Thursday, 18 December 2014

Head to head first line injectables

#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

CoI. None

3 comments:

  1. I feel that progression is a rather ambiguous word in the world of RRMS. Relapses are rarely (I'd say never) asymptotic. Unless you are on one of the newer drugs, or in a trial, an annual MRI scan is well, just a dream.
    A relapse - I prefer attack, has symptoms that last for more than 24 hours. It can take months to recover from an MS attack and sometimes the damage is permanent as gait is changed, or hand-eye coordination is affected. Is this progression?
    It's a bit like breaking a bone, over and over until the damage is inoperable. Is this progression?
    I think that NHS neurology could learn from other countries. More MRIs to monitor progression in ALL MS patients will provide a better picture of how MS works.
    Most people just get 1 MRI. This is not enough to diagnose a disease course.
    Surely there is better information since the 2002 risk-sharing scheme? Maybe not. Monitoring MS takes valuable time and people don't get enough time with their once-a-year appointment with a local neuro.

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  2. It's almost 2015 and these modestly effective drugs are still being studied ad nauseum. "But no differences in 12 month progression so are they all useless?" Yeah, pretty much.

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  3. This study would have been super useful 10 years ago.

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