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Abstract
Background: Interferon-β-1b (IFNβ-1b) has been used to prevent exacerbation of relapsing-remitting multiple sclerosis (RRMS) including optic-spinal multiple sclerosis (OSMS) in Japan. We encountered 2 patients with OSMS with unexpectedly severe exacerbation soon after the initiation of IFNβ-1b therapy. The experience urged us to retrospectively review the patients with RRMS who had been treated with IFNβ-1b to identify similar cases.
Methods: At neurologic departments of 9 hospitals, the medical records of 56 patients with RRMS were reviewed to identify those who showed severe exacerbation soon after the initiation of IFNβ-1b therapy.
Results: Of 56 patients with RRMS, we identified 7 who experienced severe exacerbation (exacerbation with increased scores of Expanded Disability Status Scale ≧7.0) within 90 days of the initiation of IFNβ-1b therapy. In all 7 patients, the exacerbations after the initiation of IFNβ-1b therapy were more severe than those experienced by the individual patients before the use of IFNβ-1b, and seemed to have occurred unexpectedly in a short time after the initiation of INFβ-1b therapy. A retrospective analysis revealed that all 7 patients had antibodies toward aquaporin 4, and the clinical features of all 7 patients after the exacerbation were consistent with those of neuromyelitis optica (NMO) spectrum.
Conclusions: Our study suggests that IFNβ-1b may trigger severe exacerbation in patients with the NMO spectrum. In INFβ-1b therapy, cases in NMO spectrum should be carefully excluded.
Footnotes
Study funding: Supported by Grants-in-Aid for Scientific Research and Health and Labour Sciences Research Grants for Research on Intractable Diseases from the Ministry of Health, Labour and Welfare of Japan.
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- AQP4
- aquaporin 4
- CMS
- conventional multiple sclerosis
- cRRMS
- RRMS not meeting the criteria of NMO
- EDSS
- Expanded Disability Status Scale
- IFNβ-1b
- interferon-β-1b
- LESCL
- longitudinally extensive spinal cord lesion
- MS
- multiple sclerosis
- NMO
- neuromyelitis optica
- OSMS
- optic-spinal multiple sclerosis
- RRMS
- relapsing-remitting multiple sclerosis
Editorial, page 1404
Supplemental data at www.neurology.org
- Received January 10, 2010.
- Accepted June 7, 2010.
- Copyright © 2010 by AAN Enterprises, Inc.
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