Treatments for relapsing–remitting multiple sclerosis: summarising current information by network meta-analysis
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Oral drugs for relapsing–remitting multiple sclerosis (RRMS) have been recently investigated and, one of these, fingolimod, is already available in several countries. In this framework, an analysis of the data in terms of the comparative effectiveness for all treatments thus far approved for RRMS can be useful to reappraise their place in therapy.
After a MEDLINE search, we selected all randomised trials studying the effectiveness of drugs for RRMS and included in our analysis those randomised trials in which interferon, glatiramer, natalizumab or fingolimod were studied. The end-point was the relapse-free rate at 12 months, which was compared between the various treatments. Direct comparisons, based on actual randomised trials, were handled by calculating the trial-specific hazard ratio (HR) or the meta-analytic value of HR (when at least 2 trials were available). Indirect comparisons for which data from actual trials were missing were instead managed through a network meta-analysis.
Ten randomised trials met the criteria set for our analysis. All active treatments were found to be significantly more effective than placebo (direct comparisons) in terms of freedom from relapse at the 12-month follow-up assessments; the values of HR ranged from 1.28 for glatiramer to 1.53 for interferon beta. The comparisons between active agents revealed that fingolimod was superior to interferon (HR = 1.18; direct comparison) and glatiramer (HR = 1.23; indirect comparison), while the other four head-to-head comparisons of treatments revealed no significant difference.
On the basis of the effectiveness data presently available, fingolimod seems to offer the advantage of oral administration together with the most favorable profile in terms of relapse-free rate at the 1-year follow-up assessment.
- Plosker GL (2011) Interferon-β-1b: a review of its use in multiple sclerosis. CNS Drugs 25(1):67–88 CrossRef
- Cohen JA (2009) Emerging therapies for relapsing multiple sclerosis. Arch Neurol 66(7):821–828 CrossRef
- Caldwell DM, Ades AE, Higgins JPT (2005) Simultaneous comparison of multiple treatments: combining direct and indirect evidence. Br Med J 331:897–900 CrossRef
- Fadda V, Maratea D, Trippoli S, Messori A (2011) Network meta-analysis. Results can be summarised in a simple figure. Br Med J 342:d1555. doi:10.1136/bmj.d1555 CrossRef
- Messori A, Del Santo F, Maratea D (2011) First-line treatments for hepatitis C. Aliment Pharmacol Ther 33:1383–1385 CrossRef
- Fadda V, Maratea D, Trippoli S, Messori A (2011) Treatments for macular degeneration: summarising evidence using network meta-analysis. Br J Ophthalmol. doi:10.1136/bjophthalmol-2011-300316
- Passaro D, Fadda V, Maratea D, Messori A (2011) Anti-platelet treatments in acute coronary syndrome: simplified network meta-analysis. Int J Cardiol 150(3):364–367
- Maratea D, Fadda V, Trippoli S, Messori A (2011) Prevention of venous thromboembolism after major orthopedic surgery: indirect comparison of three new oral anticoagulants. J Thromb Haemost 9(9):1868–1870
- Cohen D (2011) NICE rules out NHS prescription of fingolimod for multiple sclerosis. Br Med J 343:d5117 CrossRef
- NICE. Fingolimod: appraisal consultation–evaluation report. Available at: http://guidance.nice.org.uk/TA/Wave20/71/Consultation/Latest. Accessed 1 Oct 2011
- Freedman MS (2011) Long-term follow-up of clinical trials of multiple sclerosis therapies. Neurology 76(1 Suppl 1):S26–S34 CrossRef
- Boggild M, Palace J, Barton P, Ben-Shlomo Y, Bregenzer T, Dobson C, Gray R (2009) Multiple sclerosis risk sharing scheme: two year results of clinical cohort study with historical comparator. Br Med J 339:b4677. doi:10.1136/bmj.b4677 CrossRef
- Guo S, Bozkaya D, Ward A, O'Brien JA, Ishak K, Bennett R, Al-Sabbagh A, Meletiche DM (2009) Treating relapsing multiple sclerosis with subcutaneous versus intramuscular interferon-beta-1a: modelling the clinical and economic implications. PharmacoEconomics 27(1):39–53 CrossRef
- Treatments for relapsing–remitting multiple sclerosis: summarising current information by network meta-analysis
European Journal of Clinical Pharmacology
Volume 68, Issue 4 , pp 441-448
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Relapsing–remitting multiple sclerosis
- Network meta-analysis
- Industry Sectors