Journal Club Promising New Treatment Regimens For Multiple Sclerosis |
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In 2002 guidelines were published for treatments aimed at improving the course of Multiple Sclerosis.1 The Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the MS Council for Clinical Practice Guidelines set clear interpretation guidelines and cautions for studies that evaluate treatments.2 They suggested that because most studies have duration of two years or less short-term endpoints should be used. In addition, a p-value of less than 0.01 is more appropriate to demonstrate a beneficial effect of a treatment while a p value between 0.01 and 0.05 could be considered marginal. Studies should also be powered to detect any parameters such as disease progression, and even though an effect may be statistically insignificant because of a lower enrollment, it does not necessarily mean that the effect does not exist. A combination of outcome criteria, including objective (eg, magnetic resonance imaging or MRI) and more subjective measures (eg, clinical evaluation) may provide a stronger basis for results. Data evaluation should include a report of the effect size to demonstrate a level of clinical importance as well as statistical significance. In addition, because treatments are aimed at slowing or halting further nerve damage and functional decline, it is not expected that treatments will show reversal of existing damage or significant clinical improvement. Instead, outcome measures typically describe a reduction in the number of attacks or in the progressive decline compared to other treatments or non-treatment. Therapies for the various types of MS have included immunosuppressive agents, immunomodulators, and anti-inflammatory medications. The 2002 guidelines served as an evidence-base for the following summaries on the strongest recommendations for MS-targeted treatments:
This Journal Club will review recent studies that discuss treatments with IFNß-1a (Avonex3 and Rebif4) and an investigations treatment with the humanized monoclonal antibody natalizumab (Antegren5). |
Click on the link at left to go to your desired page: Introduction Page 2 Page 3 Study 1 Study 2 Conclusion Post-Test
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