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

Abstract

Introduction: Several first-line immunomodulatory treatments are available to physicians for treating patients with relapsing-remitting multiple sclerosis, namely three interferon-beta preparations and glatiramer acetate. In order to enlighten their choice of treatment, physicians need data from good quality comparative clinical trials.

Methods: This review outlines and compares the findings of the various randomized clinical trials that have assessed the efficacy and safety of immunomodulatory treatments for multiple sclerosis. Six such studies have been reported to date, a Danish study (interferon-beta 1a sc versus interferon-beta 1b sc), the EVIDENCE study (interferon-beta 1a sc versus interferon-beta 1a im), the INCOMIN study (interferon-beta 1b sc versus interferon-beta 1a im), the BECOME and BEYOND studies (interferon-beta 1b sc versus glatiramer acetate) and the REGARD study (interferon-beta 1a sc versus glatiramer acetate).

Results: These studies have demonstrated somewhat superior efficacy for interferon-beta preparations administered subcutaneously several times a week compared to preparations administered intramuscularly once a week. In contrast, no difference in efficacy has been demonstrated between the two subcutaneously administered interferon-beta preparations, or between either of these preparations and glatiramer acetate. Differences in the safety profile of the four immunomodulatory treatments were observed, in particular a more favorable skin tolerance with intramuscularly administered interferon-beta and a better systemic adverse event profile for glatiramer acetate.

Conclusions: These various randomized comparative trials have provided objective criteria that can be used by physicians for choosing between immunomodulatory treatments.