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Optic neuritis therapy after the CHAMPS study
Wilhelm H.
Universitäts-Augenklinik Tübingen, Abt. für Pathophysiologie des Sehens und Neuroophthalmologie; 72076 Tübingen
The CHAMPS study investigated the therapeutic effect of Beta-Interferon 1a given immediately after the first manifestation of Multiple Sclerosis against Placebo (Jacobs LD, Beck RW, Simons JH, et al. Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. N Engl J Med 2000; 343:898-904) Of the 383 patients participating in this study 192 suffered from optic neuritis. Inclusion criteria for this study comprised two or more clinically silent lesions of at least 3 mm diameter, at least one located periventricular or oval shaped in the cranial MRI. After 3 years 35% of the Verum group and 50% of the Placebo group had developed additional MS symptoms (significant difference). The demyelinating lesions increased in the Placebo group by 16%, in the Verum group only by 1 %. The clinical consequences of this study are debatable, because this therapy has side effects, possibly even still unknown effects after longterm application, and it is very expensive. The Multiple Sclerosis Consensus Group advocates as follows: Start therapy after the first event of Multiple Sclerosis as done in this study, if in presence of intrathecal IgG-synthesis and subclinical dissemination in MRI-scans after exclusion of other causes
- marked functional loss not sufficiently restitutes after megadose
steroids within 2 months, or
- high lesion load (= 6) is found in cranial MRI, or
- active inflammatory lesions (enhancing with Gadolinium) or clear increase of the lesion load is seen on the T2 weighted MRI scans during a 6 months follow-up (Nervenarzt (2001) 72: 150-157).