Twenty-two RCTs (with a total of n=3629 participants) and two systematic reviews were included. Six cost-utility studies were also discussed.
Azathioprine (n=2 RCTs, n=1 systematic review):
Jadad quality score=2-4.
CRD NHS quality score=4.
Results suggested azathioprine may reduce rates of relapse in patients with relapsing-remitting, relapsing-progressive and progressive MS. However, side-effects were common, particularly gastrointestinal disorders, and these may affect compliance.
Beta interferon (n=3 RCTs):
Jadad quality score=4-5.
There was evidence of limited benefit in relapsing-remitting and secondary progressive MS, respectively although all three trials had methodological limitations. Side-effects were common, particularly flu-like symptoms and injection site reactions.
Cladribine (n=2 RCTs):
Jadad quality score=3.
Results suggested that cladribine may be effective in delaying disease progression in chronic progressive MS but no significant treatment effect was found in disease progression or relapse rate in relapsing-remitting MS.
Cyclophosphamide (n=5 RCTs):
Jadad quality score=1-4.
One study suggested that in progressive MS cyclophosphamde combined with adenocorticotrophic hormone may be of some benefit, while another suggested that boosters of cyclophosphamide may slow progression. A wide range of side-effects were reported in all studies.
Glatiramer (n=2 RCTs, n=1 systematic review):
Jadad quality score=3.
CRD NHS quality socre=3.
The results suggested that relapse rate may be reduced by glatiramer treatment but the size of the benefit was not clear.
Intravenous immunoglobulin (n=3 RCTs):
Jadad quality score=3-5.
The results suggested that relapse rate may be significantly reduced by intravenous immunoglobulin therapy at 3yrs. A wide range of adverse effects was commonly reported.
Methotrexate (n=2 RCTs):
Jadad quality score=2-4.
The results suggested a treatment effect in chronic progressive MS only when using a composite outcome measure of treatment failure. Side-effects were similar to those reported for placebo.
Mitoxantrone (n=2 RCTs):
Jadad quality score=3-4.
Results suggested the mitoxantrone may be of benefit in disability progression and relapse rate, although one study was of short duration and combined mitoxantrone with methylprednisolone. A range of side-effects was reported.