PMID- 38529035
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240327
IS  - 1664-2295 (Print)
IS  - 1664-2295 (Electronic)
IS  - 1664-2295 (Linking)
VI  - 15
DP  - 2024
TI  - Disease-modifying therapy in progressive multiple sclerosis: a systematic review 
      and network meta-analysis of randomized controlled trials.
PG  - 1295770
LID - 10.3389/fneur.2024.1295770 [doi]
LID - 1295770
AB  - BACKGROUND: Currently, disease-modifying therapies (DMTs) for progressive 
      multiple sclerosis (PMS) are widely used in clinical practice. At the same time, 
      there are a variety of drug options for DMTs, but the effect of the drugs that 
      can better relieve symptoms and improve the prognosis are still inconclusive. 
      OBJECTIVES: This systematic review aimed to evaluate the efficacy and safety of 
      DMTs for PMS and to identify the best among these drugs. METHODS: MEDLINE, 
      EMBASE, the Cochrane Library, and clinicaltrials.gov were systematically searched 
      to identify relevant studies published before 30 January, 2023. We assessed the 
      certainty of the evidence using the confidence in the network meta-analysis 
      (CINeMA) framework. We estimated the summary risk ratio (RR) for dichotomous 
      outcomes and mean differences (MD) for continuous outcomes with 95% credible 
      intervals (CrIs). RESULTS: We included 18 randomized controlled trials (RCTs) 
      involving 9,234 patients in the study. DMT can effectively control the disease 
      progression of MS. Among them, mitoxantrone, siponimod, and ocrelizumab are 
      superior to other drug options in delaying disease progression (high certainty). 
      Mitoxantrone was the best (with high certainty) for mitigating deterioration 
      (progression of disability). Ocrelizumab performed best on the pre- and 
      post-treatment Timed 25-Foot Walk test (T25FW; low certainty), as did all other 
      agents (RR range: 1.12-1.05). In the 9-Hole Peg Test (9HPT), natalizumab 
      performed the best (high certainty), as did all other agents (RR range: 
      1.59-1.09). In terms of imaging, IFN-beta-1b performed better on the new T2 
      hypointense lesion on contrast, before and after treatment (high certainty), 
      while siponimod performed best on the change from baseline in the total volume of 
      lesions on T2-weighted image contrast before and after treatment (high 
      certainty), and sWASO had the highest area under the curve (SUCRA) value (100%). 
      In terms of adverse events (AEs), rituximab (RR 1.01), and laquinimod (RR 1.02) 
      were more effective than the placebo (high certainty). In terms of serious 
      adverse events (SAEs), natalizumab (RR 1.09), and ocrelizumab (RR 1.07) were 
      safer than placebo (high certainty). CONCLUSION: DMTs can effectively control 
      disease progression and reduce disease deterioration during the treatment of PMS. 
      SYSTEMATIC REVIEW REGISTRATION: https://inplasy.com/?s=202320071, identifier: 
      202320071.
CI  - Copyright (c) 2024 Wu, Wang, Xue, Tan, Li, Chen and Wang.
FAU - Wu, Xin
AU  - Wu X
AD  - Department of Neurosurgery and Brain and Nerve Research Laboratory, The First 
      Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
FAU - Wang, Shixin
AU  - Wang S
AD  - Department of Neurosurgery and Brain and Nerve Research Laboratory, The First 
      Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
FAU - Xue, Tao
AU  - Xue T
AD  - Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 
      Beijing, China.
FAU - Tan, Xin
AU  - Tan X
AD  - Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical 
      University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China.
FAU - Li, Jiaxuan
AU  - Li J
AD  - Department of Neurosurgery and Brain and Nerve Research Laboratory, The First 
      Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
FAU - Chen, Zhouqing
AU  - Chen Z
AD  - Department of Neurosurgery and Brain and Nerve Research Laboratory, The First 
      Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
FAU - Wang, Zhong
AU  - Wang Z
AD  - Department of Neurosurgery and Brain and Nerve Research Laboratory, The First 
      Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
LA  - eng
PT  - Systematic Review
DEP - 20240311
PL  - Switzerland
TA  - Front Neurol
JT  - Frontiers in neurology
JID - 101546899
PMC - PMC10962394
OTO - NOTNLM
OT  - disease-modifying therapy
OT  - multiple sclerosis
OT  - natalizumab
OT  - ocrelizumab
OT  - randomized controlled
OT  - rituximab
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2024/03/26 06:44
MHDA- 2024/03/26 06:45
PMCR- 2024/03/11
CRDT- 2024/03/26 03:37
PHST- 2023/09/20 00:00 [received]
PHST- 2024/02/06 00:00 [accepted]
PHST- 2024/03/26 06:45 [medline]
PHST- 2024/03/26 06:44 [pubmed]
PHST- 2024/03/26 03:37 [entrez]
PHST- 2024/03/11 00:00 [pmc-release]
AID - 10.3389/fneur.2024.1295770 [doi]
PST - epublish
SO  - Front Neurol. 2024 Mar 11;15:1295770. doi: 10.3389/fneur.2024.1295770. 
      eCollection 2024.