Vidyya Medical News Service
Volume 6 Issue 46 Published - 14:00 UTC 08:00 EST 15-Feb-2004 Next Update - 14:00 UTC 08:00 EST 16-Feb-2004
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Long-term MS therapy and neutralizing antibodies

The rise of biologics (protein-based medications, which are similar to regulatory proteins normally produced by humans and generally administered by injection or infusion) has benefited countless patients in the treatment and management of chronic diseases, including cancer, anemia, diabetes, rheumatoid arthritis, psoriasis and MS.

"Biologic therapies are a significant advancement in the treatment of chronic, relapsing diseases, but in recent years, we have observed an unexpected consequence of attacking the immune system," said Frederick Munschauer, M.D., Chair, Department of Neurology, SUNY at Buffalo School of Medicine and Secretary of the Board of Governors, CMSC, and the Co-Chair of the CMSC Cooperative Studies Group in Multiple Sclerosis.

Relapsing-remitting MS patients take disease-modifying therapies called interferon betas, which reduce the frequency and severity of MS relapses or attacks, reduce brain lesion development and generally delay future disability. Few options for treating MS existed until these biologic therapies became available. However, some MS patients taking an interferon beta (Avonex®, Betaseron® or Rebif®) develop neutralizing antibodies (NAbs), which limit or prevent the medication from having its full therapeutic effect. As treatment with biologics increases, physicians and patients need expert guidance regarding this issue.

In November 2003, a CMSC consensus statement on how biologics affect NAbs was published in Neurology. The consensus was the result of an extensive review of studies by over 33 immunologists and neurologists. The CMSC sought to answer the following questions:

  • What is currently known about anti-interferon beta antibodies and their effects on patients with MS treated with interferons?
  • Do all interferon betas result in comparable levels of NAbs?
  • What are the tests available to detect antibodies; how accurate are they; and what is the best method for their detection in clinical care?
  • What are the research priorities in advancing our knowledge of this field?

    Current and Future Strategies

    The CMSC recommends that a laboratory test for NAbs be performed routinely with other standardized tests at least one and two years after start of treatment. Additionally, the CMSC counsels patients and their doctors to consider NAbs when selecting a long-term treatment for MS. Based on prescribing information, NAbs have been detected at different levels among the available interferon betas:

  • 43% of Betaseron patients (Interferon Beta-1b)
  • 24% of Rebif patients (Interferon Beta-1a)
  • 5% of Avonex patients (Interferon Beta-1a)

    "Therefore, it is incumbent on both physicians and their patients to understand the potential effects of NAbs on the long-term treatment for MS," urged Frederick Munschauer, M.D. "As new information becomes available, this should be factored into the patient's care. For now, selection of MS therapy should be based on how effective the treatment is over the long-term in light of the potential impact NAbs can have among these therapies. Currently, if a patient develops NAbs, physicians are forced to consider a more toxic or less effective agent."

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