title: Interferon, azathioprine and corticosteroids in multiple sclerosis: 6-year follow-up of the ASA cohort.
abstract: OBJECTIVE
  To evaluate long-term effects of 2-year treatment with interferon beta combined with low-dose azathioprine and prednisone in multiple sclerosis.
  
  
  METHODS
  In the original 2-year ASA study, 181 patients with early relapsing-remitting multiple sclerosis were randomised into 3 treatment arms: those treated with interferon beta (n=60), with interferon beta and low-dose azathioprine (n=58), and interferon beta, azathioprine and low-dose prednisone (n=63). Of these, 172 were included in this 4-year non-study extension. Three monthly clinical controls and annual MRI scans were carried out. The primary endpoint was annual relapse activity. The secondary endpoints were disability and quantitative MRI parameters.
  
  
  RESULTS
  Nine patients were lost to follow-up and 172 were included in the analyses. None of relapse activity, disability accumulation or MRI parameters differed significantly between the groups over 6 years. Only 5.5% and 0.6% of patients were free from disease activity at year 2 and year 6 of the treatment initiation.
  
  
  CONCLUSIONS
  The tested combined therapeutic regimen does not improve long-term outcomes in patients with multiple sclerosis. Furthermore, interferon is not able to completely abolish disease activity.
authors.affiliation: Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, 1st Faculty of Medicine and General University Hospital in Prague, Czech Republic. tomas.kalincik@unimelb.edu.au
authors.forename: T
authors.initials: T
authors.lastname: Kalincik
authors.forename: D
authors.initials: D
authors.lastname: Horakova
authors.forename: O
authors.initials: O
authors.lastname: Dolezal
authors.forename: J
authors.initials: J
authors.lastname: Krasensky
authors.forename: M
authors.initials: M
authors.lastname: Vaneckova
authors.forename: Z
authors.initials: Z
authors.lastname: Seidl
authors.forename: E
authors.initials: E
authors.lastname: Havrdova
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage / Q000627:therapeutic use*; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use*; D001921:Brain / Q000473:pathology; D015331:Cohort Studies; D004185:Disability Evaluation; D018450:Disease Progression; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007273:Injections, Intramuscular; D000068556:Interferon beta-1a; D016899:Interferon-beta / Q000008:administration & dosage / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000473:pathology; D011241:Prednisone / Q000627:therapeutic use; D012008:Recurrence; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D000276:Adjuvants, Immunologic; D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D016899:Interferon-beta; D001379:Azathioprine; D011241:Prednisone; D000068556:Interferon beta-1a