The present efficacy of multiple sclerosis therapeutics: Is the new 66% just the old 33%?
A challenge for the clinician treating patients with multiple sclerosis (MS) is to determine the most effective treatment while weighing the benefits and risks. Results of the phase 2 and phase 3 studies on natalizumab were received with great interest, in part due to the "improved" risk reduction for relapse rate, disease progression, and MRI metrics observed in comparison to results in trials of beta-interferon and glatiramer acetate. However, comparison across trials is invalid, in large part due to differences in the study populations. The increased efficacy observed in more recent trials has also been attributed to a fundamental change in subjects with MS enrolled in recent trials compared with the prior decade. In this article, we debate the relative efficacy of natalizumab vs the older injectable therapies.
Klawiter
Eric C
EC
Department of Neurology,Washington University, St. Louis, MO 63110, USA. klawitere@neuro.wustl.edu
Cross
Anne H
AH
Naismith
Robert T
RT
D000911:Antibodies, Monoclonal / Q000494:pharmacology* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D002986:Clinical Trials as Topic / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D003627:Data Interpretation, Statistical; D000068717:Glatiramer Acetate; D006801:Humans; D007155:Immunologic Factors / Q000494:pharmacology* / Q000627:therapeutic use; D016899:Interferon-beta / Q000494:pharmacology / Q000627:therapeutic use; D009103:Multiple Sclerosis / Q000188:drug therapy*; D000069442:Natalizumab; D010455:Peptides / Q000494:pharmacology / Q000627:therapeutic use; D015203:Reproducibility of Results; D055502:Secondary Prevention; D015983:Selection Bias
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007155:Immunologic Factors; D000069442:Natalizumab; D010455:Peptides; D000068717:Glatiramer Acetate; D016899:Interferon-beta