Interferon beta-1b in secondary progressive MS: A combined analysis of the two trials

Outpatient Clinic Neurology-Neurosurgery, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
Neurology (Impact Factor: 8.3). 11/2004; 63(10):1779-87. DOI: 10.1212/01.WNL.0000145561.08973.4F
Source: PubMed

ABSTRACT A European (EU) and a North American (NA) placebo-controlled study with interferon beta-1b (IFNB-1b) in secondary progressive multiple sclerosis (SPMS) showed divergent results with regard to their primary outcome of sustained Expanded Disability Status Scale (EDSS) progression, while effects were similar on relapse and MRI-related endpoints. Reasons for this discrepancy were explored in the combined dataset.
Baseline characteristics and variability in EDSS assessments were compared. Retrospective combined analyses for time to confirmed progression were performed to assess treatment effects overall and in subgroups defined by pre-study disease activity criteria and other key baseline variables.
The variance of EDSS measurements was 6.5% higher in the NA-SPMS study. The EU study included patients in an earlier phase of SPMS and with more active disease both pre-study (relapses, MRI) as well as on study (EDSS, relapses, and MRI variables as assessed in the placebo groups). The pooled analysis showed an overall risk reduction by about 20% in patients treated with 8 MIU (250 mcg) IFNB-1b for EDSS progression confirmed at 6 months (p = 0.008). Risk reduction by 30% to 40% was found for patients with at least one relapse or change in EDSS by >1 in the 2 years prior to study entry. No other consistent across-studies relation of clinical and MRI variables at baseline to potential treatment response was found.
Although post hoc, this combined analysis of the two large studies with IFNB-1b in secondary progressive multiple sclerosis suggests that both pronounced disability progression and continuing relapse activity might help in identifying those patients in the secondary progressive phase of the disease who are more likely to benefit from treatment.

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    • "In contrast, another nonrandomized study of 1504 patients with RRMS showed that interferon ȕ-1a and -1b reduced disability progression (Trojano et al, 2007). Data for direct effects of interferon ȕ-1b on active SPMS are mixed, with 1 large-scale trial showing a significant reduction in disability progression and another showing no effect of the drug on progression in patients with more advanced disease (Kappos et al, 2004). Other correlational evidence suggests that interferon ȕ-1b can delay the time of onset of the progressive form of SPMS. "
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