Early treatment favored in AMA journal.

The National MS Society's Medical Advisory Board has long recommended that people consider treatment as soon as possible after diagnosis with relapsing forms of MS, and, in some cases, people considered at high risk should consider treatment even before definite diagnosis.

However, some continue to argue that early treatment may be unnecessary.

A special section of the April 2006 issue of the American Medical Association's Archives of Neurology focused on the debate, publishing input from two international panels, the first led by Elliot Frohman, MD, PhD, of the University of Texas Southwestern Medical Center at Dallas and the second headed by Sean J. Pittock, MD, of the Mayo Clinic, Rochester, Minnesota. Dr. Frohman is a member of the Society's National Medical Advisory Board.

For early treatment

Dr. Frohman and his coauthors, in their article, "Most Patients with Multiple Sclerosis or a Clinically Isolated Demyelinating Syndrome Should Be Treated at the Time of Diagnosis," pointed out that data show:

* Most people with MS will develop significant disability over time, and early on it is impossible to determine if a person's course will be benign;

* Studies suggest that injury to nerve fibers--which leads to the progression of disability--begins early in the course of the disease;

* The FDA-approved MS treatments decrease the number and severity of relapses, the number and size of new MS lesions, and the progression of disability (such as loss of vision, mobility, or cognitive ability);

* The treatments work best earlier in the course of the disease;

* Delaying treatment has been associated with more disability and a larger volume of MS damage as seen on MRI.

For waiting

Dr. Pittock and co-authors, in "Not Every Patient with Multiple Sclerosis Should Be Treated at Time of Diagnosis," countered that research indicates:

* If left untreated, MS often runs a "favorable" course, but it is difficult to distinguish a favorable course from a treatment success over time;

* The approved treatments are only partially effective in the short term;

* It is not proven that the treatments prevent disability over the long term;

* Treatments are expensive, ranging from about $16,000 to $28,000 a year. Moreover, they have adverse effects, and the interferons can become ineffective if neutralizing antibodies develop.

Conclusions

In an editorial, E.S. Roach, MD, of Wake Forest University School of Medicine, judged the debate.

"One approach," Dr. Roach wrote, "is to defer treatment until the patient's course is better established, possibly allowing those with less aggressive disease to avoid years of unnecessary treatment. But most people with newly diagnosed MS do progress, and we must consider that treatment could be less effective if started later."