Importance of relapses must not be underestimated

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7067.1263b (Published 16 November 1996) Cite this as: BMJ 1996;313:1263
  1. Peter Cardy
  1. Chief executive Multiple Sclerosis Society, London SW6 1EE

    EDITOR,—Peter Harvey asserts that patients with multiple sclerosis are interested in disability and, by implication, are not interested in relapses.1 While many patients with multiple sclerosis cope successfully with relapses, for a considerable proportion of patients relapses are frequent and severe, causing great distress and disruption to normal life. It is strange to condemn the first licensed product to show an effect on relapses because it has not also been shown to affect disability without acknowledging the importance of relapses in patients' lives.

    Equally, it is rather negative to place so much emphasis on the side effects of this drug without giving equal weight to the potential benefits. Experience even before the product was licensed in 1995 shows that patients with multiple sclerosis are capable of weighing the evidence on treatments and reaching rational conclusions; hence the lack of the feared stampede for interferon beta 1b. The Multiple Sclerosis Society has put great effort into ensuring that the evidence has been available to patients in a balanced and intelligible form and has looked to doctors to do likewise.

    Harvey's view is incapable of defence without better evidence than anecdote from the narrow context of the clinic. In Britain the shortage of neurologists means that few neurologists can afford extensive contact with their patients with multiple sclerosis, and the waiting times for outpatient appointments and admissions ensure that patients are rarely seen by their consultant during an exacerbation. It is not surprising, therefore, that the importance of relapses to patients is often underrated by British neurologists, and this may go some way to explaining the differences in levels of prescribing of interferon beta 1b between Britain and other countries.

    Harvey falls into the same trap as the authors of the landmark studies of interferon beta2 3 in making assumptions about the treatment priorities of patients with multiple sclerosis. In the context of carefully designed, multimillion dollar clinical trials it seems strange to those of us in daily contact with large numbers of patients that neither investigators nor pharmaceutical companies have sought firm evidence on this. Given the current range of possibilities, would patients with multiple sclerosis prefer their relapses to be treated or not? This is an important issue that has not yet been investigated, even though further costly large scale trials continue to be advocated. The Multiple Sclerosis Society is interested in potential collaborations on this question and would be pleased to hear from others of like mind.


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