MS Research Roundup: March 4, 2014
Evidence-Based MS Care: New Systematic Reviews and Protocols for Mycophenolate Mofetil, Cognitive Rehabilitation, Alemtuzumab vs. Interferon β-1a; Call for Reviewers
MS Research Roundup collects items of interest to multiple sclerosis researchers from around the Web. Send us your tips: firstname.lastname@example.org.
What Works—or Not—for MS
One of the highest forms of evidence in medicine is known as the systematic review. And no one does it better than the Cochrane Collaboration, an independent nonprofit group that cheerfully takes on the onerous task of finding and assessing the best available evidence about what works and what doesn't work—even if there is not yet enough good information to answer the question. Here are three new and updated reviews and protocols from the 58 total overseen by the Multiple Sclerosis and Rare Diseases of the Central Nervous System Group, based in Milan, Italy. (Cochrane Collaboration, Cochrane Library)
• Immunosuppressant: No Verdict. From the plain-language summary, published online February 7, 2014: "Preliminary data show that mycophenolate mofetil (MMF), an immunosuppressive agent, might be beneficial for MS patients. The authors of this review evaluated the efficacy and safety of MMF in patients with relapsing-remitting MS. Only one small study met the inclusion criteria, and it compared MMF versus placebo in 26 interferon β-1a–treated patients. The results showed no evidence favoring MMF in reducing relapses or preventing disability progression after a 12-month follow-up period. No data were available at 24 months. All patients receiving MMF suffered from gastrointestinal upset, and one had a transient diarrhea, but no serious adverse effects were reported." The full text of this new review is available at The Cochrane Library.
• Cognitive Rehabilitation: OK So Far. From the plain-language summary published online February 11, 2014: "The aim of this review was to evaluate the effects of cognitive (neuropsychological) rehabilitation in MS. We did this by considering the effects of rehabilitation on cognitive test performance and everyday cognitive performance, as well as on depression, fatigue, personality/behavior disturbances, anxiety and quality of life. Twenty relevant studies comprising a total of 986 participants (966 MS participants and 20 healthy controls) were identified and included in this review. Low-level evidence was found that neuropsychological rehabilitation reduces cognitive symptoms in MS. However, when analyzed individually, 18 out of the 20 studies showed positive effects. Cognitive training was found to improve memory span and working memory. Cognitive training combined with other neuropsychological rehabilitation methods was found to improve attention, immediate verbal memory and delayed memory." The full text of this updated review is available at The Cochrane Library.
• Alemtuzumab: Safety versus Efficacy. This new protocol describes a review in progress that aims "to compare the efficacy, tolerability and safety of alemtuzumab versus interferon β-1a in the treatment of patients with relapsing-remitting multiple sclerosis to prevent disease activity.” The background and methods published online February 11, 2014, describes the methods and rationale: "Monoclonal antibodies have gained relevance in the treatment of MS. Available trials show that alemtuzumab is more effective than IFN 1a, significantly reducing the relapse rate, risk for sustained accumulation of disability, and mean Expanded Disability Status Scale (EDSS) score at month 36 after treatment. However, 30% of patients develop autoimmunity. Marketing authorization for alemtuzumab has been filed, and whilst trial data suggest that its efficacy outperforms both licensed drugs and others in development, there is a significant risk of adverse events, such as infusion-associated reactions, mild-to-moderate infections and autoimmunity. While the European Medicines Agency (EMA) has already approved it for relapsing-remitting MS, it has not been approved by the FDA." MSDF hopes the authors will be able to access additional data and unpublished studies they seek.
Call for Reviewers
Want to be a part of generating authoritative, reliable, up-to-date, evidence-based reviews regarding the prevention, treatment, and rehabilitation of MS? The Cochrane MS group seeks volunteers with expertise to expand its repertoire with new reviews on vaccination interactions with MS, sexual dysfunction, MS in childhood, and MS in pregnancy. The group also welcomes review authors willing to work on comparing the efficacy of disease-modifying agents in terms of single active treatment or combination therapies. Resources for review authors and a sign-up form are here.