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MS Therapy Over Time: What Research Says About Long-Term Outcomes
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 Multiple sclerosis (MS) typically appears during early to mid adulthood, a time most consider to be the prime of a person’s life. Although MS cannot be cured, we know from numerous short-term clinical trials that relapses can be prevented and disease progression can be slowed by disease-modifying therapy (DMT). But using a DMT means continuous treatment for a lifelong disease. What matters is whether a therapy will be effective over the many years, even decades, that an individual might end up taking it. Of equal importance is the continued safety and tolerability of long-term therapy. Compelling new findings are shedding much-needed light on these questions, showing in particular that many DMT medications can safely stabilize or even improve MS-related health status well past the 10-year mark.
DMT Effects in the Long Run
Long-term, placebo-controlled trials are virtually impossible with DMT; they are impractical, and use of a placebo would be inappropriate given the known benefits of actual therapy. But researchers have still found ways to gather evidence about the impact of longer periods of continuous DMT use. Most long-term trials include the same people who participated in earlier trials (eg, the 2-year pivotal trials that are conducted before a therapy is approved and released to the market). In most, if not all, long-term follow-up (LTFU) trials, problems getting all of the original participants to return for the follow-ups are inevitable. Usually, as more years pass, more participants drop out of the studies. Though a large drop-out rate can interfere with the reliability of data from a LTFU study, the results gathered are still extremely valuable to the management of MS, and thus far, they are largely encouraging.
β-Interferons—All of the β-interferon therapies have been assessed in the long term. Though the number of years at which the follow-up occurs varies, all studies indicate that people who remain on therapy for many years continue to experience benefit. Results from a 16-year LTFU study of people taking interferon β-1b (Betaseron®) reveal that those who began therapy early during the course of the disease and who remained on therapy in the long term were less likely to be in a wheelchair or have their MS progress to the secondary-progressive (SPMS) stage. An 8-year LTFU study of people who participated in the original, placebo- controlled trial of subcutaneous interferon β-1a (Rebif®) showed that those who received treatment in the original trial had better outcomes at 8 years than those who received placebo. In a 15-year LTFU study, called ASSURANCE, of intramuscular interferon β-1a (Avonex®), investigators surveyed the original trial participants about their health status and disability. Of 116 individuals who responded, 51% were classified as long-term users of the therapy: they had been taking it for a median of 13.3 years and as long as 17.3 years. Only half as many long-term users as non–long-term users (whose median use was 6 years) had reached a point of needing assistance (eg, a cane or walker) in walking, and 89% of long-term users reported that their health was good to excellent.
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Restless Legs
This article covers some of the signs and symptoms of restless legs, describes options available to treat the condition, and addresses a possible connection between MS and RLS.
Caregiver Rights in the Workplace
This article covers the most up-to-date laws and practices, such as the Family and Medical Leave Act, that promise to help caregivers attend to their obligations while also keeping themselves healthy.
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 From the Making Strides Inbox
This new feature invites readers to send in questions about MS. In this issue, the editors of Making Strides address an important question about neuroimaging: How do lesions in specific parts of the brain seen on MRI scans correlate with the MS symptoms that I am experiencing?
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