Pharmacological treatment options for cognitive dysfunction induced by multiple sclerosis: a network meta-analysis

Area of Science:

• Neuroscience
• Pharmacology
• Clinical Medicine

Background:

• Cognitive dysfunction (CD) is a significant challenge for patients with multiple sclerosis (MS).
• Effective pharmacological interventions for MS-induced CD are actively sought.
• Current treatment options require comprehensive comparative analysis.

Purpose of the Study:

• To conduct a network meta-analysis comparing pharmacological treatments for CD in MS patients.
• To evaluate the efficacy of various drugs on cognitive test performance.
• To assess and compare the adverse effect profiles of these treatments.

Main Methods:

• Systematic retrieval of randomized controlled trials (RCTs) from PubMed, Embase, Cochrane Library, and Web of Science.
• Inclusion of 26 studies with 23,839 MS patients.
• Quality assessment using the Risk of Bias tool and data analysis using R.

Main Results:

• L-amphetamine demonstrated potential memory improvement in MS-induced CD.
• Atomoxetine showed efficacy in improving Symbol Digit Modalities Test (SDMT) and California Verbal Learning Test (CVLT) scores.
• Rivastigmine exhibited a lower incidence of dyspepsia compared to other treatments.

Conclusions:

• L-amphetamine, melatonin, and atomoxetine show potential benefits for specific cognitive domains in MS-induced CD.
• Atomoxetine appears to be a promising agent for improving both memory and executive function.
• Rivastigmine may be a preferred option when minimizing gastrointestinal side effects is a priority.