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Published in: Drugs 15/2003

01-08-2003 | Current Opinion

Early Intervention in Multiple Sclerosis

Better Outcomes for Patients and Society?

Authors: Dr Peter Flachenecker, Peter Rieckmann

Published in: Drugs | Issue 15/2003

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Abstract

Multiple sclerosis (MS) is thought to be a chronic inflammatory disorder of the CNS. The past decade has seen the introduction of the new immunomodulatory drugs, interferon (IFN)-β and glatiramer acetate, that have considerably improved the therapeutic options for this often disabling disease. The efficacy of these treatments in terms of reducing relapse rate and slowing progression has been proven in several large, multicentre, randomised, controlled trials. Similarly, early IFNβ treatment of patients with clinically isolated syndromes suggestive of MS has been shown to lengthen time to conversion into definite MS. Cost-effectiveness has been questioned with the increasing use of these innovative and, therefore, costly therapies; however, modern studies with appropriate economic modelling suggest that treatment with IFNβ may indeed be cost-effective. Since increasing disability is associated with increasing costs, stabilisation of the disease at low functional grades of disability should aim at not only improving quality of life for the individual patient, but provide for prospective cost-benefit analysis focussing on the socioeconomic aspects of MS.
Footnotes
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Literature
3.
go back to reference Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology 1996; 46: 907–11 Lublin FD, Reingold SC. Defining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology 1996; 46: 907–11
4.
go back to reference Weinshenker BG, Bass B, Rice GP, et al. The natural history of multiple sclerosis.A geographically based study: 1, clinical course and disability. Brain 1989; 112: 133–46PubMedCrossRef Weinshenker BG, Bass B, Rice GP, et al. The natural history of multiple sclerosis.A geographically based study: 1, clinical course and disability. Brain 1989; 112: 133–46PubMedCrossRef
5.
go back to reference Goodin DS, Frohman EM, Garmany Jr GP, et al. Disease modifying therapies in multiple sclerosis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines. Neurology 2002; 58: 169–78PubMedCrossRef Goodin DS, Frohman EM, Garmany Jr GP, et al. Disease modifying therapies in multiple sclerosis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines. Neurology 2002; 58: 169–78PubMedCrossRef
6.
go back to reference Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983; 33: 1444–52PubMedCrossRef Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983; 33: 1444–52PubMedCrossRef
7.
go back to reference Filippi M, Horsfield MA, Ader HJ, et al. Guidelines for using quantitative measures of brain magnetic resonance imaging abnormalities in monitoring the treatment of multiple sclerosis. Ann Neurol 1998; 43: 499–506PubMedCrossRef Filippi M, Horsfield MA, Ader HJ, et al. Guidelines for using quantitative measures of brain magnetic resonance imaging abnormalities in monitoring the treatment of multiple sclerosis. Ann Neurol 1998; 43: 499–506PubMedCrossRef
8.
go back to reference Rieckmann P, Toyka KV, Austrian-German-Swiss Multiple Sclerosis Therapy Consensus Group. Escalating immunotherapy of multiple sclerosis. Eur Neurol 1999; 42: 121–7PubMedCrossRef Rieckmann P, Toyka KV, Austrian-German-Swiss Multiple Sclerosis Therapy Consensus Group. Escalating immunotherapy of multiple sclerosis. Eur Neurol 1999; 42: 121–7PubMedCrossRef
9.
go back to reference The IFNB Multiple Sclerosis Study Group. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis: I, clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. Neurology 1993; 43: 655–61CrossRef The IFNB Multiple Sclerosis Study Group. Interferon beta-1b is effective in relapsing-remitting multiple sclerosis: I, clinical results of a multicenter, randomized, double-blind, placebo-controlled trial. Neurology 1993; 43: 655–61CrossRef
10.
go back to reference Jacobs LD, Cookfair DL, Rudick RA, et al. Intramuscular interferon beta-1a for disease progression in relapsing multiple sclerosis. Ann Neurol 1996; 39: 285–94PubMedCrossRef Jacobs LD, Cookfair DL, Rudick RA, et al. Intramuscular interferon beta-1a for disease progression in relapsing multiple sclerosis. Ann Neurol 1996; 39: 285–94PubMedCrossRef
11.
go back to reference Prisms Study Group. Randomised double-blind placebo-controlled study of interferon beta-1a in relapsing/remitting multiple sclerosis. Lancet 1998; 352: 1498–504CrossRef Prisms Study Group. Randomised double-blind placebo-controlled study of interferon beta-1a in relapsing/remitting multiple sclerosis. Lancet 1998; 352: 1498–504CrossRef
12.
go back to reference Johnson KP, Brooks BR, Cohen JA, et al. Copolymer 1 reduces relapse rate and improves disability in relapsing-remitting multiple sclerosis: results of a phase III multicenter, double-blind placebo-controlled trial. Neurology 1995; 45: 1268–76PubMedCrossRef Johnson KP, Brooks BR, Cohen JA, et al. Copolymer 1 reduces relapse rate and improves disability in relapsing-remitting multiple sclerosis: results of a phase III multicenter, double-blind placebo-controlled trial. Neurology 1995; 45: 1268–76PubMedCrossRef
13.
go back to reference Johnson KP, Brooks BR, Cohen JA, et al. Extended use of glatiramer acetate (Copaxone) is well tolerated and maintains its clinical effect on multiple sclerosis relapse rate and degree of disability: Copolymer 1 Multiple Sclerosis Study Group. Neurology 1998; 50: 701–8PubMedCrossRef Johnson KP, Brooks BR, Cohen JA, et al. Extended use of glatiramer acetate (Copaxone) is well tolerated and maintains its clinical effect on multiple sclerosis relapse rate and degree of disability: Copolymer 1 Multiple Sclerosis Study Group. Neurology 1998; 50: 701–8PubMedCrossRef
14.
go back to reference Comi G, Filippi M, Wolinsky JS, et al. European/Canadian, multicenter, double-blind, randomized, placebo-controlled study of the effects of glatiramer acetate on magnetic resonance imaging-measured disease activity and burden in patients with relapsing multiple sclerosis. Ann Neurol 2001; 49: 290–7PubMedCrossRef Comi G, Filippi M, Wolinsky JS, et al. European/Canadian, multicenter, double-blind, randomized, placebo-controlled study of the effects of glatiramer acetate on magnetic resonance imaging-measured disease activity and burden in patients with relapsing multiple sclerosis. Ann Neurol 2001; 49: 290–7PubMedCrossRef
15.
go back to reference Oger J, Freedman M. Consensus statement of the Canadian MS clinics network on the use of disease modifying agents in multiple sclerosis. Can J Neurol Sci 1999; 26: 274–5PubMed Oger J, Freedman M. Consensus statement of the Canadian MS clinics network on the use of disease modifying agents in multiple sclerosis. Can J Neurol Sci 1999; 26: 274–5PubMed
16.
go back to reference MS-Therapie Konsensus Gruppe. Immunmodulatorische Stufentherapie der multiplen Sklerose, 1: Ergänzung. Dezember 2000. Nervenarzt 2001; 72: 150–7 MS-Therapie Konsensus Gruppe. Immunmodulatorische Stufentherapie der multiplen Sklerose, 1: Ergänzung. Dezember 2000. Nervenarzt 2001; 72: 150–7
17.
go back to reference European Study Group on Interferon Beta-1B IN Secondary Progressive MS. Placebo-controlled multicentre randomised trial of interferon β-1b in treatment of secondary progressive multiple sclerosis. Lancet 1998; 352: 1491–7CrossRef European Study Group on Interferon Beta-1B IN Secondary Progressive MS. Placebo-controlled multicentre randomised trial of interferon β-1b in treatment of secondary progressive multiple sclerosis. Lancet 1998; 352: 1491–7CrossRef
18.
go back to reference Goodkin DE, North American Study Group on Interferon Beta-1B in Secondary Progressive MS. Interferon beta-1b in secondary progressive MS: clinical and MRI results of a 3-year randomized controlled trial [abstract]. Neurology 2000; 54: 2352CrossRef Goodkin DE, North American Study Group on Interferon Beta-1B in Secondary Progressive MS. Interferon beta-1b in secondary progressive MS: clinical and MRI results of a 3-year randomized controlled trial [abstract]. Neurology 2000; 54: 2352CrossRef
19.
go back to reference Spectrims Study Group. Randomized controlled trial of interferon-beta-1a in secondary progressive MS: clinical results. Neurology 2001; 56: 1496–504CrossRef Spectrims Study Group. Randomized controlled trial of interferon-beta-1a in secondary progressive MS: clinical results. Neurology 2001; 56: 1496–504CrossRef
20.
go back to reference Li DK, Zhao GJ, Paty DW, et al. Randomized controlled trial of interferon-beta-1a in secondary progressive MS: MRI results. Neurology 2001; 56: 1505–13PubMedCrossRef Li DK, Zhao GJ, Paty DW, et al. Randomized controlled trial of interferon-beta-1a in secondary progressive MS: MRI results. Neurology 2001; 56: 1505–13PubMedCrossRef
21.
go back to reference Cohen JA, Goodman AD, Heidenreich FR, et al. Results of IMPACT, a phase 3 trial of interferon beta-1a in secondary progressive multiple sclerosis [abstract]. Neurology 2001; 56 Suppl.: A148–9CrossRef Cohen JA, Goodman AD, Heidenreich FR, et al. Results of IMPACT, a phase 3 trial of interferon beta-1a in secondary progressive multiple sclerosis [abstract]. Neurology 2001; 56 Suppl.: A148–9CrossRef
22.
go back to reference Kappos L, Polman C, Pozzilli C, et al. Final analysis of the European multicenter trial on IFNβ-1b in secondary-progressive MS. Neurology 2001; 57: 1969–75PubMedCrossRef Kappos L, Polman C, Pozzilli C, et al. Final analysis of the European multicenter trial on IFNβ-1b in secondary-progressive MS. Neurology 2001; 57: 1969–75PubMedCrossRef
23.
go back to reference Prisms Study Group, University of British Columbia MS/MRI Analysis Group. PRISMS 4: long-term efficacy of interferon-β-1a in relapsing MS. Neurology 2001; 56: 1628–36CrossRef Prisms Study Group, University of British Columbia MS/MRI Analysis Group. PRISMS 4: long-term efficacy of interferon-β-1a in relapsing MS. Neurology 2001; 56: 1628–36CrossRef
24.
go back to reference Trapp BD, Peterson J, Ransohoff RM, et al. Axonal transection in the lesions of multiple sclerosis. N Engl J Med 1998; 338: 278–85PubMedCrossRef Trapp BD, Peterson J, Ransohoff RM, et al. Axonal transection in the lesions of multiple sclerosis. N Engl J Med 1998; 338: 278–85PubMedCrossRef
25.
go back to reference Brex PA, Jenkins R, Fox NC, et al. Detection of ventricular enlargement in patients at the earliest clinical stage of MS. Neurology 2000; 54: 1689–91PubMedCrossRef Brex PA, Jenkins R, Fox NC, et al. Detection of ventricular enlargement in patients at the earliest clinical stage of MS. Neurology 2000; 54: 1689–91PubMedCrossRef
26.
go back to reference Jeffery DR. Early intervention with immunomodulatory agents in the treatment of multiple sclerosis. J Neurol Sci 2002; 197: 1–8PubMedCrossRef Jeffery DR. Early intervention with immunomodulatory agents in the treatment of multiple sclerosis. J Neurol Sci 2002; 197: 1–8PubMedCrossRef
27.
go back to reference Jacobs LD, Beck R, Simon JH, et al. Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. N Engl J Med 2000; 343: 898–904PubMedCrossRef Jacobs LD, Beck R, Simon JH, et al. Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. N Engl J Med 2000; 343: 898–904PubMedCrossRef
28.
go back to reference Comi G, Filippi M, Barkhof F, et al. Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomised study. Lancet 2001; 357: 1576–82PubMedCrossRef Comi G, Filippi M, Barkhof F, et al. Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomised study. Lancet 2001; 357: 1576–82PubMedCrossRef
29.
go back to reference Coyle PK, Hartung HP. Use of interferon beta in multiple sclerosis: rationale for early treatment and evidence for dose-and frequency-dependent effects on clinical response. Mult Scler 2002; 8: 2–9PubMed Coyle PK, Hartung HP. Use of interferon beta in multiple sclerosis: rationale for early treatment and evidence for dose-and frequency-dependent effects on clinical response. Mult Scler 2002; 8: 2–9PubMed
30.
go back to reference National Multiple Sclerosis Society USA (NMSS). Disease management consensus statement [online]. Available from URL:http://www.nmss.org [Accessed 2003 Jun 13] National Multiple Sclerosis Society USA (NMSS). Disease management consensus statement [online]. Available from URL:http://​www.​nmss.​org [Accessed 2003 Jun 13]
31.
go back to reference Johnson K, Brooks BR, Ford C, et al. Sustained clinical benefits of glatiramer acetate in relapsing multiple sclerosis patients observed for 6 years. Mult Scler 2000; 6: 255–66PubMed Johnson K, Brooks BR, Ford C, et al. Sustained clinical benefits of glatiramer acetate in relapsing multiple sclerosis patients observed for 6 years. Mult Scler 2000; 6: 255–66PubMed
32.
go back to reference Blumhardt L, Wood C. The economics of multiple sclerosis. a cost of illness study. Br J Med Econ 1996; 10: 99–118 Blumhardt L, Wood C. The economics of multiple sclerosis. a cost of illness study. Br J Med Econ 1996; 10: 99–118
33.
go back to reference Murphy N, Confavreux C, Haas J, et al. Economic evaluation of multiple sclerosis in the UK, Germany and France. Pharmacoeconomics 1998; 13: 607–22PubMedCrossRef Murphy N, Confavreux C, Haas J, et al. Economic evaluation of multiple sclerosis in the UK, Germany and France. Pharmacoeconomics 1998; 13: 607–22PubMedCrossRef
34.
go back to reference Holmes J, Madgwick T, Bates D. The cost of multiple sclerosis. Br J Med Econ 1995; 8: 181–93 Holmes J, Madgwick T, Bates D. The cost of multiple sclerosis. Br J Med Econ 1995; 8: 181–93
35.
go back to reference Upmeier H, Miltenburger C. The cost of multiple sclerosis in Germany: a top down analysis [abstract]. 16th Annual Meeting of the ISTAHC; 2000 Jun 18–21; The Hague Upmeier H, Miltenburger C. The cost of multiple sclerosis in Germany: a top down analysis [abstract]. 16th Annual Meeting of the ISTAHC; 2000 Jun 18–21; The Hague
36.
go back to reference Parkin D, McNamee P, Jacoby A, et al. A cost-utility analysis of interferon beta for multiple sclerosis. Health Technol Assess 1998; 2: iii–54PubMed Parkin D, McNamee P, Jacoby A, et al. A cost-utility analysis of interferon beta for multiple sclerosis. Health Technol Assess 1998; 2: iii–54PubMed
37.
go back to reference Pope GC, Urato CJ, Kulas ED, et al. Prevalence, expenditures, utilization, and payment for persons with MS in insured populations. Neurology 2002; 58: 37–43PubMedCrossRef Pope GC, Urato CJ, Kulas ED, et al. Prevalence, expenditures, utilization, and payment for persons with MS in insured populations. Neurology 2002; 58: 37–43PubMedCrossRef
38.
go back to reference Miltenburger C, Kobelt G. Quality of life and cost of multiple sclerosis. Clin Neurol Neurosurg 2002; 104: 272–5PubMedCrossRef Miltenburger C, Kobelt G. Quality of life and cost of multiple sclerosis. Clin Neurol Neurosurg 2002; 104: 272–5PubMedCrossRef
39.
go back to reference Henriksson F, Fredrikson S, Masterman T, et al. Costs, quality of life and disease severity in multiple sclerosis: a cross-sectional study in Sweden. Eur J Neurol 2001; 8: 27–35PubMedCrossRef Henriksson F, Fredrikson S, Masterman T, et al. Costs, quality of life and disease severity in multiple sclerosis: a cross-sectional study in Sweden. Eur J Neurol 2001; 8: 27–35PubMedCrossRef
40.
go back to reference Kobelt G, Lindgren P, Smala A, et al. Cost and quality of life in multiple sclerosis: an observational study in Germany. Health Econ Prevent Care 2001; 2: 60–8 Kobelt G, Lindgren P, Smala A, et al. Cost and quality of life in multiple sclerosis: an observational study in Germany. Health Econ Prevent Care 2001; 2: 60–8
41.
go back to reference Kobelt G, Lindgren P, Parkin D, et al. Costs and quality of life in multiple sclerosis: a cross-sectional observational study in the United Kingdom. Stockholm: EFI Research Reports, 2000 Kobelt G, Lindgren P, Parkin D, et al. Costs and quality of life in multiple sclerosis: a cross-sectional observational study in the United Kingdom. Stockholm: EFI Research Reports, 2000
42.
go back to reference Amato MP, Battaglia MA, Caputo D, et al. The costs of multiple sclerosis: a cross-sectional, multicenter cost-of-illness study in Italy. J Neurol 2002; 249: 152–63PubMedCrossRef Amato MP, Battaglia MA, Caputo D, et al. The costs of multiple sclerosis: a cross-sectional, multicenter cost-of-illness study in Italy. J Neurol 2002; 249: 152–63PubMedCrossRef
43.
go back to reference Grima DT, Torrance GW, Francis G, et al. Cost and health related quality of life consequences of multiple sclerosis. Mult Scler 2000; 6: 91–8PubMed Grima DT, Torrance GW, Francis G, et al. Cost and health related quality of life consequences of multiple sclerosis. Mult Scler 2000; 6: 91–8PubMed
44.
go back to reference Jönsson B. Economic evaluation of health care technologies. Acta Endocrinol 1993; 128: 50–4PubMed Jönsson B. Economic evaluation of health care technologies. Acta Endocrinol 1993; 128: 50–4PubMed
45.
go back to reference Johannesson M. Theory and methods for economic evaluation of health care. Boston (MA): Kluwer Academic Publishers, 1996 Johannesson M. Theory and methods for economic evaluation of health care. Boston (MA): Kluwer Academic Publishers, 1996
46.
go back to reference Forbes RB, Lees A, Waugh N, et al. Population based cost utility study of interferon beta-1b in secondary progressive multiple sclerosis. BMJ 1999; 319: 1529–33PubMedCrossRef Forbes RB, Lees A, Waugh N, et al. Population based cost utility study of interferon beta-1b in secondary progressive multiple sclerosis. BMJ 1999; 319: 1529–33PubMedCrossRef
47.
go back to reference Henriksson F, Jönsson B. The economic evaluation and consequences of multiple sclerosis. Int Mult Scler J 2000; 7: 9–17 Henriksson F, Jönsson B. The economic evaluation and consequences of multiple sclerosis. Int Mult Scler J 2000; 7: 9–17
48.
go back to reference Kobelt G, Jonsson L, Henriksson F, et al. Cost-utility analysis of interferon beta-1b in secondary progressive multiple sclerosis. Int J Technol Assess Health Care 2000; 16: 768–80PubMedCrossRef Kobelt G, Jonsson L, Henriksson F, et al. Cost-utility analysis of interferon beta-1b in secondary progressive multiple sclerosis. Int J Technol Assess Health Care 2000; 16: 768–80PubMedCrossRef
49.
go back to reference Kobelt G, Jonsson L, Miltenburger C, et al. Cost-utility analysis of interferon beta-1b in secondary progressive multiple sclerosis using natural history disease data. Int J Technol Assess Health Care 2002; 18: 127–38PubMed Kobelt G, Jonsson L, Miltenburger C, et al. Cost-utility analysis of interferon beta-1b in secondary progressive multiple sclerosis using natural history disease data. Int J Technol Assess Health Care 2002; 18: 127–38PubMed
50.
go back to reference Kobelt G, Jönsson L, Fredrikson S. Cost-utility of interferon β-1b in the treatment of patients with active relapsing-remitting or secondary progressive multiple sclerosis. Eur J Health Econ. In press Kobelt G, Jönsson L, Fredrikson S. Cost-utility of interferon β-1b in the treatment of patients with active relapsing-remitting or secondary progressive multiple sclerosis. Eur J Health Econ. In press
51.
go back to reference Nuijten MJ, Hutton J. Cost-effectiveness analysis of interferon beta in multiple sclerosis: a Markov process analysis. Value Health 2002; 5: 44–54PubMedCrossRef Nuijten MJ, Hutton J. Cost-effectiveness analysis of interferon beta in multiple sclerosis: a Markov process analysis. Value Health 2002; 5: 44–54PubMedCrossRef
52.
go back to reference Coyle PK, Vollmer T, Lepen C, et al. Long-term cost-effectiveness of interferon beta-1a (Rebif 44µg tiw) in the treatment of relapsing-remitting multiple sclerosis: an econometric model [abstract]. J Neurol 2002; 249 Suppl. 1: 201–2 Coyle PK, Vollmer T, Lepen C, et al. Long-term cost-effectiveness of interferon beta-1a (Rebif 44µg tiw) in the treatment of relapsing-remitting multiple sclerosis: an econometric model [abstract]. J Neurol 2002; 249 Suppl. 1: 201–2
Metadata
Title
Early Intervention in Multiple Sclerosis
Better Outcomes for Patients and Society?
Authors
Dr Peter Flachenecker
Peter Rieckmann
Publication date
01-08-2003
Publisher
Springer International Publishing
Published in
Drugs / Issue 15/2003
Print ISSN: 0012-6667
Electronic ISSN: 1179-1950
DOI
https://doi.org/10.2165/00003495-200363150-00001

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