Although interferons have been stud...

Although interferons have been studied as treatments for multiple sclerosis for more than 20 years, their effectiveness remains controversial. Prominent affairs include the long-term gain in patients treated with these agents and the relative without deductions benefit of interferon therapy after adjustment for adverse forces and cost. Filippini and colleagues reviewed the research data upon interferon therapy for multiple sclerosis to determine the efficiency on clinical exacerbations and disease progression. They also assessed the consequence of interferon therapy in reducing hospital admissions, corticosteroid therapy, and cerebral lesions measured by means of magnetic resonance imaging (MRI).

They managemented a systematic review of all randomized, double-blind, placebo-controlled trials of alpha- or beta-recombinant interferon treatment in patients with validated relapsing-remitting multiple sclerosis. Searches of electronic databases and reviews of respects and information from experts and manufacturers identified 227 potential abstracts, yet only seven trials conducted between 1993 and 2002 met criteria for methodologic quality. Nearly 1700 patients participated in these trials, and data were available for 614 treated patients and 601 have the direction of patients. All patients were recruited during a stable phase of the illness. Treatment regimens ranged from 08 to 160 MIU of interferon beta-1b, 60 to 120 IU of interferon beta-1a, and 45 to 90 MIU of interferon alfa-2a. Duration of treatment ranged from 24 weeks to 36 month and the number of patients treated with each agent varied from six to 189

Based upon five of the trials (667 patients), interferon appeared to significantly decrease the risk of exacerbation during the first year of treatment (relative risk, 073) The authors calculated that nine patients ne to be treated to stop one exacerbation during the first year of interferon therapy. The large number of patients who withdrew or were wasted to follow-up prevented calculation of benefit beyond undivided year. Interferon therapy was associated with significantly les disability. Data were not adequate to draw conclusions about changes in hospital admission, use of steroids, or MRI-measured lesions. Side consequences were common; nearly one half of treated patients reported an influenza-type syndrome of agitation myalgia, fatigue, and headache. More than the same third of treated patients in pair studies experienced hair loss, and injection-site reactions occurr in 62 percent of patients. Depression was reported in 16 percent of patients in treatment and manage groups. Compared with patients in direction groups, treated patients had lower quality-of-life scores at three and six months; the scores adjusted as the influenza-like syndrome dissipated after about common year of therapy.

The authors close that interferon offers a virtuous protective effect against exacerbations of multiple sclerosis during the first year of therapy. However, data are difficult to interpret because of high dropout rates and methodologic moot points in the studies.

EDITOR'S NOTE: Multiple sclerosis is none easy on family physicians. We dread telling patients the diagnosis and discussing the uncertain prognosis. I have known patients who advancemented rapidly from subtle symptoms to rigid disability, while others remain essentially asymptomatic years after diagnosis despite abundant lesions onward MRI. The prospect of effective treatment had in the same state [i]or[/i] condition great promise. But, after untangling the caveats in this subject of attention we still don't know by what mode to advise patients about interferon therapy. Judging from the side effects and dropout rates, the unpretending benefits were hard won. about patients will try any available therapy to combat the disease. This consideration gives us numbers to use when cautioning families against unrealistic expectations and comforting them (and redirecting their anger) when the results are adverse effects or increased symptoms. For patients at the other final we can use the subject of attention to combat nihilism by pointing gone out that treatments capable of reducing exacerbations do exist and that it is securely only a matter of time until more effective therapies are developed

Filippini G et al. Interferons in relapsing remitting multiple sclerosis: a systematic review. Lancet February 15 2003; 361:545-52

ANNE D WALLING, MD

COPYRIGHT 2003 American Academy of Family Physicians

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