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Smith B, Carson S, Fu R, et al. Drug Class Review: Disease-modifying Drugs for Multiple Sclerosis: Final Update 1 Report [Internet]. Portland (OR): Oregon Health & Science University; 2010 Aug.

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Drug Class Review: Disease-modifying Drugs for Multiple Sclerosis

Drug Class Review: Disease-modifying Drugs for Multiple Sclerosis: Final Update 1 Report [Internet].

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Summary

The results of this review are summarized in Table 38, below, and Appendix E summarizes the strength of the evidence for each key question.

Table 38. Summary of the evidence.

Table 38

Summary of the evidence.

No study met criteria to be classified as an effectiveness study, therefore applicability of the results of this review to patients seen in usual care may be limited.

The strength of evidence in patients with relapsing remitting multiple sclerosis was moderate. We found fair direct evidence that interferon beta-1a SC (Rebif®) 44 μg SC 3 times weekly and interferon beta-1b (Betaseron®) 250 μg SC every other day were similarly efficacious for preventing relapse, while interferon beta-1a IM (Avonex®) 60 μg IM once weekly was less effective than interferon beta-1a SC (Rebif®) on this measure. There was conflicting evidence in disease progression outcomes between the interferons, and it is likely that any differences are small and clinically insignificant. Fair evidence showed no difference between glatiramer and interferon beta-1a SC (Rebif®) or interferon beta-1b (Betaseron®). The strength of the evidence in other populations was low. There was no direct evidence in patients with primary and secondary progressive multiple sclerosis, and no evidence in patients with progressive relapsing multiple sclerosis. There is moderate evidence that the beta interferons are similar in harms.

The strength of the evidence for the presence and clinical effect of neutralizing antibodies was low, with no head-to-head trials. Observational studies were limited by lack of control for confounding factors and insufficient duration to make conclusions.

The strength of the evidence for comparative effectiveness in patients with a clinically isolated syndrome was low, with no head-to-head trials. Evidence of efficacy compared with placebo was available for glatiramer (Copaxone®), interferon beta-1a IM (Avonex®), interferon beta-1a SC (Rebif®), and interferon beta-1b (Betaseron®). There was no evidence for mitoxantrone (Novantrone®) or natalizumab (Tysabri®) in this population.

We identified no trials in progress that would meet inclusion criteria for this review and potentially change conclusions.

Copyright © 2010 by Oregon Health & Science University, Portland, Oregon 97239. All rights reserved.
Bookshelf ID: NBK50566

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