TY - JOUR
T1 - Comprehensive systematic review summary
T2 - Disease-modifying therapies for adults with multiple sclerosis
AU - Rae-Grant, Alexander
AU - Day, Gregory S.
AU - Marrie, Ruth Ann
AU - Rabinstein, Alejandro
AU - Cree, Bruce A.C.
AU - Gronseth, Gary S.
AU - Haboubi, Michael
AU - Halper, June
AU - Hosey, Jonathan P.
AU - Jones, David E.
AU - Lisak, Robert
AU - Pelletier, Daniel
AU - Potrebic, Sonja
AU - Sitcov, Cynthia
AU - Sommers, Rick
AU - Stachowiak, Julie
AU - Getchius, Thomas S.D.
AU - Merillat, Shannon A.
AU - Pringsheim, Tamara
N1 - Publisher Copyright:
Copyright © 2018 American Academy of Neurology
PY - 2018
Y1 - 2018
N2 - 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 teri-flunomide 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.
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 teri-flunomide 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.
UR - http://www.scopus.com/inward/record.url?scp=85049880996&partnerID=8YFLogxK
U2 - 10.1212/WNL.0000000000005345
DO - 10.1212/WNL.0000000000005345
M3 - Article
C2 - 29686117
AN - SCOPUS:85049880996
SN - 0028-3878
VL - 90
SP - 789
EP - 800
JO - Neurology
JF - Neurology
IS - 17
ER -