Interferon-beta therapy for MS: the dilemma of having choices

Abstract

In this issue of JNS, Barbero et al. [ [1] Barbero P, Verdun E, Bergui M, et al. JNS 2004. Google Scholar ] report their observations suggesting that high-dose frequently administered interferon-beta therapy is more effective than the low dose weekly interferon-beta in RRMS. In a carefully designed “reverse” design study, 27 RRMS patients receiving interferon-beta (interferon beta-1b, Betaseron®) and deemed stable by clinical and MRI criteria were randomized to either continue interferon-1b or switched to low dose weekly interferon-beta (interferon bet-1a, Avonex™). One year after randomization, compared to the high dose interferon-beta group, patients in the low dose weekly interferon-beta group demonstrated evidence of greater disease activity by both clinical and MRI criteria. Even though MRI readings were blinded, there are several limitations to the study. As acknowledged by the authors, the small number of patients, short study duration, open-label design with a single center necessitates a careful interpretation of the results. Nevertheless, this study provides further evidence indicating that higher dose of interferon-beta administered frequently is likely to be more effective than low dose once a week interferon-beta administration in patients with RRMS. Clinicians have raised the question of discontinuing therapy in RRMS patients deemed clinically stable. This study provides indirect evidence that clinically stable patients with no recent relapses and MRI evidence of disease “inactivity” should be continued on optimal therapy instead of contemplating discontinuation or switching to therapy that may be less optimal to control disease activity.