Efficacy of subcutaneous interferon β-1a on MRI outcomes in a randomised controlled trial of patients with clinically isolated syndromes

Abstract

Aim: The REbif FLEXible dosing in early MS (REFLEX) study compared several brain MRI outcomes in patients presenting with clinically isolated syndromes suggestive of multiple sclerosis and treated with two dose-frequencies of subcutaneous interferon (IFN) β-1a or placebo.

Methods: Patients were randomised (1:1:1) to IFN β-1a, 44 µg subcutaneously three times a week or once a week, or placebo three times a week for up to 24 months. MRI scans were performed every 3 months, or every 6 months if the patient developed clinically definite multiple sclerosis. End points analysed included: number of combined unique active lesions per patient per scan; numbers and volumes of new T2, T1 hypointense and gadolinium-enhancing (Gd+) lesions per patient per scan; and brain volume.

Results: 517 patients were randomised (intent-to-treat population: subcutaneous IFN β-1a three times a week, n=171; subcutaneous IFN β-1a once a week, n=175; placebo, n=171). Combined unique active lesions were lower in patients treated with subcutaneous IFN β-1a versus placebo (mean (SD) lesions per patient per scan: three times a week 0.6 (1.15); once a week 1.23 (4.26); placebo 2.70 (5.23); reduction versus placebo: three times a week 81%; once a week 63%; p<0.001) and with three times a week versus once a week (48% reduction; p=0.002). The mean numbers of new T2, T1 hypointense and Gd+ lesions were all significantly lower in the two active treatment arms compared with placebo (p≤0.004 for three times a week or once a week) and in the three times a week group compared with once a week (p≤0.012).

Conclusions: Both subcutaneous IFN β-1a 44 µg regimens improved MRI outcomes versus placebo, with the three times a week regimen having a more pronounced effect than once a week dosing.

Trial registration: clinicaltrial.gov identifier, NCT00404352.

Keywords: INTERFERON; MRI; Multiple Sclerosis; Randomised Trials.

Figure 1

Mean number of CUA lesions during the double blind period (intent-to-treat population). p Values derived from pairwise non-parametric analysis of variance. CUA, combined unique active; IFN, interferon; sc, subcutaneous; tiw, three times a week; qw, once a week.

Figure 2

Percentage change in brain volume from baseline, by visit (intent-to-treat population), during the (A) double blind period and (B) whole study period. Red lines represent the median, boxes represent the IQR, and whiskers represent the range. IFN, interferon; LOV, last observed value; sc, subcutaneously; tiw, three times a week; qw, once a week.