VLADIMIRHACHINSKIMD, FRCPC, DSCMED
WHERE desperation prevails, any good news is welcome. One of the most heart-wrenching sights in neurology is watching a young person with MS decline relentlessly into helplessness. All contributors agree that the 2 IFNs tested in prospective randomized trials probably reduce the number of exacerbations and definitely decrease the disease burden assessed by MRI. The ultimate significance of these findings has yet to be determined.
The more substantial and controversial issue is whether IFNs slow the progression of MS. Herndon and Jacobs are encouraged by the results. They posit that most long-term disability is due to axonal loss secondary to multifocal inflammatory demyelination, upon which the IFNs seem to act, and conclude that given climbing costs associated with increased disability, IFNs should be used in most patients with MS. They further state that even if IFNs were not cost-effective, they should be administered because they are clinically efficacious, if not curative.
Hachinski V. Interferons in the Treatment of Multiple Sclerosis. Arch Neurol. 1998;55(12):1583. doi:10.1001/archneur.55.12.1583