Super-Early MS Treatment Best

Treat a disease even before it's diagnosed? Yes, if the
disease is multiple sclerosis, new research shows.

An MS diagnosis is complex and often depends on more than one attack of
neurological symptoms such as limb weakness or blurred vision. Doctors tend to
take up to a year to make the diagnosis, and only then make treatment
decisions.

Now a new study shows that it's not enough to treat multiple sclerosis as
soon as it's diagnosed. The time to start treatment is when you've had a single
MS-like event, says Mark S. Freedman, MD, FRCPC, director of the MS research
center at the University of Ottawa in Ontario, Canada.

"The first paradigm shift came at the end of the 1990s, when we learned
that waiting for an MS relapse is too late, and we started treating MS at the
time of diagnosis," Freedman tells WebMD. "Now we see you have to start
when you think you have MS. This is the new paradigm shift in MS
treatment."

That "startling" conclusion comes from compelling data Freedman
reported today at the Consortium of Multiple Sclerosis Centers annual meeting
in Washington. Freedman also reported some of the data at last month's meeting
of the American Academy of Neurology in Boston.

Freedman and colleagues at 98 MS treatment centers in 20 nations studied 468
patients who had a first episode of what doctors call "clinically isolated
syndrome" suggestive of MS. Half were treated right away with Betaseron,
one of three beta-interferon drugs currently approved for MS treatment. The
other half got inactive placebo injections and only got the real drug when
their MS diagnosis was confirmed.

After just three years, Freedman says, 85% of the patients initially treated
with placebo showed signs of "sustained progression" to full-blown MS
-- even though most of them had already switched to Betaseron a year or more
earlier. Only 15% of the patients given immediate treatment had sustained
progression.

"Permanent damage happens very early in MS, much earlier than we had
anticipated," Freedman says. "That year to year-and-a-half delay in
treatment translates into an accumulation of disability. It was startling to
see that at just year three of the study."

Rx: Super-Early MS Treatment

This means a sea change in MS treatment, says Robert Fox, MD, medical
director of Cleveland Clinic's Mellen Center for Multiple Sclerosis Treatment
and Research.

"We have finally shown that treating MS super early can have a
significant impact on the development of disability, which is what patients are
most worried about," Fox tells WebMD.

"This isn't just early treatment -- early treatment is when a patient
has had a second episode. Early treatment now turns out to be late," Fox
says. "This is the first study to show we need to treat super early, after
only a single attack with the diagnosis of MS not confirmed."

Betaseron is given to patients every other day via injection under the skin.
The side effects are flu-like symptoms, which tend to subside after a patient
becomes accustomed to the drug.

Rebif is another beta-interferon given by subcutaneous injection. Avonex is
a form of beta-interferon given by once-weekly muscle injections. Fox says he
thinks these treatments should work as well as Betaseron, but this has yet to
be demonstrated in clinical trials.

While the new findings are good news for people who get MS in the future,
they are sobering news for patients whose treatment started later in the course
of their disease.

"The damage continues to fester two to three years later despite the
fact that patients are on beta-interferon," Freedman says. Even the delayed
treatment is effective -- but you don't regain what you lost."

Late Treatment Still Effective

Don't tell Amelia Davis that late treatment doesn't help. Davis, now 38, was
diagnosed with remitting/relapsing MS two months before her 30th birthday,
after he woke to find the left side of her body had gone numb from head to
toe.

It was not an early diagnosis.

"In my 20s, I went completely blind in my left eye," Davis tells
WebMD. "That lasted four weeks, and then my sight came back. I was in
college, pulling all-nighters, so I thought it was just the stress and the eye
strain."

Four years later, the same thing happened again. Again she wrote it off to
working too hard. A few years later, she lost the feeling in both hands for
awhile. But she never sought help until half her body went numb.

At the University of California, San Francisco, doctors quickly diagnosed
Davis's MS and put her on Betaseron. In the eight years since, she's never had
another MS attack.

"Whatever damage was done to me is irreversible," Davis
acknowledges. "The great news is, on the outside I am not disabled looking.
Because I have been on this drug for so long and am still in remission, I think
I am going to stay in this remission stage for the rest of my life."

Davis has advice for other people with MS.

"If you get on aggressive drug therapy early, it is really proven to
slow the disease down. It can stop a major MS episode from happening, where the
body cannot repair itself," she says.

Davis is now a successful photographer. In 2004, she published her second
book, My Story: A Photographic Essay on Life with Multiple Sclerosis.
Davis also serves as president of MSFriends, a 24-hour multiple sclerosis
hotline that can be reached at (866) MSFRIENDS. Betaseron maker Bayer is the
main sponsor of MSFriends.

By Daniel DeNoon
Reviewed by Louise Chang
B)2005-2006 WebMD, Inc. All rights reserved