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Drugs for multiple sclerosis

Clinical bottom line

There is a depressing lack of evidecne for any efficacy from the clinical trials. There is some adverse effect cost to these treatments, and some have great cost.


Reference:

A Clegg et al. Disease-modifying driugs for multiple sclerosis: a rapid and systematic review. Health Technology Assessment 2000 4: No 9. (available as a PDF from HTA)

This is a 113-page review of drugs for the treating MS. It set out to provide a rapid review of treatments and the efficacy of disease-modifying drugs. A complete review here is both impossible and unnecessary, as a PDF of the whole report is available from the HTA Internet site. The main results were, briefly:

Azathioprine

There is some evidence that azathioprine may reduce relapse rates, but with many common adverse effects, including gastrointestinal disorders. Cost per patient is £50 to £1200 a year.

Beta interferon

Limited benefit in relapsing-remitting and secondary progressive MS. Flu-like symptoms common, and injection site reactions. Cost per patient is £10,000 to £20,000 a year.

Cladribine

Two small trials unlikely to show anything useful. Cost £6,000 to £9,000 a year

Cyclophosphamide

Five randomised trials, predominantly small. Lots of adverse effects, and limiteed evidence of efficacy. Cost £100 a year.

Glatiramer

Very limited evidnece of efficacy. Annual cost £10,000.

Intravenous immunoglobulin

More evidnece for this, with some reduced relapse rates. Cost is £2,000 to £10,000 a year. A more detailed review can be found here. The HTA review was less depressed about IVIG than the Bandolier review.

Methotrexate

No real evidence of efficacy for this cheap drug. Cost is <£100 a year.