Seeing injectable MS therapies differently

Conventional MRI is a sensitive tool to identify focal white matter inflammation in patients with multiple sclerosis (MS). Despite a limited correlation between MRI lesions and relapses in untreated individuals,1 gadolinium-enhancing lesion activity correlates with treatment response,2 and predicts relapse outcomes in phase III clinical trials.3 For this reason, new lesions on MRI are the standard primary outcome of phase II clinical trials in relapsing-remitting MS (RRMS). The potential use of MRI biomarkers to compare different MS therapies to each other is also attractive. Comparison of the results of different pivotal trials, although dangerous, has suggested to some that high-dose, high-frequency administration of interferon-β (IFNβ) may have a faster onset of action than glatiramer acetate (GA). This has led to speculation that IFNβ may be more effective than GA, at least in the early stages of treatment. In this issue of Neurology ®, Cadavid et al.4 report the results of the BECOME trial, a head-to-head comparison which sought to address this question. In this industry-sponsored, investigator-conducted trial, 75 patients with RRMS were randomized to receive …