Disease-Modifying Therapies for Relapsing-Remitting Multiple Sclerosis: A Network Meta-Analysis

• Type: Another Publication in an International Scientific Journal
• Date: 2018

Authors

Lucchetta, RC (Author) Other; Tonin, FS (Author) Other; Borba, HHL (Author) Other; Leonart, LP (Author) Other; Ferreira, VL (Author) Other; Bonetti, AF (Author) Other; Riveros, BS (Author) Other; Becker, J (Author) Other; Pontarolo, R (Author) Other; Fernandez Llimos, F (Author) Other; Wiens, A (Author) Other

Journal

Title: CNS Drugs

Vol. 32

Pages: 813-826

ISSN: 1172-7047

Publisher: Springer Nature

Indexing

ISI Web of Knowledge - 54 Citations

Scopus - 56 Citations

Other information

Authenticus ID: P-00P-1AV

DOI: 10.1007/s40263-018-0541-5

Abstract (EN): Background A broad range of disease-modifying therapies (DMTs) for relapsing-remitting multiple sclerosis (RRMS) is available. However, the efficacy and safety of traditional DMTs compared with the recently developed DMTs remain unclear. Objective Therefore, we have synthesised available evidence of clinical outcomes for DMTs in adults with RRMS. Methods PubMed, Scopus and a manual search were performed. Bayesian network meta-analyses of randomised clinical trials assessing DMTs as monotherapies were conducted. SUCRA and GRADE were used to rank therapies and to assess quality of general evidence, respectively. Results Thirty-three studies were included in the meta-analyses. The most effective therapies for the outcome of annualised relapse rate were alemtuzumab (96% probability), natalizumab (96%) and ocrelizumab (85%), compared with all other therapies (hazard ratio versus placebo, 0.31, 0.31 and 0.37, respectively; p < 0.05 for all comparisons) (high-quality evidence). However, no significant differences among these three therapies were found. Discontinuation due to adverse events revealed similarity across all therapies, except for alemtuzumab, which showed less discontinuation when compared with interferon-1a intramuscular (relative risk 0.37; p < 0.05). Conclusion High-quality evidence shows that alemtuzumab, natalizumab and ocrelizumab present the highest efficacy among DMTs, and other meta-analyses are required regarding adverse events frequency, to better understand the safety of therapies. Based on efficacy profile, guidelines should consider a three-category classification (i.e. high, intermediate and low efficacy).

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 14