Wednesday, 3 February 2016

Outcomes the greatest benefit

Tramacere I, Del Giovane C, Filippini G. Association of Immunotherapies With Outcomes in Relapsing-Remitting Multiple Sclerosis.JAMA. 2016 Jan 26;315(4):409-10. doi: 10.1001/jama.2015.18984.

CLINICAL QUESTION: What immunotherapies for multiple sclerosis are associated with the greatest benefit and highest risk of discontinuation due to adverse events in patients with relapsing-remitting multiple sclerosis?

BOTTOM LINE: Alemtuzumab, natalizumab, and fingolimod were associated with the greatest benefit with regard to relapse prevention. Their association with prevention of disability worsening was unclear. Fingolimod was associated with a high risk of treatment discontinuation due to adverse events.

Each treatment has its pros and cons you need to to know as much as possible so that you can make the best choice for yourself.

1 comment:

  1. This is a summary version of this source material.

    This kind of meta-analysis is interesting, but is lacking from a scarcity of post-market data collected by public agencies and the companies themselves. As a patient, I'm disappointed with the quantity and quality of evidence available when making a decision about which treatment to pick.

    What surprises me most is that while there is clearly heterogeneity in the disease, and therefore also with treatment efficacy, there is a general lack of companion diagnostics. There have been a number of pharmacogenetic studies put out there looking at IFN and GA responders vs. non-responders, the data associating SLC9a9 was particularly compelling, and testing one SNP (rs9828519) doesn't seem so onerous a burden when patients are routinely given MRI and LPs.


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