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Randomized, placebo-controlled studies have firmly established interferon beta (IFNβ) as standard therapy for relapsing remitting multiple sclerosis (RRMS).1–3 Many MS experts believe that early and continuous treatment with IFNβ reduces brain inflammation, irreversible CNS injury, and brain atrophy in RRMS, and reduces permanent neurologic disability. The use of IFNβ preparations has expanded to worldwide annual sales exceeding $4 billion USD. However, IFNβ is only partially effective (e.g., relapse rates are reduced by about 30%), so many patients have relapses, new MRI lesions while on treatment, and patients may become increasingly disabled with time. There are no sensitive, validated clinical markers of treatment response for individual patients. How is the neurologist to decide whether a patient is responding to treatment? Objective, practical markers of IFNβ pharmacologic response would be extremely helpful to guide therapy.
In this issue of Neurology®, Malucchi et al.4 describe a novel approach to the problem. Pharmacologic response was defined as increased levels of peripheral blood mononuclear cell myxovirus-resistance protein A (MxA) mRNA, 12 hours after an IFNβ injection. IFNβ exerts biologic effects by inducing expression of several hundred interferon-responsive genes (ISGs). This large number of ISGs is necessary …
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