, ocrelizumab, daclizumab, etc. Some of these agents are induction therapies and put MSers into long-term remission; once you have had these drugs you have had them.

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    2. Dr G, why do you not mention BG-12 among the above list of DMTs?

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  2. So why not give DMTs to all MSers without cognitive deterioration (yet) whether primary or secondary progressive?

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    1. We would need data in progressive MS before doing this; unfortunately the trials of interferon beta in progressive MS have been negative.

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    2. Prof G,

      this is not directly relevant to the post here, but is there any evidence that those with RRMS also have a PPMS element from the start, and that the relapses are just the tip of the iceberg? This then meaning that the DMTs treat the iceberg tips, but not the PPMS component? I just have a worry that the progressive element could creep up on patients who are on what seems like otherwise very effective therapy. I have wondered therefore if those with PPMS have a variant which is milder at a younger age because of the lack of relapses, but then causes disability anyway at the older age that PPMS presents at. It then makes me think that if those who say develop PPMS in their 40s or 50s could have benefitted from DMTs in their 30s, when they had no or minimal symptoms.

      Just a thought I've had about MS, not sure if it stands up to any scrutiny.

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  3. Hmm. Any hope of any of them acting induction wise for SPMS ?

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