#MSresearch First line injectables head to head in real life, which ones are better?
Kalincik T, Jokubaitis V, Izquierdo G, Duquette P, Girard M, Grammond P, Lugaresi A, Oreja-Guevara C, Bergamaschi R, Hupperts R, Grand'Maison F, Pucci E, Van Pesch V, Boz C, Iuliano G, Fernandez-Bolanos R, Flechter S, Spitaleri D, Cristiano E, Verheul F, Lechner-Scott J, Amato MP, Cabrera-Gomez JA, Saladino ML, Slee M, Moore F, Gray O, Paine M, Barnett M, Havrdova E, Horakova D, Spelman T, Trojano M, Butzkueven H;
On behalf of the MSBase Study Group; On behalf of the MSBase
Study Group. Comparative effectiveness of glatiramer acetate and interferon beta formulations in relapsing-remitting multiple sclerosis.Mult Scler. 2014 Dec. pii: 1352458514559865. [Epub ahead of print]
BACKGROUND:The results of head-to-head comparisons of injectable immunomodulators (interferon β, glatiramer acetate) have been inconclusive and a comprehensive analysis of their effectiveness is needed.
OBJECTIVE:We aimed to compare, in a real-world setting, relapse and disability outcomes among patients with multiple sclerosis (MS) treated with injectable immunomodulators.
METHODS:Pairwise analysis of the international MSBase registry data was conducted. The four injectable immunomodulators were compared in six head-to-head analyses of relapse and disability outcomes
RESULTS: Of the 3326 included patients, 345-1199 patients per therapy were matched (median pairwise-censored follow-up was 3.7 years). Propensity matching eliminated >95% of the identified indication bias. Slightly lower relapse incidence was found among patients treated with glatiramer acetate or subcutaneous interferon β-1a relative to intramuscular interferon β-1a and interferon β-1b (p≤0.001). No differences in 12-month confirmed progression of disability were observed.
CONCLUSION: Small but statistically significant differences in relapse outcomes exist among the injectable immunomodulators. MSBase is sufficiently powered to identify these differences and reflects practice in tertiary MS centres. While the present study controlled indication, selection and attrition bias, centre-dependent variance in data quality was likely.
I was hoping ProfG was going to post on this so that he could talk about his experience with these agents, but as he has been away for the past couple of weeks, I thought I would stick this up. Maybe there is no good internet connection in India or maybe our trusty ex-lab manager, the Wolfman, is keeping him too busy.
MSBase is a registry of MSers and in this study they looked to see who was taking what and how well you did in the real world as opposed to a trial. So what happened?
Slightly lower relapse incidence was found among patients treated with glatiramer acetate or subcutaneous interferon β-1a (Rebif) relative to intramuscular interferon β-1a (Avonex) and interferon β-1b (Betaseron) (p≤0.001). But no differences in 12 month progression so are they all useless? ProfG may point out that there are differences between the different interferon beta preparations in their abilities to induce Nabs. It is interesting that the market share of the above treatments does not necessarily reflect their efficacy, so is marketing a big factor in your choice of first line injectables