Goals of MS Therapy

Participants:
Heidi J. Crayton, MD - Assistant Professor of Neurology
Georgetown University Medical Center
Frederick Munschauer III, MD - State University of New York at Buffalo School of Medicine

Webcast Transcript:

Recorded Live: July 27 2006

ANNOUNCER: When a person has multiple sclerosis, it is impossible to predict the course of the disease for that individual. But there are some general trends, and at some point, people with MS will likely experience relapses and may experience problems with cognition or walking. FREDERICK MUNSCHAUER, MD: Certainly, one of the things that's most important to a patient is their ability to ambulate, to get around at home, at work, at play; and multiple sclerosis does frequently affect your ability to walk. ANNOUNCER: Untreated, large studies have shown that most people with MS would experience some problems walking within a decade of diagnosis. HEIDI CRAYTON, MD: Within about ten years, a patient with MS would probably notice that they’re having some difficulties in gait. It may be difficulties in actually walking, or walking the same distance that they could prior to the disease. Then, as their disease goes on 10 or 15 years, they probably would need some assistive device, at least a one-sided assistive device, like a cane or a crutch, to help them get around. Probably 20 years, or maybe a little bit longer, before they would actually need something like a wheelchair or bilateral assistance, meaning two canes, two crutches, to get around. ANNOUNCER: Studies also show that many people with MS will also experience problems in how they think, especially without treatment. FREDERICK MUNSCHAUER, MD: Cognitive difficulties, difficulty with memory, difficulty with problem-solving, difficulty multitasking occur frequently with MS. And about 50 percent of people, at ten to fifteen years into their illness, will be aware that they've just slowed down cognitively in some way. ANNOUNCER: Within the last 10 to 15 years, researchers have developed a series of what are called “disease modifying drugs” that have been shown to alter the course of MS. Various clinical trials show clear benefit, including studies with drugs known as interferons. HEIDI CRAYTON, MD: The phase III clinical trial data has shown us that we can decrease the progression of accumulated disability in two years with both of the interferon beta-1a products: Avonex and Rebif. Avonex decreased the rate of physical decline, accumulated physical disability, at two years by about 37 percent. Rebif, with the higher dose, showed that about 30 percent. ANNOUNCER: Measuring decreases in physical decline can be a subjective task. Designers of these studies use benchmarks upon which doctors and their patients can easily agree. FREDERICK MUNSCHAUER, MD: We measure the time to a patient progressing in a unit of disability where both the patient and doctor clearly recognize that, "You know what? I'm worse." And when we apply that scale, recognizing that a whole bunch of patients could be at a different point in the path of impairment, we can make sure that in that individual patient who received therapy that the time to progression to a point where they would notice and their physician would notice they were worse, has been lengthened. And to what extent is it lengthened? It's lengthened by about 30 to 40 percent as compared to a placebo. ANNOUNCER: Scientists have gathered evidence too that at least some of the disease-modifying drugs can delay cognitive problems in MS. HEIDI CRAYTON, MD: With Avonex and Betaseron both, they put people through a neuropsychological battery of tests and another test called the PASAT, which is a cognitive test. And we saw benefit in terms of deterioration on those tests with both of the products, Avonex and Betaseron. It was more robust with Avonex, but we saw it in both. We didn’t see that with Rebif or Copaxone. FREDERICK MUNSCHAUER, MD: That goes quite well with the ability of these drugs to slow physical impairment also. So I think it's another real reason why beginning on treatment early is important. Once you've lost cognition or lost the ability to walk, it's virtually impossible to get it back. ANNOUNCER: Yet another measure of the effectiveness of the disease-modifying drugs is a decrease in the frequency of MS relapses. FREDERICK MUNSCHAUER, MD: We have right now a great deal of evidence that interferons and Copaxone modify disease activity. Let's take each individually. We do know that interferons reduce exacerbation rates—the number of attacks you get in one, two or three years—by about 30 percent and that's been shown in not one study, not two study, but four separate phase III clinical trials that interferons reduce attack frequency by 32 percent. In one trial of Copaxone, exacerbations were also decreased by about 30 percent. So our therapies can really modify this measure of MS disease activity, the rate at which you experience attacks. ANNOUNCER: Just a few years ago, there was little rush to diagnose multiple sclerosis, because there were no effective drugs to slow the disease. Now, there’s a clear trend toward early diagnosis, so therapy can begin as soon as possible. While there’s still no cure, there are now therapies that will likely slow MS down in very significant ways. HEIDI CRAYTON, MD: These drugs are not used to stop progression of MS or to undo what’s been done or to repair what’s been done. It’s to keep people doing better for a lot longer period of time and to keep them at a more functioning level for a lot longer period of time. FREDERICK MUNSCHAUER, MD: I like to tell my patients with multiple sclerosis that the disease can be treated effectively. In any one person, I can't predict what the future will be. But untreated multiple sclerosis in the majority of patients does result in impairment and that's something we can avoid by early aggressive treatment.

Supported through an educational grant from Biogen-Idec

© 2006 Healthology, Inc.

These goals apply to all four MS Injectable Therapies, including Copaxone, not just the interferon therapies.