RT Journal Article
SR Electronic
T1 Comprehensive systematic review summary: Disease-modifying therapies for adults with multiple sclerosis
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 789
OP 800
DO 10.1212/WNL.0000000000005345
VO 90
IS 17
A1 Rae-Grant, Alexander
A1 Day, Gregory S.
A1 Marrie, Ruth Ann
A1 Rabinstein, Alejandro
A1 Cree, Bruce A.C.
A1 Gronseth, Gary S.
A1 Haboubi, Michael
A1 Halper, June
A1 Hosey, Jonathan P.
A1 Jones, David E.
A1 Lisak, Robert
A1 Pelletier, Daniel
A1 Potrebic, Sonja
A1 Sitcov, Cynthia
A1 Sommers, Rick
A1 Stachowiak, Julie
A1 Getchius, Thomas S.D.
A1 Merillat, Shannon A.
A1 Pringsheim, Tamara
YR 2018
UL http://n.neurology.org/content/90/17/789.abstract
AB Objective To review evidence on starting, switching, and stopping disease-modifying therapies (DMTs) for multiple sclerosis (MS) in clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS), and progressive MS forms.Methods Relevant, peer-reviewed research articles, systematic reviews, and abstracts were identified (MEDLINE, CENTRAL, EMBASE searched from inception to November 2016). Studies were rated using the therapeutic classification scheme. Prior published Cochrane reviews were also used.Results Twenty Cochrane reviews and an additional 73 full-text articles were selected for data extraction through an updated systematic review (completed November 2016). For people with RRMS, many DMTs are superior to placebo (annualized relapses rates [ARRs], new disease activity [new MRI T2 lesion burden], and in-study disease progression) (see summary and full text publications). For people with RRMS who experienced a relapse on interferon-β (IFN-β) or glatiramer acetate, alemtuzumab is more effective than IFN-β-1a 44 μg subcutaneous 3 times per week in reducing the ARR. For people with primary progressive MS, ocrelizumab is probably more effective than placebo (in-study disease progression). DMTs for MS have varying adverse effects. In people with CIS, glatiramer acetate and IFN-β-1a subcutaneous 3 times per week are more effective than placebo in decreasing risk of conversion to MS. Cladribine, immunoglobulins, IFN-β-1a 30 μg intramuscular weekly, IFN-β-1b subcutaneous alternate day, and teriflunomide are probably more effective than placebo in decreasing risk of conversion to MS. Suggestions for future research include studies considering comparative effectiveness, usefulness of high-efficacy treatment vs stepped-care protocols, and research into predictive biomarkers.AAN=American Academy of Neurology; AE=adverse effect; ARR=annualized relapse rate; CIS=clinically isolated syndromes; DMT=disease-modifying therapy; EDSS=Expanded Disability Status Scale; HYP=high-yield process; IFN-β=interferon-β; IM=intramuscular; MS=multiple sclerosis; PPMS=primary progressive multiple sclerosis; RCT=randomized controlled trial; RRMS=relapsing-remitting multiple sclerosis; SPMS=secondary progressive multiple sclerosis