MS - Beta interferon slows progression and reduces relapses in relapsing MS
Clinical Bottom Line:
Beta interferon slowed the progression of disability and reduced the relapse rate in patients with MS |
Appraised by Sackett at the Centre for Evidence-Based Medicine
Clinical Scenario:
A patient with relapsing multiple sclerosis.
Three-part Question:
In patients with relapsing multiple sclerosis, will beta-interferon reduce the risk of subsequent relapse? -will it slow the progression of their disease?
Search Terms:
"interferon multiple sclerosis " in Best Evidence: 4 hits; this is the most recent, but includes information from earlier trials.
The Study:
- Double-blinded concealed randomised controlled trial with intention-to-treat.
- 18-55 y/o (median age 37; 73% women). Had MS at least 1 year, with 2 or more relapses in last 3 years but none in last 2 months; Expanded Disability Status Score 1-3.5; (and NO chronic progressive MS, prior immunosuppression or interferon Rx, steroid/corticotrophin Rx in last 2 months, present or potential pregnancy, lactation, or serious second illness).
- Control group (N=143): placebo injection, acetaminophen, and usual care; if relapsed, could receive optional corticotrophin or steroids.
- Experimental group (N=158): Interferon-beta-1a, 30 ug/week I-M, with acetaminophen 650 mg PO before and 24 hours after injection; same Rx options for relapses.
The Evidence:
| Outcome | Time to Outcome | RRR | ARR | NNT |
| Progression of disability |
2 years |
37% |
0.130 |
8 |
| 95% CI: | 8% to 66% | 0.029 to 0.231 | 4 to 35 |
| Exacerbation (worse by 1 point or more for 6 months or more)
| annual rate |
18% |
0.150 |
7 |
| 95% CI: | 7% to 30% | 0.053 to 0.247 | 4 to 19 |
Comments:
- Extends earlier trial (IFNB MS Study Group: Neurology 1995;45:1277-85; EBM 1996;1:53) of 372 relapsing pts. that found reduced relapses and a non-sig favourable trend in progression.
- And similar to co-polymer 1 trial (Johnson KP et al, Neurology 1995;45:1268-76; EBM 1996;1:52) in 251 relapsing patients that found stat sig reduction in relapses and disability scores.
Expiry date: October 1997
References:
- Jacobs LD, Cookfair DL, Rudick RA et al and The Multiple Sclerosis Collaborative Research Group (MSCRG): Intramuscular interferon beta-1a for disease progression in relapsing multiple sclerosis. Ann Neurol 1996;39:285-94.
