BMJ  2003;326:1213 (31 May), doi:10.1136/bmj.326.7400.1213

Letter

Shared scheme for assessing drugs for multiple sclerosis

Why are eyes tightly shut to considering causes other than autoimmunity?

The first 150 words of the full text of this article appear below.

EDITOR—We agree with Sudlow and Counsell that the evidence for the risk sharing scheme for interferon beta and glatiramer in multiple sclerosis is poor.1 There are serious clinical and scientific flaws in advocating immunological treatments for multiple sclerosis.2 Before committing precious resources to any trial involving several thousand patients as proposed1 we have to be clear about the primary end point. In our view, it can only be the prevention of long term disability rather than reduction of short term fluctuations related to relapses.

Progressive neurological disability in multiple sclerosis is due to neuronal loss. Widespread axonal damage is always present even at the earliest clinical stages of the disease and is independent of the inflammatory changes.3 Multiple sclerosis is not an autoimmune disease and experience has shown that azathioprine is not effective. Investing in a long term randomised trial of "interferon beta or glatiramer versus azathioprine versus . . . [Full text of this article]

Abhijit Chaudhuri, senior lecturer in clinical neurosciences

ac54p@udcf.gla.ac.uk

Peter O Behan, emeritus professor of neurology

University of Glasgow Department of Neurology, Institute of Neurological Sciences, South Glasgow University Hospitals NHS Trust, Glasgow G51 4TF


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Relevant Article

Problems with UK government's risk sharing scheme for assessing drugs for multiple sclerosis
Cathie L M Sudlow and Carl E Counsell
BMJ 2003 326: 388-392. [Extract] [Full Text] [PDF]

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