OBJECTIVES: To conduct a systematic search to compare the efficacy and safety of disease-modifying therapies (DMTs) for the treatment of relapsing-remitting multiple sclerosis (RRMS)

METHODS: A systematic literature search of PubMed was conducted to identify phase III clinical trials in which the efficacy and safety of DMTs in the treatment of RRMS were evaluated. The primary efficacy outcome for this assessment was annualized relapse rate (ARR).

RESULTS: From the phase III clinical trials with approximately 2-yr ARRs reported (n=13), the outcomes were as follows: Among 512 patients who received peginterferon beta-1a, the ARR was 0.22 vs. 0.35 for delayed treatment, a relative reduction of 37%. Among 627 patients who received natalizumab, the ARR was 0.23 vs. 0.73 for placebo, a relative reduction of 68%. Among 802 patients who received alemtuzumab, the ARR was 0.18-0.26 vs. 0.39-0.52 for interferon beta-1a, a relative reduction of 49-55%. Among 827 patients who received ocrelizumab, the ARR was 0.16 vs. 0.29 for interferon beta-1a, a relative reduction of 46-47%. Among 1,582 patients who received fingolimod, the ARR was 0.16-0.21 vs. 0.40 for placebo, a relative reduction of 48-60%. Among 366 patients who received teriflunomide, the ARR was 0.37 vs. 0.54 for placebo, a relative reduction of 31%. Among 1,530 patients who received dimethyl fumarate, the ARR was 0.17-0.22 vs 0.36-0.40 for placebo, a relative reduction of 44-53%. Among 889 patients who received cladribine, the ARR was 0.14-0.15 vs. 0.33 for placebo, a relative reduction of 54-58%. Among 872 patients who received ozanimod, the ARR was 0.17-0.22 vs. 0.28 for interferon beta-1a, a relative reduction of 21%-38%. The occurrence of any serious adverse events ranged 7-20%.

CONCLUSIONS: Of the injectable, infused, and oral DMTs evaluated in this review, all provided a significant clinical benefit for relapse rate reduction. Since comparators differed, further comparison studies are warranted.