Abstract
Adverse effects of immunotherapies for multiple sclerosis: a network meta-analysis
Highlights
Description of the conditionGeneral view Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS) that affects mainly young adults - two to three times more frequently women than men - and causes significant disability two or more decades after onset
With some patients accumulating a low degree of disability during their lifetime, and others experiencing within a short time a rapidly aggressive clinical course
Immunotherapies for multiple sclerosis (MS) belong to different pharmacological categories, have different modalities of administration and have different metabolism; all target the immune system, they are characterised by different effects, as follows: (1) immunomodulation (interferon beta-1b, interferon beta-1a (Avonex, Rebif ), glatiramer acetate, pegylated interferon beta-1a, immunoglobulins, dimethyl fumarate, laquinimod); (2) systemic immunosuppression, inducing a reduction in activation or efficacy of the immune system through cytostatic or cytotoxic effects; and (3) selective immunosuppression, as with monoclonal antibodies or biological agents directed towards exactly defined antigens
Summary
General view Multiple sclerosis (MS) is a chronic disease of the central nervous system (CNS) that affects mainly young adults - two to three times more frequently women than men - and causes significant disability two or more decades after onset. Immunotherapies for MS belong to different pharmacological categories, have different modalities of administration (by intramuscular or subcutaneous injection, by infusion or by mouth) and have different metabolism; all target the immune system, they are characterised by different effects, as follows: (1) immunomodulation (interferon beta-1b, interferon beta-1a (Avonex, Rebif ), glatiramer acetate, pegylated interferon beta-1a, immunoglobulins, dimethyl fumarate, laquinimod); (2) systemic immunosuppression, inducing a reduction in activation or efficacy of the immune system through cytostatic or cytotoxic effects (mitoxantrone, methotrexate, cyclophosphamide, long-term corticosteroids, cladribine, azathioprine, teriflunomide); and (3) selective immunosuppression, as with monoclonal antibodies or biological agents directed towards exactly defined antigens (natalizumab, fingolimod, alemtuzumab, daclizumab, rituximab, ocrelizumab) These aspects must be considered when the safety profile of a drug is determined because safety is usually a consequence of the drug’s primary pharmacological effect. Systematic assessments have not been performed to compare short-, medium- and long-term adverse effects of each immunotherapy versus the others
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