Drugs

, Volume 63, Issue 15, pp 1525–1533

Early Intervention in Multiple Sclerosis

Better Outcomes for Patients and Society?
Current Opinion

Abstract

Multiple sclerosis (MS) is thought to be a chronic inflammatory disorder of the CNS. The past decade has seen the introduction of the new immunomodulatory drugs, interferon (IFN)-β and glatiramer acetate, that have considerably improved the therapeutic options for this often disabling disease. The efficacy of these treatments in terms of reducing relapse rate and slowing progression has been proven in several large, multicentre, randomised, controlled trials. Similarly, early IFNβ treatment of patients with clinically isolated syndromes suggestive of MS has been shown to lengthen time to conversion into definite MS. Cost-effectiveness has been questioned with the increasing use of these innovative and, therefore, costly therapies; however, modern studies with appropriate economic modelling suggest that treatment with IFNβ may indeed be cost-effective. Since increasing disability is associated with increasing costs, stabilisation of the disease at low functional grades of disability should aim at not only improving quality of life for the individual patient, but provide for prospective cost-benefit analysis focussing on the socioeconomic aspects of MS.

References

  1. 1.
    Compston A, Coles A. Multiple sclerosis. Lancet 2002; 359: 1221–31PubMedCrossRefGoogle Scholar
  2. 2.
    Keegan BM, Noseworthy JH. Multiple sclerosis. Annu Rev Med 2002; 53: 285–302PubMedCrossRefGoogle Scholar
  3. 3.
    Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology 1996; 46: 907–11Google Scholar
  4. 4.
    Weinshenker BG, Bass B, Rice GP, et al. The natural history of multiple sclerosis.A geographically based study: 1, clinical course and disability. Brain 1989; 112: 133–46PubMedCrossRefGoogle Scholar
  5. 5.
    Goodin DS, Frohman EM, Garmany Jr GP, et al. Disease modifying therapies in multiple sclerosis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines. Neurology 2002; 58: 169–78PubMedCrossRefGoogle Scholar
  6. 6.
    Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983; 33: 1444–52PubMedCrossRefGoogle Scholar
  7. 7.
    Filippi M, Horsfield MA, Ader HJ, et al. Guidelines for using quantitative measures of brain magnetic resonance imaging abnormalities in monitoring the treatment of multiple sclerosis. Ann Neurol 1998; 43: 499–506PubMedCrossRefGoogle Scholar
  8. 8.
    Rieckmann P, Toyka KV, Austrian-German-Swiss Multiple Sclerosis Therapy Consensus Group. Escalating immunotherapy of multiple sclerosis. Eur Neurol 1999; 42: 121–7PubMedCrossRefGoogle Scholar
  9. 9.
    The IFNB Multiple Sclerosis Study Group. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis: I, clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. Neurology 1993; 43: 655–61CrossRefGoogle Scholar
  10. 10.
    Jacobs LD, Cookfair DL, Rudick RA, et al. Intramuscular interferon beta-1a for disease progression in relapsing multiple sclerosis. Ann Neurol 1996; 39: 285–94PubMedCrossRefGoogle Scholar
  11. 11.
    Prisms Study Group. Randomised double-blind placebo-controlled study of interferon beta-1a in relapsing/remitting multiple sclerosis. Lancet 1998; 352: 1498–504CrossRefGoogle Scholar
  12. 12.
    Johnson KP, Brooks BR, Cohen JA, et al. Copolymer 1 reduces relapse rate and improves disability in relapsing-remitting multiple sclerosis: results of a phase III multicenter, double-blind placebo-controlled trial. Neurology 1995; 45: 1268–76PubMedCrossRefGoogle Scholar
  13. 13.
    Johnson KP, Brooks BR, Cohen JA, et al. Extended use of glatiramer acetate (Copaxone) is well tolerated and maintains its clinical effect on multiple sclerosis relapse rate and degree of disability: Copolymer 1 Multiple Sclerosis Study Group. Neurology 1998; 50: 701–8PubMedCrossRefGoogle Scholar
  14. 14.
    Comi G, Filippi M, Wolinsky JS, et al. European/Canadian, multicenter, double-blind, randomized, placebo-controlled study of the effects of glatiramer acetate on magnetic resonance imaging-measured disease activity and burden in patients with relapsing multiple sclerosis. Ann Neurol 2001; 49: 290–7PubMedCrossRefGoogle Scholar
  15. 15.
    Oger J, Freedman M. Consensus statement of the Canadian MS clinics network on the use of disease modifying agents in multiple sclerosis. Can J Neurol Sci 1999; 26: 274–5PubMedGoogle Scholar
  16. 16.
    MS-Therapie Konsensus Gruppe. Immunmodulatorische Stufentherapie der multiplen Sklerose, 1: Ergänzung. Dezember 2000. Nervenarzt 2001; 72: 150–7Google Scholar
  17. 17.
    European Study Group on Interferon Beta-1B IN Secondary Progressive MS. Placebo-controlled multicentre randomised trial of interferon β-1b in treatment of secondary progressive multiple sclerosis. Lancet 1998; 352: 1491–7CrossRefGoogle Scholar
  18. 18.
    Goodkin DE, North American Study Group on Interferon Beta-1B in Secondary Progressive MS. Interferon beta-1b in secondary progressive MS: clinical and MRI results of a 3-year randomized controlled trial [abstract]. Neurology 2000; 54: 2352CrossRefGoogle Scholar
  19. 19.
    Spectrims Study Group. Randomized controlled trial of interferon-beta-1a in secondary progressive MS: clinical results. Neurology 2001; 56: 1496–504CrossRefGoogle Scholar
  20. 20.
    Li DK, Zhao GJ, Paty DW, et al. Randomized controlled trial of interferon-beta-1a in secondary progressive MS: MRI results. Neurology 2001; 56: 1505–13PubMedCrossRefGoogle Scholar
  21. 21.
    Cohen JA, Goodman AD, Heidenreich FR, et al. Results of IMPACT, a phase 3 trial of interferon beta-1a in secondary progressive multiple sclerosis [abstract]. Neurology 2001; 56 Suppl.: A148–9CrossRefGoogle Scholar
  22. 22.
    Kappos L, Polman C, Pozzilli C, et al. Final analysis of the European multicenter trial on IFNβ-1b in secondary-progressive MS. Neurology 2001; 57: 1969–75PubMedCrossRefGoogle Scholar
  23. 23.
    Prisms Study Group, University of British Columbia MS/MRI Analysis Group. PRISMS 4: long-term efficacy of interferon-β-1a in relapsing MS. Neurology 2001; 56: 1628–36CrossRefGoogle Scholar
  24. 24.
    Trapp BD, Peterson J, Ransohoff RM, et al. Axonal transection in the lesions of multiple sclerosis. N Engl J Med 1998; 338: 278–85PubMedCrossRefGoogle Scholar
  25. 25.
    Brex PA, Jenkins R, Fox NC, et al. Detection of ventricular enlargement in patients at the earliest clinical stage of MS. Neurology 2000; 54: 1689–91PubMedCrossRefGoogle Scholar
  26. 26.
    Jeffery DR. Early intervention with immunomodulatory agents in the treatment of multiple sclerosis. J Neurol Sci 2002; 197: 1–8PubMedCrossRefGoogle Scholar
  27. 27.
    Jacobs LD, Beck R, Simon JH, et al. Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. N Engl J Med 2000; 343: 898–904PubMedCrossRefGoogle Scholar
  28. 28.
    Comi G, Filippi M, Barkhof F, et al. Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomised study. Lancet 2001; 357: 1576–82PubMedCrossRefGoogle Scholar
  29. 29.
    Coyle PK, Hartung HP. Use of interferon beta in multiple sclerosis: rationale for early treatment and evidence for dose-and frequency-dependent effects on clinical response. Mult Scler 2002; 8: 2–9PubMedGoogle Scholar
  30. 30.
    National Multiple Sclerosis Society USA (NMSS). Disease management consensus statement [online]. Available from URL:http://www.nmss.org [Accessed 2003 Jun 13]
  31. 31.
    Johnson K, Brooks BR, Ford C, et al. Sustained clinical benefits of glatiramer acetate in relapsing multiple sclerosis patients observed for 6 years. Mult Scler 2000; 6: 255–66PubMedGoogle Scholar
  32. 32.
    Blumhardt L, Wood C. The economics of multiple sclerosis. a cost of illness study. Br J Med Econ 1996; 10: 99–118Google Scholar
  33. 33.
    Murphy N, Confavreux C, Haas J, et al. Economic evaluation of multiple sclerosis in the UK, Germany and France. Pharmacoeconomics 1998; 13: 607–22PubMedCrossRefGoogle Scholar
  34. 34.
    Holmes J, Madgwick T, Bates D. The cost of multiple sclerosis. Br J Med Econ 1995; 8: 181–93Google Scholar
  35. 35.
    Upmeier H, Miltenburger C. The cost of multiple sclerosis in Germany: a top down analysis [abstract]. 16th Annual Meeting of the ISTAHC; 2000 Jun 18–21; The HagueGoogle Scholar
  36. 36.
    Parkin D, McNamee P, Jacoby A, et al. A cost-utility analysis of interferon beta for multiple sclerosis. Health Technol Assess 1998; 2: iii–54PubMedGoogle Scholar
  37. 37.
    Pope GC, Urato CJ, Kulas ED, et al. Prevalence, expenditures, utilization, and payment for persons with MS in insured populations. Neurology 2002; 58: 37–43PubMedCrossRefGoogle Scholar
  38. 38.
    Miltenburger C, Kobelt G. Quality of life and cost of multiple sclerosis. Clin Neurol Neurosurg 2002; 104: 272–5PubMedCrossRefGoogle Scholar
  39. 39.
    Henriksson F, Fredrikson S, Masterman T, et al. Costs, quality of life and disease severity in multiple sclerosis: a cross-sectional study in Sweden. Eur J Neurol 2001; 8: 27–35PubMedCrossRefGoogle Scholar
  40. 40.
    Kobelt G, Lindgren P, Smala A, et al. Cost and quality of life in multiple sclerosis: an observational study in Germany. Health Econ Prevent Care 2001; 2: 60–8Google Scholar
  41. 41.
    Kobelt G, Lindgren P, Parkin D, et al. Costs and quality of life in multiple sclerosis: a cross-sectional observational study in the United Kingdom. Stockholm: EFI Research Reports, 2000Google Scholar
  42. 42.
    Amato MP, Battaglia MA, Caputo D, et al. The costs of multiple sclerosis: a cross-sectional, multicenter cost-of-illness study in Italy. J Neurol 2002; 249: 152–63PubMedCrossRefGoogle Scholar
  43. 43.
    Grima DT, Torrance GW, Francis G, et al. Cost and health related quality of life consequences of multiple sclerosis. Mult Scler 2000; 6: 91–8PubMedGoogle Scholar
  44. 44.
    Jönsson B. Economic evaluation of health care technologies. Acta Endocrinol 1993; 128: 50–4PubMedGoogle Scholar
  45. 45.
    Johannesson M. Theory and methods for economic evaluation of health care. Boston (MA): Kluwer Academic Publishers, 1996Google Scholar
  46. 46.
    Forbes RB, Lees A, Waugh N, et al. Population based cost utility study of interferon beta-1b in secondary progressive multiple sclerosis. BMJ 1999; 319: 1529–33PubMedCrossRefGoogle Scholar
  47. 47.
    Henriksson F, Jönsson B. The economic evaluation and consequences of multiple sclerosis. Int Mult Scler J 2000; 7: 9–17Google Scholar
  48. 48.
    Kobelt G, Jonsson L, Henriksson F, et al. Cost-utility analysis of interferon beta-1b in secondary progressive multiple sclerosis. Int J Technol Assess Health Care 2000; 16: 768–80PubMedCrossRefGoogle Scholar
  49. 49.
    Kobelt G, Jonsson L, Miltenburger C, et al. Cost-utility analysis of interferon beta-1b in secondary progressive multiple sclerosis using natural history disease data. Int J Technol Assess Health Care 2002; 18: 127–38PubMedGoogle Scholar
  50. 50.
    Kobelt G, Jönsson L, Fredrikson S. Cost-utility of interferon β-1b in the treatment of patients with active relapsing-remitting or secondary progressive multiple sclerosis. Eur J Health Econ. In pressGoogle Scholar
  51. 51.
    Nuijten MJ, Hutton J. Cost-effectiveness analysis of interferon beta in multiple sclerosis: a Markov process analysis. Value Health 2002; 5: 44–54PubMedCrossRefGoogle Scholar
  52. 52.
    Coyle PK, Vollmer T, Lepen C, et al. Long-term cost-effectiveness of interferon beta-1a (Rebif 44µg tiw) in the treatment of relapsing-remitting multiple sclerosis: an econometric model [abstract]. J Neurol 2002; 249 Suppl. 1: 201–2Google Scholar

Copyright information

© Adis Data Information BV 2003

Authors and Affiliations

  1. 1.Department of Neurology and Clinical Research Group for NeuroimmunologyJulius-Maximilians UniversityWürzburgGermany

Personalised recommendations