Interferonbehandlung bei Multipler Sklerose

Interferonpräparate sind ein Meilenstein in der Behandlung der Multiplen Sklerose.Seit November 1995 steht das erste IFN beta-1b Präparat Betaferon® der Firma Bayer Pharma Verfügung. Im März 1997 kommt das erste IFN beta-1a Präparat der Firma Biogen mit dem Handelsnamen Avonex® auf den Markt, im Mai 1998 bringt die Firma Merck Serono das IFN beta-1a Präparat Rebif® in den Handel. Es folgen im Oktober 2007 und im Juni 2008 die Präparate CinnoVex® ein biogenerisches IFNbeta-1a Präparat von CinnaGen sowie abschließend das mit Betaferon identische Präparat Extavia® der Firma Novartis.

Alle diese Präparate sollen das Fortschreiten von Behinderungen der  Multiplen Sklerose bremsen.

Nun zeigt eine aktuelle Kanadische Studie, dass die Wirksamkeit der Interferontherapie nicht überzeugend belegt werden könne.

Aus meiner Sicht ist im Rahmen der methodischen Längsschnittbeurteilung des von mir überschauten und behandelten Patientengutes durchaus eine klinisch feststellbare Wirkung der Interferontherapie vorhanden.

Es sollte zunächst die weitere detaillierte Analyse der vorliegenden Kanadischen Studie abgewartet, sowie weitere Studien zu dieser Fragestellung durchgeführt werden.

„Zitat einer aktuellen Pressemitteilung der DGN zum oben genannten Thema“

Multiple Sklerose: Patienten nach Studie verunsichert – Interferon-Therapie bleibt aber unverzichtbar

Studie aus Kanada weist Schwächen auf Berlin/München, 13. August 2012 – Interferonpräparate werden als Standardtherapie bei Multipler Sklerose (MS) eingesetzt. In der Vergangenheit konnten mehrere Studien zeigen, dass diese Medikamente die Entzündungsaktivität im Zentralen Nervensystem reduzieren. Der Einfluss auf das Fortschreiten der Behinderung hingegen, also, ob Patienten auf Gehhilfen oder den Rollstuhl angewiesen sind, ist bislang nicht überzeugend positiv oder negativ belegt. Um dieser Frage nachzugehen, werteten Wissenschaftler aus Kanada Material aus Patientendatenbanken aus. Sie kamen zu dem Ergebnis, dass die Interferontherapie das Voranschreiten einer Behinderung nicht bremse. Diese Nachricht hat viele Patienten verunsichert, doch bei genauerem Hinsehen weist die Studie starke methodische Schwächen auf: „Aus Sicht des Kompetenznetzes MS, der Deutschen Gesellschaft für Neurologie (DGN) und des Ärztlichen Beirats der Deutschen MS Gesellschaft ergibt sich aus dieser Arbeit aktuell kein Anlass, die gegenwärtige Behandlungs- und Empfehlungspraxis mit Interferonpräparaten zu ändern“, sagt Prof. Dr. Heinz Wiendl, Direktor der Klinik und Poliklinik für Neurologie, Entzündliche Erkrankungen des Nervensystems und Neuroonkologie an der Westfälischen-Wilhelms-Universität Münster. „Wir appellieren daher an alle MS-Patienten, ihre Interferon-Behandlung nicht abzubrechen“, so der Neurologe. Auch für die im Frühjahr erschienene MS-Leitlinie ergäbe sich aus dieser Studie kein Änderungsbedarf. 

Pressemitteilung zum Download

offizielle Stellungnahme zum Download

Die kanadischen Wissenschaftler verglichen 2.556 Patienten, die in eine mit verschiedenen Interferonpräparaten behandelte, eine unbehandelte und eine „historische“ Vergleichsgruppe vor Einführung des Medikaments eingeteilt waren. Die Nachbeobachtungszeit betrug in etwa 5 Jahre. Genau diese rückwärtige Auswertung der Daten stellt die methodische Schwäche dar: „Schwierig ist der Vergleich mit einer Patientengruppe, die möglicherweise einen niedrigeren Entzündungs- und Behinderungsgrad aufweist. Auch der Vergleich mit der unbehandelten Kontrollgruppe ist unpräzise, da unter diesen Patienten einige sein könnten, die sich gar nicht für eine Therapie mit Interferonen eignen.“ In der Wissenschaft wird dann von einem sogenannten Selektionsbias gesprochen, d.h. die Ergebnisse der Studie sind aufgrund der Vorauswahl verzerrt.

Die Autoren haben versucht, diesen Bias zu begrenzen, indem Kontrollwerte wie Geschlecht, Alter, Krankheitsdauer und Behinderungsgrad in die Berechnung eingeflossen sind. „Trotzdem lässt sich aus dem Studiendesign bei mangelnden Beweisen für einen positiven Therapie-Effekt nicht im Umkehrschluss wissenschaftlich das Gegenteil ableiten“, meint Professor Wiendl. Des Weiteren sei fraglich, ob die relativ kurze Nachbeobachtungszeit ausreicht, um den langfristigen Effekt des Medikaments zu beurteilen.

Auch Professor Hans-Christoph Diener von der Deutschen Gesellschaft für Neurologie gibt in diesem Zusammenhang Folgendes zu bedenken: „Es ist wissenschaftlich fragwürdig, wenn Daten aus Beobachtungsstudien mit Daten aus großen und ordnungsgemäß durchgeführten randomisierten Placebo-kontrollierten Studien verglichen werden. Nicht-randomisierte Beobachtungen sind nur dort zulässig wo es keine Erkenntnisse aus randomisierten Studien gibt.“ Zudem hätten Langzeitstudien die Wirksamkeit von beta-Interferon eindeutig nachgewiesen, so Professor Diener“.

Hinweis an die Medien Pressekonferenz mit einem „Update Multiple Sklerose“ am Freitag, den 28. September 2012, von 10.00 bis 11.00 Uhr im CCH Hamburg auf der Jahrestagung der Deutschen Gesellschaft für Neurologie. www.dgn.org/presse

Literatur Shirani A et al.: Association Between Use of Interferon Beta and Progression of Disability in Patients With Relapsing-Remitting Multiple Sclerosis. JAMA, 2012, 308: 247-256 Fachlicher Kontakt bei Rückfragen Prof. Dr. med. Heinz Wiendl Klinik für Neurologie – Abteilung für Entzündliche Erkrankungen des Nervensystems und Neuroonkologie – Zentrum für Nervenheilkunde Albert-Schweitzer-Campus 1, Gebäude A10 48149 Münster

E-Mail:  sekretariat.neuroinflammation@ukmuenster.de Diese E-Mail-Adresse ist gegen Spambots geschützt! JavaScript muss aktiviert werden, damit sie angezeigt werden kann. Das Krankheitsbezogene Kompetenznetz Multiple Sklerose (KKNMS) ist eines von bundesweit 21 Kompetenznetzen in der Medizin, die vom Bundesministerium für Bildung und Forschung gefördert werden. Sie alle verfolgen das Ziel, Forscher zu spezifischen Krankheitsbildern bundesweit und interdisziplinär zusammenzubringen, um den Austausch zwischen Forschung und Patientenversorgung zu verbessern. Aktuell gehören dem KKNMS drei Forschungsverbünde an: CONTROLMS, UNDERSTANDMS und CHILDRENMS. Die Geschäftsstelle ist am Klinikum rechts der Isar der Technischen Universität München angesiedelt.

Die Deutsche Gesellschaft für Neurologie e.V. (DGN) sieht sich als neurologische Fachgesellschaft in der gesellschaftlichen Verantwortung, mit ihren rund 7000 Mitgliedern die neurologische Krankenversorgung in Deutschland zu verbessern. Dafür fördert die DGN Wissenschaft und Forschung sowie Lehre, Fort- und Weiterbildung in der Neurologie. Sie beteiligt sich an der gesundheitspolitischen Diskussion. Die DGN wurde im Jahr 1907 in Dresden gegründet. Sitz der Geschäftsstelle ist die Bundeshauptstadt Berlin. www.dgn.org1. Vorsitzender: Prof. Dr. med. Wolfgang Oertel 2. Vorsitzender: Prof. Dr. med. Heinz Reichmann 3. Vorsitzender: Prof. Dr. med. Martin Grond Geschäftsführer: Dr. rer. nat. Thomas Thiekötter Geschäftsstelle Reinhardtstr. 27 C, 10117 Berlin, Tel: +49 (0)30-531437930, E-Mail: info@dgn.org Ansprechpartner für die Medien Frank A. Miltner, Tel: +49 (0)89-461486-22, E-Mail: presse@dgn.orgPressesprecher der DGN: Prof. Dr. med. Hans-Christoph Diener, Essen

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