10 Nov 2023 Relative Efficacy of Drugs for Relapsing Remitting Multiple Sclerosis

MS Therapeutic Review

Date: July 2020

Relative Efficacy of Drugs for Relapsing Remitting Multiple Sclerosis

The Pharmaceutical, Laboratory and Blood Services Division of the British Columbia Ministry of Health (PLBSD) has funded the older injectable drugs (interferons and glatiramer) as first-line therapy for relapsing remitting multiple sclerosis (RRMS) for almost 20 years. To help decide whether they should fund newer drugs instead of interferons and glatiramer as first-line therapy, PLBSD requested a systematic review comparing drugs funded in British Columbia to treat RRMS: older injectable drugs (3 beta interferons plus glatiramer acetate), oral drugs (fingolimod, teriflunomide, dimethyl fumarate) and newer biologics (rituximab, alemtuzumab, natalizumab, ocrelizumab). There was a lack of comparisons between older injectable drugs, oral drugs, and newer biologics within and between groups. Most comparative RCTs use interferons as comparators, drugs which have not been shown in observational cohort studies in BC patients to reduce disability as compared to untreated natural and contemporary cohorts. Randomized controlled trial (RCT) evidence and synthesis based on them are of minimal usefulness for evaluating the relative efficacy of MS drugs. The variable and long natural history of MS means that even if the correct comparators were used in the RCTs, 2 to 3-years of evidence is inadequate to assess the long-term effectiveness. Adverse events (AE), particularly serious AE, are poorly evaluated and vary in type and health impact by specific MS drug. Trials evaluating whether early treatment with biologics is beneficial are ongoing.

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