Optimization of treatment with interferon beta in multiple sclerosis. Usefulness of automatic system application criteria.
BACKGROUND
A software based tool has been developed (Optem) to allow automatize the recommendations of the Canadian Multiple Sclerosis Working Group for optimizing MS treatment in order to avoid subjective interpretation.


METHODS
Treatment Optimization Recommendations (TORs) were applied to our database of patients treated with IFN beta1a IM. Patient data were assessed during year 1 for disease activity, and patients were assigned to 2 groups according to TOR: "change treatment" (CH) and "no change treatment" (NCH). These assessments were then compared to observed clinical outcomes for disease activity over the following years.


RESULTS
We have data on 55 patients. The "change treatment" status was assigned to 22 patients, and "no change treatment" to 33 patients. The estimated sensitivity and specificity according to last visit status were 73.9% and 84.4%. During the following years, the Relapse Rate was always higher in the "change treatment" group than in the "no change treatment" group (5 y; CH: 0.7, NCH: 0.07; p < 0.001, 12 m - last visit; CH: 0.536, NCH: 0.34). We obtained the same results with the EDSS (4 y; CH: 3.53, NCH: 2.55, annual progression rate in 12 m - last visit; CH: 0.29, NCH: 0.13).


CONCLUSIONS
Applying TOR at the first year of therapy allowed accurate prediction of continued disease activity in relapses and disability progression.
Ruiz-Peña
Juan Luís
JL
Unidad de Esclerosis Múltiple, Hospital Universitario Virgen Macarena, Avda, Dr, Fedriani 3, 41009 - Sevilla, Spain. jlruizpe@hotmail.com
Duque
Pablo
P
Izquierdo
Guillermo
G
D000328:Adult; D002985:Clinical Protocols / Q000592:standards*; D020000:Decision Support Systems, Clinical; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage; D016899:Interferon-beta / Q000008:administration & dosage*; D009103:Multiple Sclerosis / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010346:Patient Care Management / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012984:Software / Q000592:standards*; D012986:Software Validation; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
D007155:Immunologic Factors; D016899:Interferon-beta