Therapeutic approaches to disease modifying therapy for multiple sclerosis in adults: An Australian and New Zealand perspective Part 2 New and emerging therapies and their efficacy

Guideline for multiple sclerosis treatment in Brazil: Consensus from the Neuroimmunology Scientific Department of the Brazilian Academy of Neurology

“…The inclusion criteria were that the papers needed to have been published in the English language, from 2012 onwards, and needed to be classified as reviews, meta-analyses, systematic reviews, algorithms or treatment guidelines. Evidences were classified according GRADE criteria 15,16,17,18 .…”

“…In addition, there is a high level of evidence of a good safety profile for this treatment. These drugs continue to be the first-line therapy in all guidelines published so far in different countries 1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20 . Two systematic reviews assessed the results from studies on interferon and glatiramer acetate at the first demyelinating event.…”

“…Interferon beta and glatiramer acetate have similar efficacy, however the different forms of administration and regimen have to be considered according to the personal characteristics, which could promote improved adherence 23 . Among the oral drugs available, teriflunomide can be used as first-line therapy if there are no formal contraindications for its use (patients who might become pregnant within the short or medium term) 13,14,15 . Teriflunomide presents a high level of evidence regarding control of relapses and lesions on MRI, and its efficacy is considered to be similar to that of the injectable immunomodulatory drugs 13 .…”

“…Teriflunomide presents risks of adverse events that need to be continuously monitored, such as alterations to liver enzyme levels and lymphopenia. Other effects limit use of this drug, such as telogenous efflux 15 .…”

“…The primary and secondary outcomes used in clinical trials have also been modified to meet the demands of regulatory agencies. The levels of evidence comparing the efficacy of medications investigated over a decade ago and of newer drugs are unreliable, since the earlier trials were on patients with a less homogeneous profile, and considered different outcomes 15 . Likewise, regarding safety, the risk of infectious diseases and cancer is now different, and newer drugs that are more efficient come with higher risks.…”