Multiple Sclerosis: Study Shows Most Drugs Prescribed For Treatment Of Multiple Sclerosis-Related Cognitive Impairment Do Not Work!
Medical researchers from the Kessler Foundation recently conducted a comprehensive review of pharmacologic agents used in the treatment of multiple sclerosis, seeking evidence for efficacy for the cognitive dysfunction experienced by more than half of affected individuals and found that most of the prescribed drugs do not work.
The research findings were published in the journal: CNS Drugs https://link.springer.com/article/10.1007/s40263-020-00734-4
The researchers are Dr Michelle H. Chen, Ph.D., Dr Helen Genova, Ph.D., and Dr John DeLuca, Ph.D., of Kessler Foundation. Also in the team was Dr Yael Goverover, Ph.D., of New York University, who is a visiting scientist at Kessler Foundation.
The study team identified 87 articles, using the PubMed and PsycINFO databases and the 2017 American Academy of Neurology (AAN) criteria for therapeutic trials. Standardized effect sizes were calculated for comparison across trials.
Drugs and pharmaceuticals from the following therapeutic categories were represented: Disease-modifying therapies (DMTs) (interferon B-1a, B1b, glatiramer acetate, natalizumab, fingolimod); Symptomatic therapies (dalfampridine; cognition enhancers: rivastigmine, Gingko biloba, donepezil; Stimulants: modafinil, armodafinil, methylphenidate, amphetamine sulfate, amantadine); and 'Other' therapies that were neither DMTs nor stimulants (eg, estrogen, methylprednisolone, simvastatin, human erythropoietin).
A detailed review of the studies of DMTs failed to support effectiveness for treating cognitive deficits, with a majority of class III and IV evidence. "We found no class I evidence, and class II evidence was minimal to none," said Dr. Chen, postdoctoral fellow in the Center for Neuropsychology and Neuroscience Research at Kessler Foundation.
Though most of the studies of symptomatic therapies were randomized controlled trials with primary cognitive outcomes (i.e., higher quality evidence), there were contradictory findings, resulting in inconclusive evidence for the cognitive efficacy of symptomatic therapies.
For research involving 'other' agents, there was again insufficient evidence to support their use to treat cognitive problems.
In conclusion, there was insufficient evidence for cognitive efficacy across the spectrum of pharmacologic agents used in the treatment of multiple sclerosis.
Dr Genova, director of the Center for Neuropsychology and Neuroscience Research explained, "Given the impact of cognitive dysfunction on individuals with Multiple Sclerosis, it is prudent to explore the potential for cognitive efficacy of available pharmaceuticals. The design of future studies, especially of DMTs, must focus on cognitive outcomes and follow standardized criteria such as the AAN's. Randomized, controlled studies with cognition as the primary outcomes will provide clinicians with the information they need to choose optimal treatments for patients."
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