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Immunomodulators and immunosuppressants for multiple sclerosis: a network meta-analysis

  1. Graziella Filippini1,*,
  2. Cinzia Del Giovane2,
  3. Laura Vacchi3,
  4. Roberto D'Amico2,
  5. Carlo Di Pietrantonj4,
  6. Deirdre Beecher5,
  7. Georgia Salanti6

Editorial Group: Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group

Published Online: 6 JUN 2013

Assessed as up-to-date: 10 FEB 2012

DOI: 10.1002/14651858.CD008933.pub2


How to Cite

Filippini G, Del Giovane C, Vacchi L, D'Amico R, Di Pietrantonj C, Beecher D, Salanti G. Immunomodulators and immunosuppressants for multiple sclerosis: a network meta-analysis. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD008933. DOI: 10.1002/14651858.CD008933.pub2.

Author Information

  1. 1

    Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, Neuroepidemiology Unit, Milano, Italy

  2. 2

    University of Modena and Reggio Emilia, Statistics Unit, Department of Clinical and Diagnostic Medicine and Public Health, Modena, Italy

  3. 3

    Scientific Institute and University Ospedale San Raffaele, Institute of Experimental Neurology (INSPE), Milano, Italy

  4. 4

    Azienda Sanitaria Locale ASL AL, Servizio Regionale di Riferimento per l'Epidemiologia, SSEpi-SeREMI - Cochrane Vaccines Field, Alessandria, Piemonte, Italy

  5. 5

    London School of Hygiene & Tropical Medicine, Cochrane Injuries Group, London, UK

  6. 6

    University of Ioannina School of Medicine, Department of Hygiene and Epidemiology, Ioannina, Greece

*Graziella Filippini, Neuroepidemiology Unit, Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta, via Celoria, 11, Milano, 20133, Italy. gfilippini@istituto-besta.it.

Publication History

  1. Publication Status: New
  2. Published Online: 6 JUN 2013

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[Figure 1]
Figure 1. Study flow diagrams
[Figure 2]
Figure 2. Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
[Figure 3]
Figure 3. Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
[Figure 4]
Figure 4. Networks of the treatments for recurrence of relapses and disability progression at each time point and acceptability of treatments over 24 months of follow-up
[Figure 5]
Figure 5. Evaluation of consistency within first order closed loops for recurrence of relapses and disability progression at each time point. Difference in log odds ratios between indirect and direct evidence is reported on x-axis.  
[Figure 6]
Figure 6. Forest plot: disability progression over 24 months in MS of all types according to each agent-dose compared to placebo.
[Figure 7]
Figure 7. ‘Comparison-adjusted’ funnel plots. In the horizontal axis the differences between the observed log-odds ratios of each active treatment versus placebo and their summary effect obtained from the pairwise meta-analysis are presented; in the vertical axis the standard errors of the log-odds ratios are presented. Differences on the left of null represent studies with estimates larger than the comparison-specific mean.
[Analysis 1.1]
Analysis 1.1. Comparison 1 Comparisons for relapse over 12 months, Outcome 1 Relapse over 12 months in MS of all types.
[Analysis 1.2]
Analysis 1.2. Comparison 1 Comparisons for relapse over 12 months, Outcome 2 Relapse over 12 months in relapsing-remitting MS.
[Analysis 1.3]
Analysis 1.3. Comparison 1 Comparisons for relapse over 12 months, Outcome 3 Relapse over 12 months in progressive MS.
[Analysis 2.1]
Analysis 2.1. Comparison 2 Comparisons for relapse over 24 months, Outcome 1 Relapse over 24 months in MS of all types.
[Analysis 2.2]
Analysis 2.2. Comparison 2 Comparisons for relapse over 24 months, Outcome 2 Relapse over 24 months in relapsing-remitting MS.
[Analysis 2.3]
Analysis 2.3. Comparison 2 Comparisons for relapse over 24 months, Outcome 3 Relapse over 24 months in progressive MS.
[Analysis 3.1]
Analysis 3.1. Comparison 3 Comparisons for relapse over 36 months, Outcome 1 Relapse over 36 months in MS of all types.
[Analysis 4.1]
Analysis 4.1. Comparison 4 Comparisons for disability progression over 24 months, Outcome 1 Disability progression over 24 months in MS of all types.
[Analysis 4.2]
Analysis 4.2. Comparison 4 Comparisons for disability progression over 24 months, Outcome 2 Disability progression over 24 months in relapse-remitting MS.
[Analysis 4.3]
Analysis 4.3. Comparison 4 Comparisons for disability progression over 24 months, Outcome 3 Disability progression over 24 months in progressive MS.
[Analysis 5.1]
Analysis 5.1. Comparison 5 Comparisons for disability progression over 36 months, Outcome 1 Disability progression over 36 months in progressive MS.
[Analysis 6.1]
Analysis 6.1. Comparison 6 Comparison for adverse events, Outcome 1 Serious adverse events.
[Analysis 6.2]
Analysis 6.2. Comparison 6 Comparison for adverse events, Outcome 2 Withdrawals due to adverse events.