title: A network meta-analysis of randomized controlled trials for comparing the effectiveness and safety profile of treatments with marketing authorization for relapsing multiple sclerosis.
abstract: OBJECTIVE
  The relative effectiveness and safety profile of the treatments with marketing authorization for relapsing multiple sclerosis (MS) are not well known because randomized controlled trials with head-to-head comparisons between these treatments do not exist. Thus, a network of multiple-treatments meta-analysis was performed using four clinical outcomes: 'patients free of relapse', 'patients without disease progression', 'patients without MRI progression' and 'patients with adverse events'.
  
  
  METHODS
  Randomized controlled trials (RCTs) on MS were systematically searched in PubMed and Cochrane Central Register of Controlled Trial. The network analysis performed pairwise comparisons between the marketed treatments (Betaferon 250mcg, Avonex 30mcg, Rebif 44mcg, Rebif 22mcg, Aubagio 7 mg, Aubagio 14 mg, Copaxone 20 mg, Tysabri 300 mg, Gilenya 0·5 mg and Novantrone 12 mg/m(2)) using direct and indirect analyses.
  
  
  CONCLUSIONS
  The analysis included 48 articles, involving 20 455 patients with MS. The direct analysis showed better response for more than one outcome for Gilenya compared with Avonex ('patients free of relapse' and 'patients without MRI progression') and for Betaferon compared with Avonex ('patients without disease progression' and 'patients without MRI progression'). The indirect analysis indicated that Tysabri may have better relative effectiveness compared with the other treatments for two outcomes: 'patients free of relapse' and 'patients without MRI progression'. Regarding 'patients with adverse events', no data were available for all comparisons to make fair inferences.
  
  
  CONCLUSIONS
  This was an attempt, for the first time, to compare the efficacy and safety profile of existing approved treatments for relapsing MS. Although some treatments have shown better response, the results of the network analysis should be interpreted with caution because of the lack of RCTs with head-to-head comparisons between treatments.
authors: Department of Neurology, University of Thessaly School of Medicine, Larissa, Greece.
authors: G M
authors: GM
authors: Hadjigeorgiou
authors: C
authors: C
authors: Doxani
authors: M
authors: M
authors: Miligkos
authors: P
authors: P
authors: Ziakas
authors: G
authors: G
authors: Bakalos
authors: D
authors: D
authors: Papadimitriou
authors: T
authors: T
authors: Mprotsis
authors: N
authors: N
authors: Grigoriadis
authors: E
authors: E
authors: Zintzaras
mesh_terms: D003627:Data Interpretation, Statistical; D018450:Disease Progression; D000068717:Glatiramer Acetate; D000068556:Interferon beta-1a; D016899:Interferon-beta / Q000009:adverse effects / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008942:Mitoxantrone / Q000009:adverse effects / Q000627:therapeutic use; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D010455:Peptides / Q000009:adverse effects / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D055502:Secondary Prevention
chemical_list: D010455:Peptides; D000068717:Glatiramer Acetate; D016899:Interferon-beta; D008942:Mitoxantrone; D000068556:Interferon beta-1a
keywords: evidence-based medicine; network meta-analysis; systematic review