Evidence⁃based evaluation of treatment strategy for multiple sclerosis

Abstract

Objective To formulate the best treatment plan for multiple sclerosis (MS) patients by evaluating the therapeutic efficacy and side effect of various evidence ⁃ based programs. Methods Key words were defined as multiple sclerosis, immunomodulatory therapy and therapy, etc. We searched MEDLINE, Cochrane Library, Wanfang data bases for Scientific Journals in China and National Knowledge Infrastructure for Chinese Scientific Journals Database. Additionally, we applied manual searching and screened out conference paper and academic dissertation, etc, from various references. After that we obtained and evaluated by Jadad scales on systematic reviews, randomized controlled trials, controlled clinical trials and observational study cases about glucocorticoids, plasmapheresis, intravenous immunoglobulin, IFN ⁃ β, glatiramer acetate, mitoxantrone, natalizumab, fingolimod. Results After screening, all seventeen selected resources included systematic reviews 6 articles, randomized controlled trials 7 articles, controlled clinical trials 2 articles, observational study cases 2 articles, among which fifteen articles were proved to be high quality (according to Jadad scoring system, five score 4, six score 5, four score 7), two chapters were judged to be low quality scoring 3. Finally, we summerize that: 1) The first choice of treatment for acute relapses is glucocorticoids and we suggest that plasmapheresis or intravenous immunoglobulin may be tried as an alternative therapy in acute MS relapse, especially in case of contraindications to intravenous methylprednisolone. 2) Immunomodulatory or immunosuppressive treatment (IFN ⁃ β, glatiramer acetate, mitoxantrone, natalizumab) can be an option to prevent new relapses and progression of disability. 3) Fingolimod is an oral treatment for multiple sclerosis to improve treatment adherence. Conclusion Using evidence⁃based medicine methods can provide us best clinical evidence on MS treatment. DOI：10.3969/j.issn.1672⁃6731.2012.02.012