Saturday 18 October 2008, 12:00AM
PEARLS 110, August 2008, written by Brian R
McAvoy
Clinical question
How effective are immunomodulatory drugs (glatiramer acetate or
recombinant interferon beta) in preventing conversion from
clinically isolated syndromes (CIS) to clinically definite multiple
sclerosis (CDMS)?
Bottom line
Compared to placebo, interferon beta is effective in preventing
the conversion from CIS to CDMS (ie, prevention of a second attack)
over 2 years of follow-up. There is no evidence delaying a second
clinical or MRI detected attack has any effect on delaying
disability outcomes.
Caveat
Some limitations in the interpretation of the results are implied
by analysis of the quality of the studies. In one trial no clear
information about blinding of the investigators involved in
treatment and evaluation is provided. In another trial the number
of patients lost to follow-up during the second year is high
(around 40%) due to early trial terminations. No trials tested the
efficacy of glatiramer acetate.
Context
Multiple sclerosis is a chronic, inflammatory, demyelinating
disease of the central nervous system that most commonly affects
women, with an onset typically between 20 and 40 years of age. It
is the most common cause of neurological disability in young
adults.
Cochrane Systematic Review
Clerico M et al. Recombinant interferon beta or glatiramer acetate
for delaying conversion of the first demyelinating event to
multiple sclerosis. Cochrane Reviews 2008, Issue 2. Article No.
CD005278. DOI: 10.1002/14651858. CD005278.pub3. This review
contains 3 trials involving 1160 participants.