A Systematic Review and Mixed Treatment Comparison of Pharmaceutical Interventions for Multiple Sclerosis
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REVIEW
A Systematic Review and Mixed Treatment Comparison of Pharmaceutical Interventions for Multiple Sclerosis Gavin Giovannoni . Shona Lang Steven Duffy
. Robert Wolff
.
. Robert Hyde . Elizabeth Kinter . Craig Wakeford .
Maria Pia Sormani . Jos Kleijnen
Received: June 5, 2020 / Accepted: September 4, 2020 Ó The Author(s) 2020
ABSTRACT Background: Since 2010, 27 mixed-treatment comparisons (MTCs) of disease-modifying therapies (DMTs) for multiple sclerosis have been published. However, there has been continued evolution in the field of MTCs. Additionally,
Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12912446. Electronic Supplementary Material The online version of this article (https://doi.org/10.1007/s40120020-00212-5) contains supplementary material, which is available to authorized users. G. Giovannoni Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK S. Lang R. Wolff (&) S. Duffy Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York YO19 6FD, UK e-mail: [email protected] R. Hyde E. Kinter C. Wakeford Biogen, Cambridge, USA M. P. Sormani Department of Health Sciences, University of Genoa, Genoa, Italy J. Kleijnen School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
limitations in methodological approach and reporting transparency, even in the most recent publications, makes interpretation and comparison of existing studies difficult. Objectives: The objectives of this study are twofold: (1) to estimate the efficacy and safety of DMTs at European Commission-approved doses compared with placebo in adults with relapsing–remitting multiple sclerosis (RRMS) using MTC, and (2) to identify and address methodological challenges when performing MTC in RRMS, thereby creating a baseline for comparisons with future treatments. Methods: Searches were completed in 14 databases, including MEDLINE, Embase, CENTRAL, CDSR and DARE, from inception to June 2018 to identify published or unpublished prospective, randomised controlled trials of all European Union-approved DMTs or DMTs expected to be approved in the near future in RRMS or rapidly-evolving severe RRMS. No language or date restrictions were applied. Studies were included in the MTC if they were judged to have sufficiently similar characteristics, based on the following: patient age; proportion of male participants; Expanded Disability Status Scale (EDSS) score; duration of disease; number of relapses prior to enrolment and proportion of previously treated patients. Background information from the included studies, as well as effect size and confidence intervals (where relevant) of defined outcomes were extracted. Reporting of the MTC was consistent with the
Neurol Ther
International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) network
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