A subcommittee of the American Academy of Neurology (AAN) and the MS Council for Clinical Practice Guidelines has published a major review of disease modifying therapies in multiple sclerosis. The team concluded that several medications do alter the course of MS, but that the evidence for or against any specific drug or treatment varies widely between them.
Conclusive evidence from randomized trials is lacking about the risks and benefits of several treatments for MS. In many cases, this lack is a result of the poor quality of clinical trials or is due to the absence of pharmaceutical industry support—such as funding for large trials—of drugs that are off patent. Although the review, which was endorsed by the AAN, called for more and better studies of such treatments, it also stressed that waiting until the evidence is perfect would mean that physicians and patients today would miss an opportunity to prevent or delay disability due to MS. MS treatment is continually evolving, the authors noted, and new studies are underway of various treatments alone and in different combinations.
The report stated there is good evidence that interferon betas reduce attack rates in MS, that glucocorticoid drugs show a short-term benefit in recovery in patients with acute attacks of MS, and that glatiramer acetate reduces attack rates in patients with relapsing-remitting MS. Cladribine was found to reduce gadolinium enhancement in patients with relapsing-remitting MS, but does not appear to alter the course of the disease. Moreover, exchanging blood plasma in an MS patient does not appear to have any value in treating progressive MS. Other treatments were deemed to have less reliable evidence on their effectiveness, making the group's recommendations for them—negative or positive—less strong.
The authors of the report based their conclusions not only on the number of studies done, but also on the reliability of evidence. A treatment with strong evidence from 1 or 2 large, controlled clinical studies and from several smaller, less well controlled studies is more likely to be effective than a treatment with less strong evidence from a few small studies or from individual reports such as case studies.
The purpose of a review article in a medical journal is to give an overview of what is currently known about drugs and treatments for a given disease. The subcommittee evaluated published reports on drugs and treatments that claim to modify the progress of MS. They looked at results from large, controlled clinical trials, smaller controlled or uncontrolled studies, case reports, and opinions and examined evidence for several treatments, including glucocorticoids, interferon beta, glatiramer acetate, cyclophosphamide, methotrexate, cyclosporine, cladribine, mitoxantrone, intravenous immune globulin, plasma exchange, and sulfasalazine.
The article was published in the January 22 issue of the journal Neurology. The lead author is Dr. Douglas S. Goodin.
Source: Neurology. 2002;58:169-178.