Table 1.
Drugs in secondary progressive multiple sclerosis
| Drug | Year | Studies | Number of patients | MS type | RRR | Reduction in disease progression | Decrease in Gd+/new T2 lesions | Conclusion |
|---|---|---|---|---|---|---|---|---|
| Drugs used in RRMS | ||||||||
| Beta IFN[13] | 2012 | 5 | 1829: IFN beta 1293: Placebo |
SPMS | 0.91 (0.84–0.97) | 0.88 (0.80–0.97) (NS) | No | May be used in early SPMS |
| Glatiramer acetate[14] | 2010 | 6 | 1049 | PMS | 0.81 (0.5–1.29) | −0.45 (NS) | No | May be used in early SPMS |
| Immune suppressive drugs | ||||||||
| Mitoxantrone[15] | 2013 | 1 | 194 | RRMS SPMS |
−0.85 (–1.47–−0.23) | 0.23 (0.09–0.59) | Yes(S) | Is approved in SPMS with ongoing inflammation |
| Azathioprine[16] | 2007 | 5 | 698 | RRMS SPMS |
−0.26 (−0.43–−0.10) | 0.42 (0.07–0.64) | No | Limited evidence |
| Cyclosporine[17] | 1990 | 1 | 273: CSA 274: Placebo |
PMS | 0.765 | 0.17±0.39 (NS) | No | Limited evidence |
| MTX[18] | 2004 | 1 | 31: MTX 29: Placebo |
PMS | NA | 11/31: MTX, 15/29: Placebo (NS) | No | May be used in financial constraints or those with other rheumatological disorders |
| CPP[19,20] | 2007 | 4 | 152 | SPMS | NA | 1.05 (0.79–1.41) | No | May be used |
| 2017 | 1 | 72: CPP 66: MPS |
SPMS | NA | 0.61 (0.31–1.22) (NS) | - | - | |
| Linomide[21] | 2000 | 1 | 715 | SPMS | Terminated early due to ADR | No evidence | ||
| Cladiribine[22] | 2000 | 1 | Cladiribine: 105 Placebo: 54 |
SPMS | NA | 24% versus 33% (NS) | Yes(S) | No clinical evidence |
| Monoclonal antibodies | ||||||||
| NTZ[23] | 2018 | 1 | 439: NTZ 449: Placebo |
SPMS | NA | 0.86 (0.66–0.13) (NS) | No | Limited evidence |
| RTX[24] | - | 1 | RTX: 292 Placebo: 147 | PMS | NA | Mean change in EDSS 0.33 versus 0.45 (NS) | Yes(S) | Limited evidence |
| Alemtuzumab[25] | 2017 | 1 | 15 | SPMS | NA | −0.5 | No | Limited evidence |
| IVIg[26,27] | 2004 | 1 | 159: IVIg 159: Placebo |
SPMS | 0.46 | 1.11 (0.80–1.53) | No | Limited evidence |
| - | 2007 | 1 | 99: SPMS 98: Placebo |
SPMS | 0.50 versus 0.49 (NS) | 48% versus 39% (NS) | - | - |
Gd=Gadolinium, MS=Multiple sclerosis, RRMS=Relapsing-remitting MS, SPMS=Secondary progressive MS, PMS=Progressive MS, MTX=Methotrexate, CPP=Cyclophosphamide, MPS=Methylprednisolone, S=Significant, NS=Nonsignificant, IVIg=Intravenous immune globulin, RTX=Rituximab, RRR=Relative risk reduction, IFN=Interferon, CSA=Cambridge Scientific Abstracts, ADR=Adverse drug reaction, NA=Not available, NTZ=Natalizumab, EDSS=Expanded Disability Status Scale