Scarce information comparing treatments for HA and RES RRMS
There is a shortage of information comparing the efficacy of treatments for patients with highly active (HA) and rapidly evolving severe (RES) relapsing-remitting multiple sclerosis (RRMS), resulting in low-confidence conclusions, a new systematic literature review reveals.
The present review accessed the databases of The Cochrane Library, Embase and Medline, the US Food and Drug Administration, ClinicalTrials.gov and the European Medicines Agency. Studies that investigated treatments for HA or RES RRMS recommended for reimbursements in the UK were included.
A Bayesian network meta-analysis (NMA) was performed on the collected data to determine the efficacy of fingolimod vs dimethyl fumarate (DMF) for HA RRMS vs natalizumab for RES RRMS.
After applying the inclusion and exclusion criteria, the review yielded 8 studies eligible for inclusion: four on RES RRMS and five on HA RRMS (one study reported on both). Of these, only two for HA RRMS and three for RES RRMS had adequate patient subgroup data for NMA.
The network for HA RRMS associated fingolimod with DMF via placebo as the common comparator. Both fingolimod and DMF produced significant improvements over 3 months. However, there was no significant difference between fingolimod and DMF.
In the network for RES RRMS, fingolimod was associated with natalizumab through placebo. Similarly, both treatments yielded significant improvements over placebo but not over each other.
More importantly, the systematic literature review and subsequent NMA revealed the lack of existing data and information comparing treatments between multiple sclerosis patient subgroups. This may impose important limitations in creating recommendations for clinical guidelines.