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

[What-hapens-if]

Posted By What happens if.... on May 01, 1999 at 19:49:14
My question is, what happens when a person w/ MS is taken off one of the interferons? Does the MS get worse? Do they relapse? Have they lost all the benefits they've received while they were on the drug?
Thanks!

[Il-Try-This-Again]

Posted By I'll Try This Again.... on May 03, 1999 at 13:04:47
In addition to my questions above about what happens when a person with MS is taken off Betaseron - do they relapse viciously, do they lose all the benefits they've gained, etc - I have an additional question.
If a person DID NOT MS to begin with, would they still have the benefit of a lessening of their symptoms while on it, & would they relapse intensely after stopping it?
Seems to me, they would notice nothing at all, while on the Betaseron, or after taken off of it, if they never had MS to begin with. But, as I'm not a doctor, I just want to know for sure.
Thanks.

[CCF Neuro[P] MD RPS]

Posted By CCF Neuro[P] MD, RPS on May 04, 1999 at 08:50:06
Dear "I'll try this again"
If you stop interferon, you should not experience an immediately exacerbation, nor should you symptoms worsen.  The interferons are lessening the effects of the demyelination process when they occur.  If there isn't an exacerbation, then the process of demyelination is not occuring and the interferon is not having any effect.  Although this is theoretical, it seems to be what is occuring.  So, if there is no demyelination occuring, there would be no effect.  Since interferons are only stopping the process from occuring, you would not loose any benefit but you would not be covered for the next exacerbation.  The interferons would not have an effect on other processes, only on those processes that are demyelinating, presumably viral.  So, if the process of demyelination was never occuring, one would not see any benefit or likely worsening after interferon is stopped.
I hoped this helps.
Sincerely,
CCF Neuro[P] MD










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