title: Treatments for relapsing-remitting multiple sclerosis: summarising current information by network meta-analysis.
abstract: OBJECTIVE
  Oral drugs for relapsing-remitting multiple sclerosis (RRMS) have been recently investigated and, one of these, fingolimod, is already available in several countries. In this framework, an analysis of the data in terms of the comparative effectiveness for all treatments thus far approved for RRMS can be useful to reappraise their place in therapy.
  
  
  METHODS
  After a MEDLINE search, we selected all randomised trials studying the effectiveness of drugs for RRMS and included in our analysis those randomised trials in which interferon, glatiramer, natalizumab or fingolimod were studied. The end-point was the relapse-free rate at 12 months, which was compared between the various treatments. Direct comparisons, based on actual randomised trials, were handled by calculating the trial-specific hazard ratio (HR) or the meta-analytic value of HR (when at least 2 trials were available). Indirect comparisons for which data from actual trials were missing were instead managed through a network meta-analysis.
  
  
  RESULTS
  Ten randomised trials met the criteria set for our analysis. All active treatments were found to be significantly more effective than placebo (direct comparisons) in terms of freedom from relapse at the 12-month follow-up assessments; the values of HR ranged from 1.28 for glatiramer to 1.53 for interferon beta. The comparisons between active agents revealed that fingolimod was superior to interferon (HR = 1.18; direct comparison) and glatiramer (HR = 1.23; indirect comparison), while the other four head-to-head comparisons of treatments revealed no significant difference.
  
  
  CONCLUSIONS
  On the basis of the effectiveness data presently available, fingolimod seems to offer the advantage of oral administration together with the most favorable profile in terms of relapse-free rate at the 1-year follow-up assessment.
authors: Laboratorio SIFO di Farmacoeconomia, c/o Area Vasta Centro Toscana, Regional Health System, Via Guimaraes 9-11, 59100, Prato, Italy.
authors: Fabiola
authors: F
authors: Del Santo
authors: Dario
authors: D
authors: Maratea
authors: Valeria
authors: V
authors: Fadda
authors: Sabrina
authors: S
authors: Trippoli
authors: Andrea
authors: A
authors: Messori
mesh_terms: D006801:Humans; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000068876:Fingolimod Hydrochloride; D000068717:Glatiramer Acetate; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016899:Interferon-beta / Q000627:therapeutic use; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy; D000069442:Natalizumab; D010455:Peptides / Q000627:therapeutic use; D011409:Propylene Glycols / Q000627:therapeutic use; D013110:Sphingosine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000068876:Fingolimod Hydrochloride; D000068717:Glatiramer Acetate; D007166:Immunosuppressive Agents; D016899:Interferon-beta; D000069442:Natalizumab; D010455:Peptides; D011409:Propylene Glycols; D013110:Sphingosine