Disease-modifying treatments and cognition in relapsing-remitting multiple sclerosis
- 2 June 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurology
- Vol. 94 (22), E2373-E2383
- https://doi.org/10.1212/wnl.0000000000009522
Abstract
Objective Disease-modifying treatments (DMTs) are the gold standard for slowing disability progression in multiple sclerosis (MS), but their effects on cognitive impairment, a key symptom of the disease, are mostly unknown. We conducted a systematic review and meta-analysis to evaluate the differential effects of DMTs on cognitive test performance in relapsing-remitting MS (RRMS). Methods PubMed, Scopus, and Cochrane Library were searched for studies reporting longitudinal cognitive performance data related to all major DMTs. The standardized mean difference (Hedges g) between baseline and follow-up cognitive assessment was used as the main effect size measure. Results Forty-four studies, including 55 distinct MS patient samples, were found eligible for the systematic review. Twenty-five studies were related to platform therapies (mainly β-interferon [n = 17] and glatiramer acetate [n = 4]), whereas 22 studies were related to escalation therapies (mainly natalizumab [n = 14] and fingolimod [n = 6]). Reported data were mostly confined to the cognitive domain processing speed. A meta-analysis including 41 studies and 7,131 patients revealed a small to moderate positive effect on cognitive test performance of DMTs in general (g = 0.27, 95% confidence interval [CI] = [0.21–0.33]), but no statistically significant differences between platform (g = 0.27, 95% CI = [0.18–0.35]) and escalation therapies (g = 0.28, 95% CI = [0.19–0.37]) or between any single DMT and β-interferon. Conclusions DMTs are effective in improving cognitive test performance in RRMS, but a treatment escalation mainly to amend cognition is not supported by the current evidence. Given the multitude of DMTs and their widespread use, the available data regarding differential treatment effects on cognitive impairment are remarkably scant. Clinical drug trials that use more extensive cognitive outcome measures are urgently needed.This publication has 56 references indexed in Scilit:
- A single nucleotide polymorphism in the coding region of PGC-1α is a male-specific modifier of Huntington disease age-at-onset in a large European cohortBMC Neurology, 2014
- Natalizumab Treatment Reduces Fatigue in Multiple Sclerosis. Results from the TYNERGY Trial; A Study in the Real Life SettingPLOS ONE, 2013
- Positive Outcomes Influence the Rate and Time to Publication, but Not the Impact Factor of Publications of Clinical Trial ResultsPLOS ONE, 2013
- Perceptions and Experiences of Research Participants on Gender-Based Violence Community Based Survey: Implications for Ethical GuidelinesPLOS ONE, 2012
- Impact of Natalizumab on Cognitive Performances and Fatigue in Relapsing Multiple Sclerosis: A Prospective, Open-Label, Two Years Observational StudyPLOS ONE, 2012
- Relevance of cognitive deterioration in early relapsing-remitting MS: a 3-year follow-up studyMultiple Sclerosis Journal, 2010
- Natalizumab efficacy on cognitive impairment in MSNeurological Sciences, 2010
- Cytokine polymorphisms and Alzheimer disease: possible associationsNeurological Sciences, 2010
- Electrophysiological, Neuropsychological and Clinical Findings in Multiple Sclerosis Patients Receiving Interferon β-1b: A 1-Year Follow-UpEuropean Neurology, 2000