, Volume 10, Issue 5, pp 307-325
Date: 17 Sep 2012

Management of Relapsing-Remitting Multiple Sclerosis

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Summary

Abstract

Multiple sclerosis (MS) is a chronic neurological disease of adults that affects over 1 million people worldwide. Relapsing-remitting MS, characterized by acute attacks (relapses) followed by complete or partial remissions, is the most common type of MS at disease onset. Over time, most patients develop secondary-progressive disease. Costs for patients, caregivers, healthcare providers and insurers, and society in general are high because of the progressive disability and long-term care associated with MS. Historically, drug therapy has represented a relatively small component of the overall cost of the disease and indirect costs have accounted for most of the costs. Although not curative, disease-modifying agents are available for first-line use in patients with relapsing-remitting MS; the goals of therapy are to reduce the frequency and severity of relapses and postpone disease progression. All of the disease-modifying agents are associated with high cost-utility ratios.

Various sections of the manuscript reviewed by: D.N. Bourdette, Department of Veteran Affairs Medical Center, Neurology Service, Portland, Oregon, USA; B. Brochet, Hopital Pellegin, Bordeaux, France; G. Comi, Scientific Institute Ospedale San Raffaele, University of Milan, Department of Neuroscience, Milan, Italy; R. Hohlfeld, University of Munich, Institute for Clinical Neuroimmunology, Munich, Germany; G.L. Mancardi, University of Genoa, Department of Neurological Sciences and Vision, Genoa, Italy; R. Milo, Assaf Harofeh Medical Center, Zerifin, Israel; D.W. Paty, Department of Medicine, University of British Columbia, Division of Neurology, Vancouver, British Columbia, Canada; B. Weinstock-Guttman, Baird Multiple Sclerosis Center, Buffalo, New York, USA.
Data Selection
Sources: Medical literature published in any language since 1980 on interferon-beta-1a, identified using AdisBase (a proprietary database of Adis International) and Medline. Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from the company developing the drug.
Search strategy: AdisBase search terms were ‘multiple sclerosis’ and (‘guideline’ or ‘guideline-utilisation’ or ‘practice-guideline’ or ‘disease-management-programmes’ or ‘treatment-algorithms’ or ‘reviews-on-treatment’ or ‘drug-evaluations’ or ‘epidemiology’ or ‘cost-of-illness’ or ‘pathogenesis’), or ‘interferon-β-1a’ and (‘review’ or ‘clinical-study’). Medline search terms were ‘multiple sclerosis’ and (‘guidelines’ or ‘decision-making’ or ‘health-policy’ or ‘managed-care-programmes’ or ‘epidemiology’ or ‘outcome-assessment-health-care’ or ‘clinical-protocols’ or ‘guideline in pt’ or ‘polic* in ti’ or ‘expert panel’ or ‘utilization review’ or ‘algorithms’ or ‘disease management’ or ‘quality of life’), or ‘interferon-beta-1a’ and ‘review in pt’. Searches were last updated 11 March 2002.
Selection: Studies in patients with multiple sclerosis who received subcutaneous interferon-β-1a. Inclusion of studies was based mainly on the methods section of the trials. When available, large, well controlled trials with appropriate statistical methodology were preferred. Relevant pharmacodynamic, pharmacokinetic, pharmacoeconomic and epidemiological data are also included.
Index terms: Multiple sclerosis, interferon-β-1a, disease management, review on treatment.
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