The REFLEX study demonstrates the clinical benefits of thrice weekly subcutaneous administration of IFN β-1a over once weekly and/or placebo, and this indicates a clear dose effect. However, it is at the clinical level itself where challenges may present themselves. Typically, what clinicians want to see in the research literature is evidence of efficacy and treatment objectives being met with smaller doses at less frequent regimens, with less adverse reactions, and manufacturers want to see evidence of the effectiveness of compounds which are cheaper and easier to manufacture and distribute. From the clinician’s perspective, in particular, this is because of patient compliance, which is made more difficult the more is being asked of the patient. Where there is an increase in dose or regimen, there is invariably an increase in the likelihood and/or severity of adverse reactions, just as there is an increase in production costs and healthcare budgets. Contrary to many other business models, in healthcare economics it is actually more often more advantageous to reduce disease and symptom recrudescence, or, better still, to cure outright than it is to merely match supply with demand. This is because the costs of ongoing recurring treatments invariably outweigh the financial benefits, and this is particularly the case in healthcare systems which have been nationalised, such as the United Kingdom’s National Health Service (NHS). An applicable analogy is that it is often more advantageous to simply sell property rather than to attempt to rent it out, and face all of the challenges therein. The eradication of Smallpox is a famous, real-world example of the benefits of a single cure over recurring treatments.

With MS, however, there is no known cure, there is only (currently) the option to manage symptoms and mitigate detriments towards patients’ health and wellbeing resulting from the effects of the disease. In this case, the clinician must balance the detriments to the patient caused by the disease against potential detriments resulting from the side effects of treatment. In oncology, for instance, this can be an extremely fine line between the potential extreme effects of treatments like chemotherapy balanced against the potentially even more extreme effects of having cancer. As a neurodegenerative disease, the effects of MS typically increase in severity, and can include sensory, such as vision problems and problems with balance and co-ordination, numbness or tingling, motor, such as difficulty walking, muscle stiffness and muscle spasms as well as incontinence and sexual dysfunction, and cognitive symptoms, such as problems thinking, learning or planning. IFN β-1a, by comparison, presents side effects in the form of flu like symptoms, and/or transient effects of disease symptom reduction. The most salient risk is the onset of cutaneous necrosis around the injection site, which can be reduced by rotating the site of administration. This must, again, be balanced against clinical trial data showing more pronounced reductions in lesions observed in MRI in thrice weekly dose regimens vs. once weekly.

Since the REFLEX study and associated works in 2012 and 2014 discussed herein, Beta interferons have continued to be used to treat relapsing-recurrent MS, in conjunction with other MS treatments, such as repurposed Histaminergic drugs, developments into both of which are still ongoing. [10] Steroidal medicines may also be used to speed up recovery time between relapses. However, there is still no known treatment which can slow the progress of primary or secondary progressive MS, and so clinical emphasis for this rests primarily on the mitigation of symptoms, and, potentially, on cytokines like interferons, which have a proven track record in reducing the risk of neural degeneration and lesions in the early onset of MS.