Table ii

ABN Guidelines (2001)⁵

Relapsing-Remitting MS

Beta interferon (using any one of the three preparations licensed for this indication) is appropriate treatment and should be offered to patients with relapsing-remitting MS who fulfil the following four criteria:

1.      Able to walk independently

2.      At least two clinically significant relapses in the last two years

3.      Adult age group

4.      There are no contraindications

Secondary Progressive MS

A consideration of all three trials suggests that beta interferon is not effective in slowing progression in disability in patients with a non relapsing secondary progressive course.  It is therefore not recommended in such patients.  In patients with relapsing secondary progressive MS treatment should only be considered when relapses are the dominant cause of the increasing disability.  Specifically, the following criteria should be fulfilled:

1.      Able to walk at least 10 metres with or without assistance.

2.      At least 2 disabling relapses in the last two years.

3.      Any increase in disability due to slow progression over the last two years has been minimal.

4.      Adult age group (18 or over).

5.      There are no contraindications.

Stopping Criteria

In some patients, discontinuation of treatment may become necessary because of intolerable adverse effects, or when a pregnancy is planned.  Treatment should be discontinued when it is no longer effective.  The following features are likely to indicate lack of efficacy and should normally be used as stopping criteria:

1.      Two disabling relapses, as defined by the examining neurologist, within a 12 month period.

2.      Secondary progression with an increase in disability observable over 6 months.

3.      Loss of ability to walk, with or without assistance, persistent for at least 6 months.

The stopping criteria should be made known to patients and agreed before treatment is begun.  For all patients, it is recommended that a formal review of the treatment takes place at two years.  If the patient and their neurologist agrees that the treatment is having a beneficial effect, it should be continued.