Comprehensive systematic review summary: Disease-modifying therapies for adults with multiple sclerosis

Alexander Rae-Grant, Gregory S. Day, Ruth Ann Marrie, Alejandro Rabinstein, Bruce A.C. Cree, Gary S. Gronseth, Michael Haboubi, June Halper, Jonathan P. Hosey, David E. Jones, Robert Lisak, Daniel Pelletier, Sonja Potrebic, Cynthia Sitcov, Rick Sommers, Julie Stachowiak, Thomas S.D. Getchius, Shannon A. Merillat, Tamara Pringsheim

Research output: Contribution to journalArticle

30 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)789-800
Number of pages12
JournalNeurology
Volume90
Issue number17
DOIs
StatePublished - Jan 1 2018

ASJC Scopus subject areas

  • Clinical Neurology

Fingerprint Dive into the research topics of 'Comprehensive systematic review summary: Disease-modifying therapies for adults with multiple sclerosis'. Together they form a unique fingerprint.

  • Cite this

    Rae-Grant, A., Day, G. S., Marrie, R. A., Rabinstein, A., Cree, B. A. C., Gronseth, G. S., Haboubi, M., Halper, J., Hosey, J. P., Jones, D. E., Lisak, R., Pelletier, D., Potrebic, S., Sitcov, C., Sommers, R., Stachowiak, J., Getchius, T. S. D., Merillat, S. A., & Pringsheim, T. (2018). Comprehensive systematic review summary: Disease-modifying therapies for adults with multiple sclerosis. Neurology, 90(17), 789-800. https://doi.org/10.1212/WNL.0000000000005345