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How much evidence do we need? Considering the number of RRMSers who are not on therapy, more. And more. - Dave
Long-term effect of disease-modifying drugs on disability progression in multiple sclerosis: a meta-analysis
A. Signori, M.P. Sormani
University of Genova, Genova, Italy
Background: In recent years the impact of disease-modifying drugs on long-term progression was assessed both in several observational studies and in randomized controlled trial (RCT) extensions.
Objectives: To summarize the long-term impact of immunomodulatory drugs (Interferon-Beta (IFN-β) or Glatiramer Acetate (GA)) in relapsing-remitting (RR) multiple sclerosis (MS) patients.
Methods: We systematically collected all published studies reporting the long-term efficacy of IFN-β or GA in RRMS patients. Treatment effect was assessed on two endpoints: the time to progression to a confirmed and sustained EDSS score of 6 and the time to progression to Secondary Progressive (SP) phase. A random effect model was used to pooling the effects of treatment on endpoints in terms of hazard-ratios (HR) with their 95% confidence interval (CI).
Results: Nine studies, 8 observational and 1 RCT extension, with a total of 11261 RRMS patients, reported quantitative data on treatment effect for time to EDSS 6. The main treatment was IFN-β and only two studies had a small portion of patients treated with GA. A significant treatment effect in reducing progression to EDSS 6 resulted from the pooled estimate: HRpooled = 0.49 (95% CI: 0.34-0.69; p< 0.001). Five observational studies, involving a total of 3723 patients, reported quantitative information on time to SP. All studies reported a significant treatment effect on this outcome with an estimated pooled HR of 0.36 (95% CI: 0.29 - 0.44; p< 0.001).
Conclusions: Treatment with immunomodulatory drugs seems to reduce long-term probability of disability progression. Additional well-designed observational studies could help to confirm these findings.
Long-term effect of disease-modifying drugs on disability progression in multiple sclerosis: a meta-analysis
A. Signori, M.P. Sormani
University of Genova, Genova, Italy
Background: In recent years the impact of disease-modifying drugs on long-term progression was assessed both in several observational studies and in randomized controlled trial (RCT) extensions.
Objectives: To summarize the long-term impact of immunomodulatory drugs (Interferon-Beta (IFN-β) or Glatiramer Acetate (GA)) in relapsing-remitting (RR) multiple sclerosis (MS) patients.
Methods: We systematically collected all published studies reporting the long-term efficacy of IFN-β or GA in RRMS patients. Treatment effect was assessed on two endpoints: the time to progression to a confirmed and sustained EDSS score of 6 and the time to progression to Secondary Progressive (SP) phase. A random effect model was used to pooling the effects of treatment on endpoints in terms of hazard-ratios (HR) with their 95% confidence interval (CI).
Results: Nine studies, 8 observational and 1 RCT extension, with a total of 11261 RRMS patients, reported quantitative data on treatment effect for time to EDSS 6. The main treatment was IFN-β and only two studies had a small portion of patients treated with GA. A significant treatment effect in reducing progression to EDSS 6 resulted from the pooled estimate: HRpooled = 0.49 (95% CI: 0.34-0.69; p< 0.001). Five observational studies, involving a total of 3723 patients, reported quantitative information on time to SP. All studies reported a significant treatment effect on this outcome with an estimated pooled HR of 0.36 (95% CI: 0.29 - 0.44; p< 0.001).
Conclusions: Treatment with immunomodulatory drugs seems to reduce long-term probability of disability progression. Additional well-designed observational studies could help to confirm these findings.