OBJECTIVES: In Brazil, the treatment of relapsing-remitting multiple sclerosis (RRMS) involves the use of several drugs, with different efficacies, safety profiles and cost-effectiveness ratios. The use of early highly effective treatment at the beginning of the disease, rather than escalation in therapeutic lines, has been a currently recommended approach. The objective of this study is to conduct a network meta-analysis (NMA) that compares the efficacy of all disease modifying therapies (DMTs) approved in Brazil, regardless of the severity of the disease or previous treatments.

METHODS: A systematic review of the literature was conducted, searching for randomized controlled trials (RCTs) for the treatment of RRMS. A frequentist NMA was performed comparing the outcomes of annualized relapse rate (ARR) and six-month confirmed disability progression (CDP6). Scenario analyzes were carried out by removing studies considered to be at high risk of bias or heterogeneity.

RESULTS: The base case includes 33 RCTs, only three of which were deemed to be at high risk of bias. Alemtuzumab (ALE), ofatumumab (OFA), and natalizumab (NAT) demonstrated the best efficacy in reducing ARR (hazard ratio (HR): 0.30, 0.30, and 0.32, respectively). For CDP6, ALE, NAT, and ocrelizumab (OCRE) presented the highest efficacy (HR: 0.42, 0.46, and 0.46, respectively), with glatiramer, interferon beta 1a44, and teriflunomide showing no statistical difference to placebo. The p-score analysis indicated that ALE was probably the best option for both outcomes. The main study limitation was that adverse effects were neglected. The findings, excluding studies deemed to have a high risk of bias or heterogeneity, were in line with the results of the base case analysis.

CONCLUSIONS: Based on the NMA results, ALE demonstrated superior efficacy in reducing ARR and CDP6. This data can support future assessments of cost-effectiveness and budgetary implications in Brazil, encompassing both the public and private healthcare sectors.