In Part One, Quality of Life for MS Patients: Is it Health-Related?, we outlined four aspects to quality of life which include clinical health, role-performance, adaptability, and well-being. However, not one commenter mentioned disability in relation to Quality of Life. The overwhelming response was that we want to feel productive, to use our skills to pursue meaningful work, to enjoy simple pleasures, and to gain a satisfying sense of accomplishment. And as Sherry points out, we cannot beat “Father Time.”
Since multiple sclerosis is a chronic, progressive disease which has no cure, chemical treatments are aimed at controlling the symptoms and slowing the progression of the disease. I say chemical simply because a nutritional approach to symptom- and disease-management is beyond the scope of this brief post.
What are Disease-Modifying Treatments?
During the past 15 years, disease-modifying agents (aka DMDs) have been developed for use in the treatment of multiple sclerosis (MS). Basic goals of disease-modifying treatments for MS are to decrease central nervous system inflammation, reduce relapse rates, slow disability and the accumulation of cognitive dysfunction, reduce new lesion formation and the progression of brain atrophy, and improve a patient’s Health-Related Quality of Life (HRQOL).
Currently there are six FDA-approved disease-modifying agents for MS which include interferon beta-1a (Avonex and Rebif), interferon beta-1b (Betaseron), glatiramer acetate (Copaxone), natalizumab (Tysabri) and mitoxantrone (Novantrone). There are also a number of disease-modifying agents which are in clinical trials, including laquinimod, fingolimod, alemtuzumab, daclizumab, cyclophosphamide, teriflunomide, and cladribine.
In The Importance of Early Diagnosis of Multiple Sclerosis by James R. Miller, MD., found in the Supplement to Journal of Managed Care Pharmacy June 2004; 10(3):S4-S11, three significant trials are discussed in relationship to early treatment in MS.
1. Controlled High Risk Subjects Avonex Multiple Sclerosis Prevention Study [CHAMPS] - Results from this study show that early treatment delayed or prevented Clinically Definite MS and reduced the frequency of new lesions. The probability of developing Clinically Definite MS were 44% lower in patients who received Avonex, and at 18 months, there were 58% fewer new or enlarging lesions and 71% fewer Gd+ lesions in patients who received treatment than in those who received placebo.
2. Early Treatment of Multiple Sclerosis [ETOMS] - Over 2 years, 24% fewer patients who received treatment developed Clinically Definite MS than those who received placebo. Annual relapse rates were lessened in the treatment group as were the number and volume of T2 lesions seen on MRI as compared to the placebo group.
3. Prevention of Relapses and Disability by Interferon-beta-1a Subcutaneously in Multiple Sclerosis [PRISMS] - Parallel groups of patients either received Rebif (22-mcg or 44-mcg) or a placebo for 2 years after which those on placebo were switched to Rebif for another 2 years. After 4 years, the crossover groups had greater increases in EDSS, and disease burden was progressively higher than in groups who received continuous treatment. Those patients for whom treatment is delayed do not see the same benefits as those who began treatment early. “What was lost cannot be regained.”