Put Out the Fires of MS - Today, we have an array of “hoses” to combat this disease [Review of Optometry]...MORE
".....Beginning MS treatment as soon as possible is very important; over time, nerve damage caused by multiple sclerosis in the brain and spinal cord becomes permanent and leads to physical disability or cognitive impairment. The treatment of MS focuses mainly on decreasing the rate and severity of relapse, reducing the number of MS lesions, delaying the progression of the disease, and providing symptomatic relief for the patient. (A discussion of the symptoms, relapses and remissions of MS is beyond the scope of this column.)


Over time, nerve damage caused by MS in the brain and spinal cord becomes permanent and leads to physical disability or cognitive impairment.


Advances in interferon therapy have assisted greatly in the management of impairment from MS. Interferons are substances produced by the body to combat viral infections and regulate the immune system.

Recombinant interferon therapies have proven to be effective in reducing relapses and accumulation of brain lesions over time.2-10 The overall reduction in risk of relapse appears to be nearly 30%.2 Patients who have a lower baseline relapse rate prior to the initiation of interferon therapy seem to have a more favorable prognosis.4 Adverse reactions associated with these medications include flu-like symptoms, increased spasticity of lower limbs, site injection reactions and systemic allergic reactions.7

All MS treatments are given by injection. There are currently four available MS drugs:
• Avonex (interferon beta-1a, Biogen Idec). This is indicated for patients who have relapsing forms of MS to slow the accumulation of physical disability and decrease the frequency of clinical exacerbations. Avonex appears to be most successful in patients who have experienced a first clinical episode of focal neurologic deficit and have MRI features consistent with MS.4

Avonex is injected intramuscularly once a week. It decreases the rate of relapse and the development of new lesions. It also delays the progression of motor and cognitive disability.

• Rebif (interferon beta-1a, Serono and Pfizer). Similar to Avonex, this interferon is injected subcutaneously three times per week. Rebif also reduces the rate of relapse and slows the progression of disability.3

• Betaseron (interferon beta-1b, Berlex). This drug is injected subcutaneously three to four times per week. It has similar indications and actions of Avonex and Rebif.4,5

• Copaxone (glatiramer acetate, Teva Pharmaceutical). This is actually a mixture of amino acids. It is injected subcutaneously seven times per week. Exactly how Copaxone works is unclear, but it is believed to modify the immune process that causes MS.7 In one study, nearly all patients who used Copaxone (with a mean disease duration of 15 years) remained ambulatory after 10 years.10 Patients who withdrew from treatment had greater disability than patients who continued treatment.10

Patients can develop resistance to these drugs if they endogenously produce neutralizing antibodies that inactivate MS therapy. Although the significance of neutralizing antibodies is not fully understood, it is thought that they can render MS treatments less effective over time.11 So, the potential for development of neutralizing antibodies is an important consideration in determining whether to initiate treatment.

Optic neuritis has long been seen as a calling card of MS. While we typically suspected underlying MS in patients who had optic neuritis, we were averse to actually diagnosing MS in these patients years ago because we could offer them no effective treatment. Today, however, we have several therapies that reduce the relapse rate of the disease and slow the progression and development of both motor and cognitive disabilities. Because the clinical course of MS can now be altered, it is imperative to diagnose the patient as quickly as possible so that immunomodulatory therapies can be offered"