The pros and cons of early treatment of relapsing forms of multiple sclerosis.

Cerebral axonal damage and brain atrophy begin at the earliest stages of multiple sclerosis (MS). Progressive neuronal degeneration contributes to irreversible neurological deficit, and ultimately disability. Axonal loss, which seems to be related to the inflammatory process, occurs much more rapidly in the early than later phases of disease, providing additional impetus for early intervention. The CHAMPS (Controlled High risk Avonex MultiPle Sclerosis) and ETOMS (Early Treatment Of MS) studies show that fewer patients with a first demyelinating event and abnormal magnetic resonance imaging (MRI) had a second clinical attack within 2 years if once-weekly treatment with interferon beta-1a was started at the time of the first episode. However, these studies provide no information on long-term outcomes. The BENEFIT study (BEtaferon/betaseron in Newly Emerging multiple sclerosis For Initial Treatment) will evaluate the efficacy and tolerability of 250 micro g (8 MIU) interferon beta-1b administered every other day to patients with a first demyelinating event suggestive of MS. This study should add some information about some of the outstanding questions relating to the long-term effects of early treatment on disease course, although it is likely that further investigation will be needed before a definite picture can be obtained.