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Comparative effectiveness of beta-interferons and glatiramer acetate for relapsing-remitting multiple sclerosis : systematic review and network meta-analysis of trials including recommended dosages
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Melendez-Torres, G. J., Armoiry, Xavier, Court, Rachel A., Patterson, Jacoby, Kan, Alan, Auguste, Peter, Madan, Jason, Counsell, Carl, Ciccarelli, Olga and Clarke, Aileen (2018) Comparative effectiveness of beta-interferons and glatiramer acetate for relapsing-remitting multiple sclerosis : systematic review and network meta-analysis of trials including recommended dosages. BMC Neurology, 18 (1). doi:10.1186/s12883-018-1162-9
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WRAP-comparative-interferons-acetate-relapsing-remitting-sclerosis-Clarke-2018.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (843Kb) | Preview |
Official URL: http://dx.doi.org/10.1186/s12883-018-1162-9
Abstract
Background
We systematically reviewed the comparative effectiveness of injectable beta-interferons (IFN-β) and glatiramer acetate (GA) on annualised relapse rate (ARR), progression and discontinuation due to adverse events (AEs) in RRMS, using evidence from within the drugs’ recommended dosages.
Methods
We updated prior comprehensive reviews, checked references of included studies, contacted experts in the field, and screened websites for relevant publications to locate randomised trials of IFN-β and GA with recommended dosages in RRMS populations, compared against placebo or other recommended dosages. Abstracts were screened and assessed for inclusion in duplicate and independently. Studies were appraised using the Cochrane risk of bias tool. Rate ratios for ARR, hazard ratios for time to progression, and risk ratios for discontinuation due to AEs were synthesised in separate models using random effects network meta-analysis.
Results
We identified 24 studies reported in 42 publications. Most studies were at high risk of bias in at least one domain. All drugs had a beneficial effect on ARR as compared to placebo, but not compared to each other, and findings were robust to sensitivity analysis. We considered time to progression confirmed at 3 months and confirmed at 6 months in separate models; while both models suggested that the included drugs were effective, findings were not consistent between models. Discontinuation due to AEs did not appear to be different between drugs.
Conclusions
Meta-analyses confirmed that IFN-β and GA reduce ARR and generally delay progression as defined in these trials, though there was no clear ‘winner’ across outcomes. Findings are additionally tempered by the high risk of bias across studies, and the use of an impairment/mobility scale to measure disease progression. Future research should consider more relevant measures of disability and, given that most trials have been short-term, consider a longitudinal approach to comparative effectiveness.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RC Internal medicine | |||||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Science > Life Sciences (2010- ) Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Multiple sclerosis -- Treatment, Interferon -- Therapeutic use, Immunological adjuvants, Systematic reviews (Medical research), Multiple sclerosis -- Relapse | |||||||||
| Journal or Publication Title: | BMC Neurology | |||||||||
| Publisher: | B M J Group | |||||||||
| ISSN: | 1471-2377 | |||||||||
| Official Date: | 3 October 2018 | |||||||||
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| Volume: | 18 | |||||||||
| Number: | 1 | |||||||||
| DOI: | 10.1186/s12883-018-1162-9 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Access rights to Published version: | Open Access | |||||||||
| RIOXX Funder/Project Grant: |
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