Abstract
Immunomodulators and immunosuppressants for multiple sclerosis: a network meta-analysis
Highlights
Different therapeutic strategies are available for treatment of multiple sclerosis (MS) including immunosuppressants, immunomodulators, and monoclonal antibodies
Moderate quality evidence supports a protective effect of natalizumab and interferon ß-1a (IFNß-1a) (Rebif ) against disability progression in relapsing-remitting MS (RRMS) in the short-term compared to placebo
The lack of convincing efficacy data shows that IFNß-1a (Avonex), intravenous immunoglobulins, cyclophosphamide and long-term steroids have an unfavourable benefit-risk balance in RRMS
Summary
Different therapeutic strategies are available for treatment of multiple sclerosis (MS) including immunosuppressants, immunomodulators, and monoclonal antibodies. Their relative effectiveness in the prevention of relapse or disability progression is unclear due to the limited number of direct comparison trials. The sequential involvement of these processes influences the clinical course, characterized by attacks with recovery, attacks leaving persistent deficits, and progression that causes fixed physical and cognitive disability (Compston 2002). PPMS (approximately 10% of all participants with MS) is characterized, from the beginning, by a slow worsening of neurological deficits without experiencing attacks, and PRMS by a progressive course from onset with attacks and continuing progression (Lublin 1996). Preventing progressive disability is the key therapeutic goal for MS
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