Male doctor giving an MRI to a patient

Two signs that MS treatment isn’t working

The most commonly prescribed treatments for multiple sclerosis (MS) are Copaxone or one of the interferons (Avonex, Betaseron/Extavia, Rebif). While many people will respond well to these drugs, some will not and might do better if they were switched to another drug.

How do you know if your drug is working? A recent study has investigated this question by looking at people taking Avonex for the past 15 years (Bermel and colleagues. Ann Neurol 2013;73:95-103).

The benefits of the interferons are primarily to reduce the frequency of relapses and the amount of inflammation in the brain as seen on MRI. As you might expect, it was a bad sign if problems persisted in either of these two areas.

The worst sign was new lesions on the MRI. Enhancing T1 lesions (using a contrast agent), which indicate new inflammation, were associated with a 9-fold greater risk of developing disability over the long term. There was a 3-fold higher risk of disability if there were new T2 lesions, which indicate more chronic inflammatory damage. Continuing to have relapses while on treatment was also a significant risk factor for long-term disability.

Some caution is needed in interpreting these results. The study was an extension of the original Avonex trial (Jacobs and colleagues. Mult Scler 1995;1:118-135). However, after the first two years there was no placebo comparison group. In addition, the follow-up study included fewer than one-half of the original participants, so it’s unclear how well those people did and if excluding them skews the results. The findings may apply to people on medications other than Avonex, but that would need to be studied further.

That said, it appears that if a person continues to have relapses and MRI activity while on a specific treatment, it may well be that this drug may not be the best choice over the long term. At the very least it would merit a conversation with your MS doctor about whether you should change therapies and what your options are.

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