Early treatment of multiple sclerosis (MS) is important and access to proven therapies should not be restricted by where a person with MS happens to live, urge the Canadian MS Clinics Network and the Multiple Sclerosis Society of Canada.

"There is increasing evidence that damage to nerve fibres occurs early in MS, and it is important that all people with active disease be treated as early as possible regardless of their ability to pay or where they happen to live," said Dr. Joël Oger, neurologist at the University of British Columbia and one of the co-authors of a consensus statement on the use of MS therapies.

The consensus statement makes a number of recommendations on the use of the four approved MS therapies that modify the course of this frequently disabling disease of the central nervous system. The statement is in the November 1999 issue of The Canadian Journal of Neurological Sciences.

The consensus statement also insists that access to treatment should not be determined by the criteria used for entry into clinical trials.

Currently a number of provincial drug programs require that the person be totally ambulatory (not even using a cane), have a minimum number of MS attacks and between 18 and 55 years old. The consensus statement rejects these restrictions, arguing that they were meant for use during clinical trials and not intended for ongoing treatment usage.

New information about how MS causes damage within the central nervous system is making treatment more important. While multiple sclerosis is known as a disease that attacks and destroys the protective myelin covering of the central nervous system, in the past two years researchers have found that nerve fibres themselves are damaged and the size of the brain may shrink early in the disease.

"While we already knew these treatments reduce the frequency and severity of relapses and slowed progression of disability, this new information tells us that MS may cause damage in the central nervous system before a person has significant visible disability," said Dr. William J. McIlroy, Multiple Sclerosis Society of Canada national medical advisor.

"Also important is recent evidence that treatment with existing therapies can slow brain atrophy," Dr. McIlroy added.

The consensus statement was signed by 24 members of the Canadian MS Clinics Network and the Multiple Sclerosis Society of Canada to guide the prescribing and reimbursement of the four federally approved MS therapies for relapsing-remitting MS: Avonex, Betaseron, Copaxone and Rebif.

One of the drugs, Betaseron, has recently been approved for treating the progressive form of MS that often develops from relapsing-remitting MS.

"The consensus statement covers the use of an approved therapy for secondary-progressive MS, especially if a patient is still able to walk. However, as MS neurologists, we believe that there are MS patients in this group who fall outside the criteria such as not being ambulatory, but who would benefit from treatment and should be reimbursed," said Dr. Mark Freedman, neurologist at Ottawa General Hospital and the other consensus statement co-author.

The Multiple Sclerosis Society of Canada will be using the consensus statement to urge physicians to offer treatment to all people with MS who could benefit from treatment and to ask provincial governments and third party payers to expand their criteria for drug cost reimbursement.

Multiple sclerosis is a disease that randomly attacks the central nervous system, affecting the control a person has over the body. Symptoms may range from numbness to blindness to paralysis. Canada is known to be a high risk area for MS.

The Multiple Sclerosis Society of Canada is the foremost voluntary agency which provides hope and help to the estimated 50,000 Canadians with MS and their families through extensive MS research and services programs.

The Canadian MS Clinics Network is a non-profit organization of university hospital-based MS clinics which have specialized expertise in the diagnosis and management of MS.

Disclaimer
The Multiple Sclerosis Society of Canada is an independent, voluntary health agency and does not approve, endorse or recommend any specific product or therapy but provides information to assist individuals in making their own decisions.

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