Multiple sclerosis, disease-modifying treatments and behavioral change

Anthony Feinstein

doi:10.1017/CBO9780511543760.012

11 - Multiple sclerosis, disease-modifying treatments and behavioral change

Published online by Cambridge University Press: 13 August 2009

Anthony Feinstein

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Anthony Feinstein: Affiliation:
University of Toronto

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Summary

Introduction

There are currently four disease-modifying drugs available: interferon beta-1b, two forms of interferon beta-1a (Rebif, Avonex) and glatiramer acetate (Copaxone). All are injectable, but differ in their route and frequency of administration (Table 11.1). They are usually prescribed for patients with a relapsing–remitting disease course, where their chief benefit is a reduction in the frequency of relapse. A disparate finding is that whereas all treatments significantly reduce the lesion burden as visualized on MRI, this does not necessarily translate into the same degree of clinical improvement (O'Connor, 2000). This chapter will not review evidence pertaining to mechanism of action, therapeutic efficacy and general side effects of disease-modifying therapies. Instead, in keeping with the neurobehavioral content of this book, the focus will fall exclusively on the relationship between disease-modifying therapies on the one hand and depression and cognition on the other.

Disease-modifying drugs and depression

Interferon beta-1b

Concerns that treatment with the interferons may trigger depression first surfaced in the initial inteferon beta-1b trial (IFNB Multiple Sclerosis Study Group, 1993, 1995). Adding urgency to the observation was the fact that four subjects attempted, and one completed, suicide over the course of the five year study, in comparison with no such acts in the placebo group. While these differences were not found to be statistically significant, they were a harbinger of future concerns over a possible association between depression and the drug.

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Type: Chapter
Information: The Clinical Neuropsychiatry of Multiple Sclerosis , pp. 214 - 231

DOI: https://doi.org/10.1017/CBO9780511543760.012 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2007

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References

American Psychiatric Association. (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Press.

Barak, Y, Achiron, A. (2002) Effect of interferon-beta-1b on cognitive functions in multiple sclerosis. European Neurology, 47, 11–14.Google Scholar

Beck, AT, Steer, RA, Brown, GK. (1996) Beck Depression Inventory (BDI)-II Manual. San Antonio, TX: Psychological Corporation.

Borras, BS, Rio, J, Porcel, J, et al. (1999) Emotional state of patients with relapsing–remitting MS treated with interferon beta-1b. Neurology, 52, 1636–1639.Google Scholar

Dilitz E, Kurz M, Deisenhammer F, Gasse T, Berger T. (1998) Is depression really a side effect of interferon-β therapy in multiple sclerosis? In ECTRIMS 98. 14th Congress of the European Committee for Treatment and Research in Multiple Sclerosis, Sweden, (abstract P3058), p. 389.

Durelli, L, Bongioanni, MR, Ferrero, B, et al. (1996) Long term recombinant interferon alpha treatment with special emphasis on side effect. Multiple Sclerosis, 1: 366–371.Google Scholar

European Study Group on Interferon B-1b in secondary progressive MS. (1998) Placebo controlled multicentre randomized trial of interferon beta-1b, in treatment of secondary progressive multiple sclerosis. Lancet, 352, 1491–1497.

Feinstein, A, O'Connor, P, Feinstein, KJ. (2002) Multiple sclerosis, interferon beta-1b and depression: a prospective investigation. Journal of Neurology, 249, 815–820.Google Scholar

First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. (1994) Structured Clinical Interview for Axis 1 DSM-IV Disorders, patient edn (SCID-I/P, version 2.0). New York: Biometrics Research Department, New York State Psychiatric Institute.

Fischer, JS, Priore, RL, Jacobs, LD, et al. (2000) Neuropsychological effects of interferon b-1a in relapsing–remitting multiple sclerosis. Annals of Neurology, 48, 885–892.Google Scholar

Galetta, SL, Markowitz, C, Lee, AG. (2002) Immunomodulatory agents for the treatment of relapsing multiple sclerosis: a systematic review. Archives of Internal Medicine, 162, 2161–2169.Google Scholar

Goëb, JL, Caileau, A, Lainé, P, et al. (2003) Acute delirium, delusion, and depression during IFN-B-1a therapy for multiple sclerosis. Clinical Neuropharmacology, 26, 5–7.Google Scholar

IFNB Multiple Sclerosis Study Group. (1993) Interferon beta-1b is effective in relapsing–remitting multiple sclerosis. 1. Clinical results of a multi-centre, randomized, double-blind placebo controlled trail. Neurology, 43, 655–661.

IFNB Multiple Sclerosis Study Group and the UBC MS/MRI Analysis Group. (1995) Interferon beta-1b in the treatment of multiple sclerosis: final outcome of the randomized controlled trial. Neurology, 45, 1277–1285.CrossRef

Jacobs, LD, Cookfair, DL, Rudick, RA, et al. (1996) Intramuscular interferon beta-1a for disease progression in relapsing–remitting multiple sclerosis. Annals of Neurology, 39, 285–294.Google Scholar

Jacobs, LD, Beck, RW, Simon, JH, et al. (2000) Intramuscular interferon beta-1a therapy initiated during a first demyelination event in multiple scleosis. New England Journal of Medicine, 343, 898–904.Google Scholar

Joffe, RT, Lippert, GP, Gray, TA, Sawa, G, Horvath, Z. (1987a) Personal and family history of affective disorder in patients with multiple sclerosis. Journal of Affective Disorders, 12, 63–65.Google Scholar

Joffe, RT, Lippert, GP, Gray, TA, Sawa, G, Horvath, Z. (1987b) Mood disorder and multiple sclerosis. Archives of Neurology, 44, 376–378.Google Scholar

Johnson, KP, Brooks, BR, Cohen, JA, et al. (1995) Copolymer 1 reduces relapse rate and improves disability in relapsing–remitting multiple sclerosis: results of a phase 111 multicentre, double- blind placebo-controlled trial. Neurology, 45, 1268–1276.Google Scholar

Korczyn, AD, Nispeanu, P. (1996) Safety profile of copolymer 1: analysis of cumulative experience in the United States and Israel. Journal of Neurology, 243 (Suppl.1), S23–S26.Google Scholar

Liang, KY, Zeger, SL. (1986) Longitudinal data analysis for discrete and continuous outcomes. Biometrics, 42, 121–130.Google Scholar

Lublin, FD, Whitaker, JN, Eidelman, BH, et al. (1996) Management of patients receiving interferon beta-1b for multiple sclerosis. Neurology, 46, 12–18.Google Scholar

Malek-Ahmadi, P. (2001) Mood disorders associated with interferon treatment: theoretical and practical considerations. Annals of Pharmacotherapy, 35, 489–495.Google Scholar

Menkes, DB, MacDonald, JA. (2000) Interferons, serotonin and neurotoxicity. Psychological Medicine, 30, 259–268.Google Scholar

Minden, SL, Schiffer, RB. (1990) Affective disorders in multiple sclerosis. Review and recommendations for clinical research. Archives of Neurology, 47, 98–104.Google Scholar

Minden, SL, Orav, J, Schildkraut, JJ. (1988) Hypomanic reactions to ACTH and prednisone treatment for multiple sclerosis. Neurology, 38, 1631–1634.Google Scholar

Mohr, DC, Goodkin, , Likosky, W, et al. (1996) Therapeutic expectations of patients with multiple sclerosis upon initiating interferon beta-1b: relationship to adherence to treatment. Multiple Sclerosis, 2, 222–226.Google Scholar

Mohr, DC, Goodkin, , Likosky, W, et al. (1997) Treatment of depression improves adherence to interferon beta-1b therapy for multiple sclerosis. Archives of Neurology 54, 531–533.Google Scholar

Mohr, DC, Likosky, W, Boudewyn, AC, et al. (1998) Side effect profile and adherence to in the treatment of multiple sclerosis with interferon beta-1a. Multiple Sclerosis, 4, 487–489.Google Scholar

Mohr, DC, Likosky, W, Dwyer, P, et al. (1999) Course of depression during the initiation of interferon beta-1a for multiple sclerosis. Archives of Neurology, 56, 1263–1265.Google Scholar

Mohr, D, Cox, D, Epstein, L, Boudewyn, A. (2002) Teaching patients to self-inject: a pilot study of a treatment for injection anxiety and phobia in multiple sclerosis patients prescribed injectable medications. Journal of Behavior Therapy and Experimental Psychiatry, 33, 39–47.Google Scholar

Mohr, D, Cox, D, Merluzzi, N. (2005) Self-injection anxiety training: a treatment for patients unable to self-inject injectable medications. Multiple Sclerosis, 11, 182–185.Google Scholar

Munschauer, FE III, Kinkel, KP. (1997) Managing side effects of interferon beta in patients with relapsing–remitting multiple sclerosis. Clinical Therapy, 19, 883–893.Google Scholar

Neilley, LK, Goodkin, DS, Goodkin, , Mohr, DC, Hauser, SL. (1996) Side effect profile of interferon beta-1b (Betaseron). Neurology, 46, 552–554.Google Scholar

O'Connor, P. (2000) Reason for hope: the advent of disease modifying therapies in multiple sclerosis. Canadian Medical Association Journal, 162, 83–85.Google Scholar

OWINS Study Group. (1999) Evidence of interferon beta-1a dose response in relapsing–remitting MS. Neurology, 53, 679–686.

Panitch, H, Goodin, DS, Grancis, G, et al. (2002) Randomized, comparative study of interferon beta-1a treatment regimes in MS. The EVIDENCE trial. Neurology, 59, 1496–1506.Google Scholar

Patten, SB, Metz, LM. (2001) Interferon beta-1a and depression in relapsing–remitting multiple sclerosis: an analysis of depression data from the PRISMS clinical trial. Multiple Sclerosis, 7, 243–248.Google Scholar

Patten, SB, Metz, LM. (2002) Interferon beta-1a and depression in secondary progressive MS: Data from the SPECTRIMS trial. Neurology, 59, 744–746.Google Scholar

Patten, SB, Francis, G, Metz, LM, et al. (2005) The relationship between depression and interferon beta-1a therapy in patients with multiple sclerosis. Multiple Sclerosis, 11, 175–181.Google Scholar

Pjrek, E, Winkler, D, Dervic, K, Aschauer, H, Kasper, S. (2005) Psychosis as a possible side-effect of treatment with glatiramer acetate. International Journal of Neuropsychopharmacology, 8, 487–488.Google Scholar

Pliskin, NH, Hamer, DP, Goldstein, MSet al. (1996) Improved delayed visual reproduction test performance in multiple sclerosis patients receiving interferon beta-1b. Neurology, 47, 1463–1468.Google Scholar

PRISMS (Prevention of Relapses and Disability by Interferon beta-1a Subcutaneously in Multiple Sclerosis) Study Group. (1998) Randomised double-blind placebo-controlled study of interferon B-1a in relapsing/remitting multiple sclerosis. Lancet, 352, 1498–1504.

Quesada JR. (1992) Toxicity and side effects of interferons. In Baron S, Interferon: Principles and Medical Applications, ed. Baron, S, Coppenhaver, DH, Dianzani, F, et al. Galveston, TX: University of Texas Medical Branch Department of Microbiology, pp. 427–432.

Rao, SM, Leo, HJ, Bernardin, L, Unverzagt, F. (1991) Cognitive dysfunction in multiple sclerosis. 1. Frequency, patterns and prediction. Neurology, 41, 685–691.CrossRef Google Scholar

Schwartz, CE, Coulthard-Morris, L, Cole, B, Vollmer, T. (1997) The quality of life effects of interferon beta-1b in multiple sclerosis. An extended Q-TWIST analysis. Archives of Neurology, 54, 1475–1480.Google Scholar

Selby, MJ, Ling, N, Williams, JM, Dawson, A. (1998) Interferon beta-1b in verbal memory functioning of patients with relapsing–remitting multiple sclerosis. Perceptual Motor Skills, 86, 1099–1106.Google Scholar

Vickrey, BG, Hays, RD, Genovese, BJ, Myers, LW, Ellison, GW. (1997) Comparison of a generic to disease-targeted health related quality of life measures for multiple sclerosis, Journal of Clinical Epidemiology, 50, 557–569.Google Scholar

Vollmer, T, Ni, W, Hadjimichael, O. (2000) MS treatment patterns at the end of the 20th century. [Consortium of Multiple Sclerosis Centres (CMSC) Annual Meeting, Halifax, Canada.] Journal of MS Care, 2, 000–000.Google Scholar

Walther, EU, Hohlfied, R. (1999) Multiple sclerosis. Side effects on interferon beta therapy and their management. Neurology, 16, 22–27.Google Scholar

Weinstein, A, Schwid, SI, Schiffer, RB, et al. (1999) Neuropsychologic status in multiple sclerosis after treatment with glatiramer. Archives of Neurology, 56, 319–324.CrossRef Google Scholar

Zephir, H, Seze, J, Stojkovic, T, et al. (2003) Multiple sclerosis and depression: influence of interferon beta therapy. Multiple Sclerosis, 9, 284–288.Google Scholar

Zivadinov, R, Zorzon, M, Tommasi, MA, et al. (2003) A longitudinal study of quality of life and side effects in patients with multiple sclerosis treated with interferon beta-1a. Journal of the Neurological Sciences, 216, 113–118.Google Scholar

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