Efficacy of disease-modifying therapies in relapsing remitting multiple sclerosis: a systematic comparison.

Freedman MS, Hughes B, Mikol DD, Bennett R, Cuffel B, Divan V, LaVallee N, Al-Sabbagh A.
Department of Medicine (Neurology), University of Ottawa, Ottawa, Ontario, Canada. mfreedman@ottawahospital.on.ca

The treatment of relapsing-remitting multiple sclerosis (RRMS) has become more effective over the last decade with the advent of the currently available disease-modifying therapies (DMTs). Pivotal clinical studies differ in many characteristics, such that cross-comparisons of relative risk reductions are of limited value and can be misleading.

Our objective was to compare the clinical efficacy of currently approved first-line DMTs in patients with RRMS, applying an evidence-based medicine approach. We reviewed all phase III pivotal trials of DMTs. Six clinical trials of Avonex, Betaseron, Copaxone, Rebif and Tysabri in patients with RRMS were identified for analysis. Only randomized, placebo-controlled, double-blind studies were included. The clinical efficacy endpoints compared were: proportion of relapse-free patients at 1 and 2 years; annualized relapse rate at 2 years; proportion of progression-free patients at 2 years, and proportion of patients free of gadolinium-enhancing lesions at 1 year or 9 months.

Based on these analyses, Betaseron, Rebif, and Tysabri show comparable effects, whereas for several endpoints Avonex or Copaxone did not significantly differ from placebo. In the absence of head-to-head studies for all products used to treat RRMS, it still may be possible to compare treatment effects by applying evidence-based medicine principles. (c) 2008 S. Karger AG, Basel.

PMID: 18437041 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/18437041

Cherie

Great...now I'll have switch to something that gives me the Interferon Flu.

It would explain all the funky annoying MS symptoms I've been having since starting the C. Numb toes, feet, legs, fingers...more ON symptoms, and spasticity.

I was on Copaxone first and it was not effective for me. I switched to Beta and it has worked well. Last MRI showed no new lesions and the ones I had before that were enhanced were not this time. I'm still having symptoms, though, and the numbness in my right hand/arm will not go away.

Erin, the flu like side effects are only temporary (for most people) and you titrate up to a full dose so as not to have too many flu like reactions. As long as I pre-medicated with Motrin before the shot and then again about 4 hours afterwards I was fine. I'm on a full dose now and only pre-medicate. I don't have to take anything afterwards.

Not having that awful welt-like site reaction and the itching was a blessed relief. And....only having to take the shot every other day is nice, too.

Erin, I am on Rebif, about the 8th wk., and have never had any fluish side effects and have dropped all but one coated aspirin pre-med.

Cherie, thanks for the post, and thanks for the wealth of information you share here.

Thank you for this Cherie. One of my favorite things about you is that even though you don't use a DMD at this point you don't discredit them and are willing to share new information that you come across. Thank you.
Jules

P.S. with regard to this study, and I will get a copy of the full text before I make my final decision, for the most part my personal opinion is that I am very skeptical of all the MS studies that don't last for more than a couple of years.

This disease can move pretty slowly but that doesn't doesn't mean that at some point it won't change its course. My optimism is always haunted by the folks that did wonderfully for 20 years and then really declined quickly. No rhyme or reason.

Has Rebif been having the same problem with dull needles that the Copaxone has been having lately?

I hurt my right shoulder the other day, and couldnt use my right arm to do the shot on my right side, so I had my dad give me my shot of C last night...got a really dull needle. OMG! It felt like he was stabbing me with a dull steak knife! Almost as painful as using the autoject and a dull needle. Owwwwie!

The dull needles are what are making me consider switching over to something new.

Cherie, your post prompted my post about looking at the clinical trial site again.

Congratulations. I'm like that guy (the alcoholic) in Independence Day - "I've been telling you for ten long years..."

When beta 1B got approved (betaseron) it was like - why??? Results were basically in line with placebo affect. Then they approved beta 1a (huh?) - avonex and rebif. Then COPII (copaxone). The MS community (at least those on the internet at the time in 1993) were shocked.

Nothing really worked. Ted Yednock's work with monoclonal antibodies seemed to be the only promising thing at the time but all these drugs were getting approved. We were all flabbergasted. Why?

I did enter the Betaseron lottery in 1993 - drew such a high number that I had a 15 month wait. Results from the trials didn't improve so I elected not to take a DMD.

Personal opinion - I've had MS for over 20 years and haven't taken a DMD. I still work/live/play a normal life. This disease is a crap shoot... Ain't no drug gonna help ya. Just bankrupt ya.

Tom