Re: Benefits of interferons

Posted By Joe  on May 01, 1999 at 10:15:44
Not every neuro is recommending interferons for the treatment of MS.  I was recently diagnosed with probable MS.  I have seen three neuros.  One recommended immediate treatment with interferons.  One recommended no treatment now since he felt the two lesions on the MRI may not be lesions (cervical c2 and c3)...and he recommended redoing the MRIs with contrast.  The other recommended a wait and see approach for one year since my symptoms are mild (numbness, burning sensation on feet), but recommended antidepressants (celexa).  If just one more lesion is found on the MRI she recommends IMMEDIATE treatment.
My PCP recommended no treatment.  He felt in the next couple of years an oral dosage may be available for clinical studies/trials.  
If I choose to be aggressive, I will go on interferons.
Since your center is a leader in this field, what is the current thinking on interferon treatment and what inroads are being made in the development of oral meds.  Also what about the use of antibiotics in the treatment of MS?  

[CCF Neuro[P] MD RPS]

Posted By CCF Neuro[P] MD, RPS on May 01, 1999 at 14:24:17
Dear Joe:
Sorry to hear about your medical problems.  I think the issue is whether you have MS or not.  If not, then interferon treatment will have no effect.  If yes, then interferon treatment has been proven to delay time to next exacerbation, decrease defined CNS lesions (MS activity) even when clinical symptoms were not present, and maybe prolong muscle use and strength.  Early in the illness it can be difficult to make a firm diagnosis.  MS is a clinical diagnosis with relapsing clinical signs needed.  However, MRI signs coupled with clinical signs adds strength to the diagnosis.  I know that you probably know all this, and I am assuming that the analysis of your CSF did not show oligoclonal bands, increased IgG synthesis, increased albumin etc.  My collegues differ in their approach, much in the same way your advice has been.  But I think that most of us would begin treatment if the MRI was convincing (multiple hyperintense spots on MRI) and a clinical exam that made us suspicious.  
About waiting for the oral medication, I would not hold my breath.  I think it will come out in the near future (a few years) but then the question will be how well it works compared to the injection interferons.  If it works better than you can shift, if not then you wouldn't have wasted time and functional brain.
It is your decision and without doing the exam and seeing the MRI it is tough for me to tell you my opinion.  I would tend to lean toward treatment.  Any brain function lost is lost forever.
Sincerely,
CCF Neuro[P] MD

[Lisa__0__0]

Posted By Lisa on May 01, 1999 at 15:56:16
Forgive me for using this post as a conduit to my question (see "Various Query," posted on 4/24/99) but I just wanted to make sure that this subject and its relation to Multiple Sclerosis would be seen.
If C.Pneumoniae is implicated, what consequences could the interferons have? I realize that interferons DO NOT supress the immune system and they only serve as immunemodulators; but in consequence it would certainly be most interesting to see the a study done on this pathogen and the interferons....
Organism Responsible for Common Form of Pneumonia May Play Role in
                                      Development of MS

Toronto (April 23, 1999)  An agent that causes respiratory tract infections  such as community-acquired pneumonia, called
chlamydia pneumonia, may be a  factor in the development of multiple sclerosis (MS) in some patients,  according to a study
released during the American Academy of Neurology 51st  Annual Meeting April 17-24 in Toronto.
These results suggest that infection of the central nervous system with  chlamydia pneumonia is an early event in MS, and may
directly or indirectly  be responsible for the development of the disease," said study author and  neurologist Subramaniam
Sriram, MD, of Vanderbilt Medical Center, in  Nashville, TN. "What is not clear is whether C. pneumonia is the cause of MS,
a fortuitous bystander, or whether it in some way triggers an autoimmune  response which causes the disease."
The cause of MS is not known. In MS, the insulating material of the nerves,  myelin, is destroyed. This leads to problems in
vision, balance, gait, and  other neurologic functions. Current theories suggest that a poorly regulated  immune response against
common infectious agents may be responsible for the  disease.
Chlamydial species are well-known pathogens involved in a number of human  diseases. Chlamydia pneumonia was discovered
about 10 years ago and is now  thought to be responsible for many cases of community-acquired pneumonia. The  association
between C. pneumonia and MS has not been previously noted.

In a study of 17 patients with newly diagnosed relapsing remitting MS and 13   patients without the disease, researchers found
evidence of the chlamydia   pneumonia organism in the spinal fluid of all 17 MS patients. In 47 percent   of newly diagnosed
MS patients, the organism was directly cultured from   cerebrospinal fluid. Using sophisticated genetic tests, researchers found
the   DNA of chlamydia pneumonia in the cerebrospinal fluid of all the MS patients.   In contrast, the organism was not found in
the cultures of any of the 13   control patients, and only two had evidence of C. pneumonia DNA.
"There is a possibility that these two patients may develop MS in the future   since their symptoms were suggestive of an initial
attack," Sriram said.
Also, a majority of the MS patients had an antibody response to chlamydial  antigens in the cerebrospinal fluid, indicating
evidence of a chronic immune  activation to chlamydia pneumonia.
In earlier studies, the researchers had established that a large number of  patients with chronic progressive MS had evidence of
C. pneumonia infection  in the cerebrospinal fluid. However, it was unclear whether the infection was  a secondary event
following long-standing inflammatory injury or was directly  involved in the immune process, Sriram said.
"Its clear from this study that the association between MS and the presence   of C. pneumonia infection is extremely
highmuch higher than any other   organism people have looked at in the past," he said.
"Since a number of currently available antibodies prevent the replication of  C. pneumonia, a therapeutic trial is likely to answer
the question of cause  and effect between C. pneumonia and multiple sclerosis," Sriram said.
Improving care for patients with neurological disorders through education and   research is the goal of the American Academy
of Neurology, an association of   more than 15,000 neurologists and neuroscience professionals.

[CCF Neuro[P] MD RPS]

Posted By CCF Neuro[P] MD, RPS on May 01, 1999 at 19:45:09
Dear Lisa:
Thanks for you posting.  There have been many agents implicated in MS, from the measles virus to the recent statements about HSV-6 and C. Pneumonia.  The tincture of time will tell.  Some things do not hold with C. Pneumonia.  First would be the large number of people who have had C. Pneumonia and the small numbers of people with MS.  Furthermore, the haplotype associated with autoimmune disease and MS in particular.  If anything, it might turn out to be another of the superantigen like-epitope that trick the immune system into making agents to attack itself in the context of a specific genotype.  However, I am an optimist and each step we take forward is a place closer to helping finding better treatment and possibly a cure for MS.
As both interferon 1 alfa and beta would be involved in the immune system attack on C. pneumonia it might have an effect.  However, the interferons are not specific in their affect, they are more generalized inhibitors of growth, i.e. eif-2 inhibitors, pentose shunt inhibitors etc.
Thanks again.
Sincerely,
CCF Neuro[P] MD  

[Marcie-Crain]

Posted By Marcie Crain on May 01, 1999 at 23:32:15
I have had MS diag. since 1986 with little activity until the last 2-3 years
I took disability in 98 due to cognitive, comprehension problems and severe fatigue.   I have been having fatigue occur. every week or two lately and called my Neuro to tell him of them at the advice of my Physiatrist he sent me to as she felt they were exacerbations.  He agreed and asked me if I wanted to start on Interferon.  I was diag with RR progressive by this Neuro in 97.  He said he felt Avonex would be best for me as it had fewest side affects.
Like the writer before me, I have been trying to do some reading about the ABC drugs and find the problems they cause to be less than  encouraging.  Flu like feelings, fatigue, fever, shot site problems, one person even was hosp for a week due to a reaction to the Avonex shot.
Are these side affects short lived?  Any permanent problems from the ABC Drugs?
Someone said to have your "Liver" tested every 3 months???I also developed a shot phobia 10 yrs ago due to alergy (allergy) shots twice a week so don't feel I could give them to myself.  Someone wrote in on the Harvard Forum that the ABC shots have not even been fully tested for side affects yet???
(Any info you can share with us and if you feel I need to start the shots based on my medical noted would be appreciated.  My 1st MRI showed 14 spots and Dr. Banowitz, Neuro OKC, OKC diag. me.  I am now seeing Kevin Wood Neuro. in the event you've known either to them.)  Thanks so much.  By the way I have been started on Neurontin for pain (as suggested by one of your Dr.s several months back) and it has helped my quality of life!! My Dr. said he had not started me on this due to my fatigue problem but I feel the trade off was worth it.Thanks

[CCF Neuro[P] MD RPS]

Posted By CCF Neuro[P] MD, RPS on May 02, 1999 at 15:56:02
Dear Ms. Crain:
I can only tell you what I would tell my patients and friends with MS.  I personally think that the interferons work.  They have been shown to decrease exacerbations, time to next exacerbation, silent lesions, and time to disability.  Yes, there are some side effects, however these side effects can be controlled by medications, such as ibuprofen or tylenol for the flu-like symptoms.  Lost function is forever lost, and to prevent or slow the process is what we are trying to obtain with using the interferons.  They are not perfect medications but they work.  I am not sure what to tell you about the shot phobia.  There is an oral medication on the horizon, but when it will come on to the market is still unknown. However, this is all up to you and your physician.  I would sit in the corner of you physician who recommended the initiation of interferon treatment and would agree with avonex.
Sincerely,
CCF Neuro[P] MD










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