Disease modifying therapies in multiple sclerosis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines.
Disease modifying therapies in multiple sclerosis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines.
American Academy of Neurology - Medical Specialty Society
Multiple Sclerosis Council - Disease Specific Society
Summary,
GUIDELINE OBJECTIVE(S)
To consider the clinical utility of disease-modifying agents for multiple sclerosis, including anti-inflammatory, immunomodulatory, and immunosuppressive treatments
TARGET POPULATION
Patients who have multiple sclerosis (MS), including relapsing/remitting MS (RRMS), secondary progressive MS (SPMS), primary progressive MS (PPMS), and progressive/relapsing MS (PRMS)
INTERVENTIONS AND PRACTICES CONSIDERED
Disease-Modifying Treatment of Multiple Sclerosis:
1. Glucocorticoids
2. Interferon-beta-1a and interferon-beta-1-b (Avonex, Betaferon, Betaseron, Rebif)
3. Glatiramer acetate (Copaxone)
4. Cyclophosphamide
5. Methotrexate
6. Azathioprine
7. Cladribine
8. Cyclosporine
9. Mitoxantrone
10. Intravenous immune globulin
11. Plasma exchange
12. Sulfasalazine
Note: Symptomatic and reparative therapies are not considered.
MAJOR OUTCOMES CONSIDERED
* Effects of disease modifying therapies on clinical outcomes (e.g., clinical attack rate, relapse rate, disability progression)
* Clinical magnetic resonance imaging (MRI) outcomes:
o Attack rate
o Disease severity/progression
o Relapse rate
