Efficacy classification of modern therapies in multiple sclerosis

Abstract

Background: The Association of British Neurologists (ABN) 2015 guidelines suggested classifying multiple sclerosis therapies according to their average relapse reduction. We sought to classify newer therapies (cladribine, ocrelizumab, ofatumumab, ozanimod) based on these guidelines. Materials & methods: Therapies were classified by using direct comparative trial results as per ABN guidelines and generating classification probabilities for each therapy based on comparisons versus placebo in a network meta-analysis for annualized relapse rate. Results: For both approaches, cladribine and ofatumumab were classified as high efficacy. Ocrelizumab and ozanimod (1.0 mg) were classified as moderate or high efficacy depending on the approach used. Conclusion: Cladribine and ofatumumab have an efficacy comparable with therapies classified in the ABN guidelines as high efficacy.

Mechanisms of central brain atrophy in multiple sclerosis

“…Fifty consecutive MS patients who were enrolled in longitudinal study of MS-related axonal loss and who had 5 years follow-up were included in the study. 11 patients were maintained on low-efficacy treatment (injectables, such as interferon and glatiramer acetate, teriflunomide and dimethyl-fumarate) (Samjoo et al, 2021), while 21 patients were receiving high-efficacy drugs (fingolimod, natalizumab, and alemtuzumab) (Samjoo et al, 2021) during the study period. Two patients were treatment-free, while 16 patients changed treatment category between baseline and follow-up visits.…”

Therapy Switches in Fingolimod-Treated Patients with Multiple Sclerosis: Long-Term Experience from the German MS Registry

“…The second period was set from 2014 to 2016 due to the approval of further DMDs for RRMS treatment during this time period, i.e., dimethyl fumarate in 2014 and daclizumab in 2016 [ 17 , 18 ]. The third period covered 2017 to 2019, during which time the new high-efficacy DMDs cladribine (2017) and ocrelizumab (2018) were approved to treat RRMS [ 16 , 19 , 20 ]. Another factor considered in determining the three periods was the comparability regarding the sizes of the patient groups and the length of the time periods.…”

“…We divided the PwMS into three subgroups according to the time of their fingolimod treatment initiation. The first period was set from 2010 to 2013 and covers the approval of fingolimod in the European Union in 2011 including compassionate use in Germany in 2010 as well as the post-approval period during which time the high-efficacy DMD alemtuzumab (2013) and the modest-/moderate-efficacy DMD teriflunomide (2013) were also approved [7,[14][15][16]. The second period was set from 2014 to 2016 due to the approval of further DMDs for RRMS treatment during this time period, i.e., dimethyl fumarate in 2014 and daclizumab in 2016 [17,18].…”

Choroid plexus volume predicts expansion of chronic lesions and brain atrophy

“…Forty-nine consecutive MS patients enrolled in longitudinal study of axonal loss in MS who reached 5 years follow-up were included in the study. 10 patients remained on low-efficacy treatment (injectables, such as interferon and glatiramer acetate, teriflunomide and dimethyl-fumarate) 21 and 21 patients were receiving high-efficacy drugs (fingolimod, natalizumab, and alemtuzumab) 21 during the study period. Two patients were treatment-free, while 16 patients changed treatment category between baseline and follow-up visits.…”