Super-Early MS Treatment Best

June 1, 2007 -- 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 a year or more 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 MS to progress was too late, and we started treating MS earlier -- usually soon after confirming the 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 a second attack confirmed their MS diagnosis.

After just two years, Freedman says, 85% of the patients initially treated with placebo would have met the new criteria for MS diagnosis -- and after three years, 24% showed signs of  "sustained progression" -- even though most of them had already switched to Betaseron a year or more earlier. Only 16% 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 she 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.