Impact of Disease-Modifying Therapies on MRI Outcomes in Patients with
Relapsing -Remitting Multiple Sclerosis: A Systematic Review and Network
Meta-Analysis
Abstract
Background Multiple sclerosis is a chronic autoimmune inflammatory
demyelinating disorder of the central nervous system. The clinical
presentation supported by characteristic findings on MRI forms the
backbone of the current diagnostic criteria. This study was aimed to
investigate the efficacy based on MRI outcomes of FDA approved
disease-modifying therapies (DMTs) for relapsing-remitting MS (RRMS).
Materials and Methods We searched PubMed, Embase, and the Cochrane
Central Register of Controlled Trials for randomised controlled trials
(RCTs) of DMTs. The outcome measures were the change from baseline in
the number of T2, T1 and/or gadolinium-enhancing (Gd+) lesions in brain
MRI performed at 12 months to 24 months. We performed a network
meta-analysis using the frequentist approach in STATA version 16.0.
Results We identified 26 RCTs for final analysis. Interferon β-1a and
placebo were the most common comparison treatment. Dimethyl fumarate
(DMF) 480 mg was more effective in reducing the Gd+ lesions and T1
lesions. Pegylated interferon β1a 250 mcg was relatively better in
reducing T2 lesions. The treatment ranking showed that DMF 480 mg/720 mg
and interferon β1b 250 mcg were more efficacious (0.9, 0.8 and 0.8 in
SUCRA, respectively) for Gd+ lesions; pegylated interferon β1b 250 mcg
and DMF 480 mg/720 mg were more efficacious (1.0, 0.9 and 0.9 in SUCRA,
respectively) for T2 lesions and dimethyl fumarate 480 mg/720 mg were
more effective (0.9 in SUCRA both, respectively) for T1 lesions.
Conclusion Dimethyl fumarate 480 mg and pegylated interferon β1a 250 mcg
demonstrated favourable MRI outcomes in patients with the RRMS