July 7, 2010

Evidence 2 Practice: interferon-β1a to Multiple Sclerosis

A few months ago, I was invited to write a new kind of paper called: Evidence to Practice (E2P).  This new format is aimed at finding the best evidence for the treatments of a condition, give practical guidance to clinicians, and is a disease focused format. There are many sources of evidence and many practical articles, but E2P's are unique in describing how to make the best use of the best evidence. 

We write a paper on Multiple Sclerosis treatment entitled: González-Andrade F & Alcaraz-Alvarez JL. Disease-modifying therapies in relapsing–remitting multiple sclerosis. Neuropsychiatric Disease and Treatment, July 2010 (6): 365-7. This is an Open Journal available for anyone. 

Clinical question: What is the best current disease-modifying therapy for relapsing–remitting multiple sclerosis?
Results: The evidence shows that the most effective disease-modifying therapy for delaying short- to medium-term disability progression, prevention of relapses, reducing the area and activity of lesions on magnetic resonance imaging, with the least side effects, is high-dose, high-frequency subcutaneous interferon-β1a 44 μg three times per week.

Implementation: The pitfalls in treatment of MS can be avoided by remembering the following points:
- The most effective therapy to prevent or delay the appearance of permanent neurological disability with the fewest side effects should be chosen, and treatment should not be delayed.
- Adherence to treatment should be monitored closely, and needs comprehensive patient information and education to establish long-term adherence, which is a critical determinant of long-term outcome.
- The correct approach to the disease includes disease management, symptom management, and patient management. 
- A combination of tools is necessary to ease the various symptoms, which fall into three broad categories, i.e. rehabilitation, pharmacological, and procedural.
- It is important to understand that no treatment modality should be used alone, unless it is in itself sufficient to remedy the particular symptom/problem.
Keywords: relapsing–remitting multiple sclerosis, interferon, disease-modifying therapy, relapse prevention

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