Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Autoimmun Rev. 2021 Jun;20(6):102826. doi: 10.1016/j.autrev.2021.102826. Epub 2021 Apr 18.
To compare the efficacy and compliance of up-to-date disease modifying therapies (DMTs) in patients with remitting-relapsing MS (RRMS).
We searched PubMed, EMBASE and Cochrane Library for eligible studies. Annualized relapse rate, discontinuation due to adverse events (AEs) were assessed as primary outcomes. Sensitivity analysis and inconsistency detection were performed to evaluated whether exclusion of high-risk studies affected the validity. Risk of bias was assessed using Cochrane's Risk-of-Bias Tool 2. Surface under the cumulative ranking curve (SUCRA) was used to estimate the rankings among different DMTs.
21 studies were included for main report. Seven studies were evaluated as "high risk" and were therefore excluded. Exclusion of high-risk studies did not affect the validity of evidence. The risk of relapses for most DMTs except Betaseron 50 μg was significantly lower comparing to placebo. Incompliance in patients treated with DMTs was not significantly increased comparing to placebo. Dimethyl fumarate and ocrelizumab had superiority in improving MRI outcomes. Ocrelizumab and ofatumumab had the largest reduction of risk in disability progression at 3 months. Referring to SUCRA, ofatumumab, alemtuzumab and natalizumab showed the best efficacy and compliance.
The present study demonstrated the hierarchy of DMTs treating RRMS. Ofatumumab, alemtuzumab and natalizumab have superiority with respect to effectiveness and compliance. More studies are required to explore the long-term effect of DMTs. Our findings could provide helpful information and contribute to clinical treatment decision-making.
比较缓解-复发型多发性硬化症（RRMS）患者最新的疾病修正治疗（DMT）的疗效和依从性。
我们在 PubMed、EMBASE 和 Cochrane Library 中搜索了符合条件的研究。将年复发率和因不良反应（AE）停药作为主要结局进行评估。进行敏感性分析和不一致性检测，以评估排除高风险研究是否会影响有效性。使用 Cochrane 的风险偏倚工具 2 评估风险偏倚。累积排序曲线下面积（SUCRA）用于估计不同 DMT 之间的排名。
主要报告纳入了 21 项研究。7 项研究被评估为“高风险”，因此被排除在外。排除高风险研究并未影响证据的有效性。除贝伐单抗 50μg 外，大多数 DMT 的复发风险均明显低于安慰剂。与安慰剂相比，接受 DMT 治疗的患者的不依从率并未显著增加。富马酸二甲酯和奥瑞珠单抗在改善 MRI 结果方面具有优势。奥瑞珠单抗和奥法妥木单抗在 3 个月时残疾进展风险降低方面具有最大优势。根据 SUCRA，奥法妥木单抗、阿仑单抗和那他珠单抗显示出最佳的疗效和依从性。
本研究展示了治疗 RRMS 的 DMT 等级。奥法妥木单抗、阿仑单抗和那他珠单抗在有效性和依从性方面具有优势。需要更多研究来探索 DMT 的长期效果。我们的发现可以提供有价值的信息，有助于临床治疗决策。
