[Immunomodulatory treatments for multiple sclerosis: lessons from direct comparative studies]

Area of Science:

• Neurology
• Immunology
• Pharmacology

Background:

• Relapsing-remitting multiple sclerosis (RRMS) has several first-line immunomodulatory treatments.
• Physicians require comparative clinical trial data to guide treatment selection for RRMS.

Purpose of the Study:

• To review and compare randomized clinical trials on the efficacy and safety of immunomodulatory treatments for RRMS.

Main Methods:

• Systematic review of six randomized clinical trials comparing interferon-beta (IFN-β) preparations and glatiramer acetate (GA).
• Trials included comparisons of subcutaneous (sc) vs. intramuscular (im) IFN-β, and IFN-β vs. GA.

Main Results:

• Subcutaneous IFN-β (multiple times weekly) demonstrated superior efficacy compared to intramuscular IFN-β (once weekly).
• No significant efficacy differences were found between different subcutaneous IFN-β preparations or between subcutaneous IFN-β and GA.
• Safety profiles varied, with intramuscular IFN-β showing better skin tolerance and GA having a better systemic adverse event profile.

Conclusions:

• Randomized comparative trials offer objective criteria for physicians selecting between RRMS immunomodulatory treatments.
• Treatment choice can be informed by efficacy and safety data, including administration frequency and adverse event profiles.