Home Cómo funciona Idiomas Ingresar a Epistemonikos Búsqueda avanzada Eficacia comparativa de los interferones en la esclerosis múltiple remitente-remitente: un meta-análisis de los estudios del mundo real.

BACKGROUND:

Differences between interferons have been evaluated for over 20 years. While RCT data are mainly used for assessments and strong data for causal inferences, they do not necessarily reflect everyday practice. Real-world data may provide additional information.

PURPOSE:

To assess the results, quality, and representativeness of observational studies directly comparing IFNs in RRMS.

METHODS:

Medline and Embase were searched for observational studies comparing IFN-beta-1a 30 mcg IM (Avonex), IFN-beta-1a 44 mcg SC (Rebif) and/or IFN-beta-1b 250 mcg SC (Betaseron). Outcomes included annualized relapse rate (ARR), proportions relapse-free, confirmed progression-free, treatment persistence, and neutralizing antibodies rates (NABs) measured up to 5 years of treatment. Data were combined using random effects meta-analyses. Categorical values were analyzed using chi-squared and Mann-Whitney tests.

RESULTS:

Thirty-six studies examining 32,026 patients (72.5% females, age = 39.2±3.7 years, disease duration = 5.6±2.0 years) were identified. Thirty-three studies investigated Avonex (N = 11,925), 30 Rebif (N = 10,684) and 34 Betaseron (N = 9,417). Baseline ARRs were similar (1.37±0.35, 1.51±0.27 and 1.55±0.23, respectively; P = 0.101) as were EDSS scores (2.24±0.39, 2.33±0.30, 2.55±0.38; P = 0.070) and >75% were naïve to IFNs. On treatment, ARRs were comparable (Avonex 0.52±0.27, Rebif 0.51±0.24, Betaseron 0.55±0.23; P = 0.595). Proportions of relapse-free patients were similar between drugs (P > 0.05 for all data points), except Rebif was superior to Betaseron in years 3-5 (all P≤0.001). After one year, EDSS scores were comparable; after 2 years, Avonex and Rebif incurred less disease progression than Betaseron (P < 0.02). Confirmed progression-free rates and persistence were similar over 5 years. Fewer patients developed NABs with Avonex (4.7±1.5%) versus Rebif (21.4±2.8%) %; P < 0.001) or Betaseron (32.2%±3.3%); P < 0.001).

CONCLUSIONS:

In this comprehensive meta-analysis of real-world studies in RRMS, Avonex, Rebif and Betaseron had similar clinical profiles. When selecting an IFN, practitioners should consider observational data in their decision making process.