Consensus Statement urges early
treatment and wider access for MS drugs
December 9, 1999
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
"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
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.
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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