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Effectiveness of early beta interferon on the first attack after confirmed multiple sclerosis: a comparative cohort
Yann Mikaeloff1, Guillaume Caridade, Marc Tardieu
1Assistance publique-Hôpitaux de Paris, Service de Neurologie, Pédiatrique, Hôpital Bicêtre, INSERM U802, Université Paris Sud 11, Le Kremlin Bicêtre, France. yann.mikaeloff@bct.aphp.fr
Insights
Beta interferon (ssIFN) significantly reduces the risk of a first attack in pediatric multiple sclerosis (MS) patients within the first two years of treatment. This observational study highlights ssIFN
Area of Science:
- Pediatric Neurology
- Immunology
- Clinical Therapeutics
Background:
- Randomized controlled trials are lacking for pediatric multiple sclerosis (MS) treatment decisions.
- Comparative observational studies are crucial for understanding real-world physician practices in pediatric MS.
- This study addresses the need for evidence supporting therapeutic choices in pediatric MS.
Purpose of the Study:
- To evaluate the effectiveness of beta interferon (ssIFN) in preventing initial attacks and severe disability in pediatric MS patients.
- To analyze the impact of ssIFN on disease progression in a cohort of children diagnosed with MS.
Main Methods:
- A cohort of 197 relapsing-remitting pediatric MS patients was followed from 1990-2005.
- Cox proportional hazards models with time-dependent ssIFN exposure were used to assess treatment effects.
- Confounding factors were adjusted for to estimate the risk of first attack or severe disability (DSS score >=4).
Main Results:
- Beta interferon (ssIFN) use significantly reduced the rate of the first MS attack in the first year (HR: 0.31) and first two years (HR: 0.40).
- The protective effect of ssIFN on first attacks diminished after 4 years of treatment (HR: 0.57).
- A trend towards reduced severe disability was observed with ssIFN use, though not statistically significant (HR: 0.78).
Conclusions:
- Beta interferon (ssIFN) therapy initiated after MS diagnosis significantly lowers relapse risk in pediatric patients within the initial two years.
- Findings support the early use of ssIFN for managing pediatric MS relapses.
- Further research may be needed to confirm ssIFN's impact on severe disability progression.
Background:
In the absence of randomized controlled trials to support therapeutic decisions in pediatric MS (multiple sclerosis), comparative observational studies based on the real practice of physicians are important tools.
Aim:
To assess the effectiveness of beta interferon (ssIFN) in preventing the first attack and severe disability after confirmed MS diagnosis in a pediatric cohort.
Methods:
A cohort of 197 relapsing-remitting pediatric MS patients was studied (1990-2005). Patients were followed from MS diagnosis until the first subsequent attack or severe disability occurrence (DSS score of >or=4) or were censored. The Cox model, with time-dependent ssIFN exposure to account for the varying times of starting this treatment, was used to estimate the effect of ssIFN on the risk of this attack or severe disability, adjusting for potential confounding factors.
Results:
During cohort follow-up (mean 5.5 years), 70.5% of the 197 children had a first attack (80% within the first 2 years) and 24 started ssIFN (mean delay 3.6 months; mean duration 17.1 months). The use of ssIFN was associated with a significant reduction in the rate of the first attack during the first year of treatment (hazard ratio: 0.31, 95% confidence interval: 0.13-0.72) as well as the first 2 years (0.40, 0.20-0.83). This effect was less significant over the entire follow-up of up to 4 years of treatment (0.57, 0.30-1.10). The use of ssIFN suggests a reduction on the occurrence of severe disability, although not statistically significant (HR 0.78; 95% CI: 0.25-2.42).
Conclusions:
The use of ssIFN, given after the diagnosis of MS, significantly reduces the risk of relapse during the first 2 years.
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