Abstract
Purpose :
Several early intervention drugs are being tested in clinical trials for the early intervention in patients with clinically isolated syndrome (CIS) which may leads to Multiple Sclerosis (MS). The aim of the present study was to systematically evaluate the effect of drugs on the progression of CIS to MS.
Methods :
The systematic review included an electronic search of EMBASE, MEDLINE, PUBMED, Clinicaltrials.gov and Cochrane databases to include all available placebo-controlled randomized clinical trials (RCT) of early intervention of CIS progression to clinically defined MS (CDMS) or Defined MS (DMS), comparing the treated group patients versus non treated group (Placebo) that reported absolute numbers or percentages of progression during each study, from January 1, 2007 through November 1, 2018. Observational studies, case series, case reports, RCTs without placebo subgroups, and studies reporting the use of drugs that has not being completed or terminated or still under recruitment or are not still officially approved were excluded. The Risk ratios (RRs), Od rations (ODs), 95 % CI and p values were calculated in each study protocol to express the comparison of the treated group to the placebo group. Publication bias was evaluated.
Results :
Database search yielded to only 6 potential related eligible RCTs that met the inclusion criteria of a total of 1569 participants for the meta-analysis study. Drug treated group were found to have significantly lower risk of progression compared to placebo ( RR= 0.675, 95 % CI:0.605-0.753; P<0.001, and an Odd Ratio (OR), OR =0.373, 95 % 0.251-0.554; P < 0.001) were calculated. This data suggests that early intervention lead to 32.5 % reduction in the risk of conversion of CIS to CDMS or DMS and 37.3 % reduction in the odds of conversion of CIS to CDMS or DMS. No evidence of statistical heterogeneity was found ( I2= 21.495 %, p= 0.272). Moreover, no evidence of publication bias was detected in the funnel plot inspection or in the Egger’s statistical test (p=0.45).
Conclusions :
The treatment group was found to have lower risk of progression to develop to CDMS or DMS than the untreated group, and due to the fact that individuals who were treated early tend to have better outcome, we suggest that intervention early treatment should be routinely considered.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.