Cochrane · systematic review · CD012200
Treatment with disease‐modifying drugs for people with a first clinical attack suggestive of multiple sclerosis
Filippini, G, Del Giovane, C, Clerico, M, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
Multiple Sclerosis and Rare Diseases of the CNSAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
6
current version
GRADE rated
6
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 4 · 66.7%Low 2 · 33.3%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Are disease‐modifying drugs for a first attack suggestive of multiple sclerosis (MS) effective and safe compared to placebo?
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Disability‐worsening Proportion of participants with disability‐worsening, assessed by EDSS** during 24 months of treatment Participants: N = 927 (2 RCTs) Are disease‐modifying drugs for a first attack suggestive of multiple sclerosis (MS) effective and safe vs placebo? | OR 0.74 [0.49, 1.14] | NR | Very low Downgraded: risk of bias, indirectness |
Relapse Proportion of participants with relapse during 24 months of treatment Participants: N = 618 (1 RCT) Are disease‐modifying drugs for a first attack suggestive of multiple sclerosis (MS) effective and safe vs placebo? | OR 0.65 [0.38, 1.12] | NR | Very low Downgraded: risk of bias, imprecision |
Occurrence of at least one serious adverse event Proportion of participants with at least one serious adverse event during 24 months of treatment Participants: N = 3385 (7 RCTs) Are disease‐modifying drugs for a first attack suggestive of multiple sclerosis (MS) effective and safe vs placebo? | OR 0.78 [0.6, 1.03] | NR | Low Downgraded: risk of bias |
Withdrawls or drug discontinuation due to adverse events during 24 months of treatment Participants: N = 2693 (5 RCTs) Are disease‐modifying drugs for a first attack suggestive of multiple sclerosis (MS) effective and safe vs placebo? | OR 2.43 [0.91, 6.49] | NR | Very low Downgraded: risk of bias, inconsistency |
Is early treatment with disease‐modifying drugs more efficacious and safer than delayed treatment?
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Disability‐worsening Proportion of participants with disability‐worsening at a maximum of five years' | OR 0.88 [0.5, 1.57] | NR | Very low Downgraded: risk of bias, inconsistency, indirectness |
Relapse Proportion of participants with relapse at a maximum of five years' | OR 0.35 [0.26, 0.48] | NR | Low Downgraded: risk of bias |