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Management of Relapsing-Remitting Multiple Sclerosis [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2013 Oct. (CADTH Therapeutic Review, No. 1.2.)

6CONCLUSIONS AND IMPLICATIONS FOR DECISION-OR POLICY-MAKING

Results from the systematic review and NMA suggest that all active treatments produce statistically significant reductions in the ARR compared with no treatment, and that there are clear between-treatment differences. Specifically, compared with no treatment, reductions in the ARR are approximately 70% for natalizumab or alemtuzumab, 50% for fingolimod or dimethyl fumarate, and 30% for subcutaneous interferons, glatiramer acetate, or teriflunomide. Between-treatment differences were less apparent in the risk of sustained disability progression. Given the wide credible intervals observed in the NMA, small between-treatment differences observed in the NMA should be interpreted with caution.

Adverse events were treatment-specific and may be an important consideration in treatment selection. Given that the included studies were limited in their ability to identify infrequent or rare adverse events, decision-makers may consider that older agents such as the interferons and glatiramer have the benefit of a longer post-market period.

Patient-group input suggests that patient experience is variable, and that having options that match a person’s life and situation are important considerations in treatment selection.

Results from the base case economic analysis suggest that, when compared with no treatment, treatment with any of the interferon therapies, glatiramer acetate, or dimethyl fumarate dominates no treatment (less costly and more effective). The ICUR of fingolimod versus no treatment is $18,234, and the ICUR of natalizumab versus no treatment is $121,456. Regarding comparative cost-effectiveness across active treatments, based on the base case, glatiramer is the most cost-effective treatment unless willingness to pay exceeds $118,242 per QALY, at which point interferon beta-1b 250 mcg (Extavia) is the cost-effective treatment unless willingness to pay exceeds $425,655, at which point dimethyl fumarate is the cost-effective treatment unless willingness to pay exceeds $872,972, at which point natalizumab is the cost-effective treatment. Base case results were little affected by varying model assumptions in sensitivity analyses.

The review was limited in its ability to assess the clinical and cost-effectiveness of sequential treatment, given that none of the reviewed trials specifically included patients with inadequate response or intolerance to previous treatments. The review was likewise limited by the paucity of data related to quality of life and many of the outcomes of importance to patients.

The development of novel treatments for MS is an area of active research, given the unmet need of patients for acceptable, safe, and effective treatments. New oral agents for the treatment of RRMS have recently been approved by Health Canada and additional agents are expected to enter the Canadian market shortly. Further research is needed that addresses outcomes of importance to patients and that establishes the value for money of existing and emerging treatments for MS.

Copyright © CADTH March 2013.

You are permitted to make copies of this document for non-commercial purposes provided it is not modified when reproduced and appropriate credit is given to CADTH. You may not otherwise copy, modify, translate, post on a website, store electronically, republish or redistribute any material from the website in any form or by any means without the prior written permission of CADTH.

Please contact CADTH’s Vice-President of Corporate Services at ac.htdac@secivresetaroproc with any inquiries about this notice or other legal matters relating to CADTH’s services.

Cover of Management of Relapsing-Remitting Multiple Sclerosis
Management of Relapsing-Remitting Multiple Sclerosis [Internet].
CADTH Therapeutic Review, No. 1.2.

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