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Interferon beta is a disease modifying treatment for multiple sclerosis. In patients who have had just one suggestive neurological event, treatment can delay progression to clinically definite disease. But can it delay or reduce disability, the outcome most feared by patients and their relatives? Extended follow-up of a randomised controlled trial suggests it can, but not by much.
Patients who began treatment at the start of the trial after a single suggestive event, had slightly but significantly lower disability scores three years later than patients who began treatment after an initial two year delay. Early treatment reduced the risk of worsening disability from an estimated 24% to 16%, compared with delayed treatment (hazard ratio 0.60 95% CI 0.39 to 0.92).
Even so, the absolute differences between the groups were small, says a linked editorial. The change in disability scores was clinically unimportant in both groups, and the findings don't justify early treatment for everyone. Interferon beta is given by subcutaneous injection every other day. Patients may be reluctant to start a long course of injections when they feel well and could stay reasonably well for decades without them. In a subgroup analysis, early treatment didn't help those with very limited disease at baseline.