Copaxone, Rebif slightly better than A & B in reducing relapses?

[agate]

A 3.5-year study of over 3,000 MS patients, each taking one of the 4 injectable immunomodulatory drugs (Rebif, Copaxone, Betaseron, Avonex) has shown Copaxone and Rebif to have a "slightly lower relapse incidence" compared to Avonex and Betaseron.

Is this a reliable study, I'm wondering? Some years back there was a Cochrane review study indicating that there was no evidence to support Copaxone's effectiveness in treating MS, and there have been studies showing it to be effective but not usually as effective as the interferons. Now this study seems to show that it beats Avonex and Betaseron ever so slightly when it comes to relapses.



From Multiple Sclerosis Journal, December 5, 2014:

Quote

Comparative effectiveness of glatiramer acetate and interferon beta formulations in relapsing–remitting multiple sclerosis

Tomas Kalincik
Department of Medicine, University of Melbourne, Melbourne, Australia and Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia

Vilija Jokubaitis
Department of Medicine, University of Melbourne, Melbourne, Australia and Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia

Guillermo Izquierdo
Hospital Universitario Virgen Macarena, Sevilla, Spain

Pierre Duquette
Hôpital Notre Dame, Montreal, Canada

Marc Girard
Hôpital Notre Dame, Montreal, Canada

Pierre Grammond
Hotel-Dieu de Levis, Quebec, Canada

Alessandra Lugaresi
MS Center, Neuroscience, Imaging and Clinical Sciences, University ‘G. d’Annunzio’, Chieti, Italy

Celia Oreja-Guevara
University Hospital San Carlos, IdISSC, Madrid, Spain

Roberto Bergamaschi
National Neurological Institute C. Mondino, Pavia, Italy

Raymond Hupperts
Orbis Medical Center, Sittard, the Netherlands

Francois Grand’Maison
Neuro Rive-Sud, Hôpital Charles LeMoyne, Quebec, Canada

Eugenio Pucci
Ospedale di Macerata, Macerata, Italy

Vincent Van Pesch
Cliniques Universitaires Saint-Luc, Brussels, Belgium

Cavit Boz
Karadeniz Technical University, Trabzon, Turkey

Gerardo Iuliano
Ospedali Riuniti di Salerno, Salerno, Italy

Ricardo Fernandez-Bolanos
Hospital Universitario Virgen de Valme, Seville, Spain

Shlomo Flechter
Assaf Harofeh Medical Center, Beer-Yaakov, Israel

Daniele Spitaleri
AORN San Giuseppe Moscati, Avellino, Italy

Edgardo Cristiano
Hospital Italiano, Buenos Aires, Argentina

Freek Verheul
Groen Hart Ziekenhuis, Gouda, the Netherlands

Jeannette Lechner-Scott
John Hunter Hospital, Newcastle, Australia

Maria Pia Amato
Department NEUROFARBA, Section of Neurosciences, University of Florence, Florence, Italy

Jose Antonio Cabrera-Gomez
Centro Internacional de Restauracion Neurologica, Havana, Cuba

Maria Laura Saladino
INEBA, Buenos Aires, Argentina

Mark Slee
Flinders University and Medical Centre, Adelaide, Australia

Fraser Moore
Jewish General Hospital, Montreal, Canada

Orla Gray
Craigavon Area Hospital, Portadown, UK

Mark Paine
St Vincent’s Hospital, Melbourne, Australia

Michael Barnett
Brain and Mind Research Institute, Sydney, Australia

Eva Havrdova
Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine, General University Hospital and Charles University in Prague, Czech Republic

Dana Horakova
Department of Neurology and Center of Clinical Neuroscience, 1st Faculty of Medicine, General University Hospital and Charles University in Prague, Czech Republic

Timothy Spelman
Department of Medicine, University of Melbourne, Melbourne, Australia and Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia

Maria Trojano*
Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy

These authors contributed equally to the manuscript:

Helmut Butzkueven*
Department of Medicine, University of Melbourne, Melbourne, Australia, Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia, and Department of Neurology, Box Hill Hospital, Monash University, Box Hill, Australia

On behalf of the MSBase Study Group

Department of Medicine, University of Melbourne, Melbourne, Australia, and Department of Neurology, Royal Melbourne Hospital, Melbourne, L4 Centre, Melbourne Brain Centre at Royal Melbourne Hospital, Grattan St, Parkville VIC 3050, Australia.tomas.kalincik@unimelb.edu.au

Background:

The results of head-to-head comparisons of injectable immunomodulators (interferon β, glatiramer acetate) have been inconclusive and a comprehensive analysis of their effectiveness is needed.

Objective:

We aimed to compare, in a real-world setting, relapse and disability outcomes among patients with multiple sclerosis (MS) treated with injectable immunomodulators.

Methods:

Pairwise analysis of the international MSBase registry data was conducted using propensity-score matching. The four injectable immunomodulators were compared in six head-to-head analyses of relapse and disability outcomes using paired mixed models or frailty proportional hazards models adjusted for magnetic resonance imaging variables. Sensitivity and power analyses were conducted.

Results:

Of the 3326 included patients, 345–1199 patients per therapy were matched (median pairwise-censored follow-up was 3.7 years). Propensity matching eliminated >95% of the identified indication bias. Slightly lower relapse incidence was found among patients treated with glatiramer acetate or subcutaneous interferon β-1a relative to intramuscular interferon β-1a and interferon β-1b (p≤0.001). No differences in 12-month confirmed progression of disability were observed.

Conclusion:


Small but statistically significant differences in relapse outcomes exist among the injectable immunomodulators. MSBase is sufficiently powered to identify these differences and reflects practice in tertiary MS centres. While the present study controlled indication, selection and attrition bias, centre-dependent variance in data quality was likely.

Link to the abstract (if it works without subscriber-only access):

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[renee]

Shlomo Flechter is disqualified because he's in Israel rooting for Copaxone, the home-team product.
Freek Verheul from Gouda, Netherlands is disqualified because he can't possibly be a real person.

The results surprise me for all the poo-pooing of Copaxone that I have heard.

Interferons make me sick and crazy.
I feel better about injecting Copaxone, now.

Tanx.

[SuzE-Q]

That's what I've always suspected, probably because of anecdotal evidence from so many MSer's thru the years of their experiences.

Glad someone did this study, it is long overdue.

[SuzE-Q]

Lol@Renee.

I just love how you can inject such excellent humor into an otherwise very dry, academic discussion.

[agate]

Thanks for the author info, renee! The only name that rang a bell with me was Havrdova.

Sorry about the dry-as-dust thread. I'd been sitting on this post for days, starting to post it but deleting it. You can think of it as filler, maybe.

[SuzE-Q]

I didn't mean that in a bad way, Joan!

In my experience, I don't often get a lot of discussion in the informational posts that I post, not that I expect it since I typically share any new info I come across for interest's sake alone.

That's why it is always a delight to me when I am thrown off course by a funny remark that I wasn't expecting. I really enjoy being startled like that, in a good way. I love it when people see the funny in something that wouldn't ordinarily BE funny, It's an outlook on life that I aspire to. I saw your post as serious and informational (not a bad thing), someone else found the humor imbedded in it that gave me a smile too.

I wasn't meaning anything negative about your post, agate or in my use of the word "dry", I hope I didn't offend you, I always appreciate learning new info myself!

[agate]

Not at all!

You have to marvel at the long list of authors' names on some of these articles and wonder how much each person actually contributed. Maybe one person inserted a comma somewhere and got his/her name listed as an author.