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."
: 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.