Interferon beta for secondary progressive multiple sclerosis.


BACKGROUND:Therapy with either recombinant beta-1a or beta-1b interferons (IFNs) is worldwide approved for Relapsing Remitting Multiple Sclerosis (RRMS). A major unanswered question is whether this treatment is able to safely reverse or retard the progressive phase of the disease. OBJECTIVES:The main objective was to verify whether IFNs treatment in Secondary Progressive Multiple Sclerosis (SPMS) is more effective than placebo in reducing the number of patients who experience disability progression. SEARCH METHODS:We searched the Cochrane Multiple Sclerosis Group's Trials Register (1995 to 15 February 2011), the reference lists of relevant articles and conference proceedings. Regulatory agencies were used as additional sources of information. SELECTION CRITERIA:We included all randomised, double or single blind, placebo-controlled trials (RCTs) evaluating the efficacy of IFNs versus placebo in SPMS patients. DATA COLLECTION AND ANALYSIS:Two review authors independently assessed all reports retrieved from the search. They independently extracted clinical, safety and MRI data, using a predefined data extraction form, resolving disagreements after discussion with a third reviewer. Risk of bias was evaluated to assess the quality of the studies. Treatment effect was measured using Risk Ratio (RR) with 95% confidence intervals (CI) for the binary outcomes and Standard Mean Difference with 95% CI for the continuous outcomes. MAIN RESULTS:Five RCTs met the inclusion criteria, from which 3122 (1829 IFN and 1293 placebo) treated patients contributed to the analysis. Included population was heterogeneous in terms of baseline clinical characteristics of the disease, in particular the percentage of patients affected by secondary progression with superimposed relapse ranging from 72% to 44%. IFN beta 1a and 1b did not decrease the risk of progression sustained at 6 months (RR, 95% CI: 0.98, [0.82-1.16]) after three years of treatment. A significant decrease of the risk of progression sustained at 3 months (RR, 95% CI: 0.88 [0.80, 0.97]) and of the risk of developing new relapses at three years (RR 0.91, [0.84-0.97]) were found. The risk of developing new active brain lesions decreased over time but this data was obtained from single studies on Magnetic Resonance Imaging (MRI), performed in subgroups of patients; in spite of no effect on progression, the radiological data supported an effect on MRI parameters. The safety profile reflects what is commonly reported in MS IFN-treated patients. AUTHORS' CONCLUSIONS:Well designed RCTs, evaluating a high number of patients were included in the review. Recombinant IFN beta does not prevent the development of permanent physical disability in SPMS. We were unable to verify the effect on cognitive function for the lack of comparable data. This treatment significantly reduces the risk of relapse and of short -term relapse-related disability.Overall, these results show that IFNs' anti-inflammatory effect is unable to retard progression, when established. In the future, no new RCTs for IFNs versus placebo in SPMS will probably be undertaken, because research is now focusing on innovative drugs. We believe that this review gives conclusive evidence on the clinical efficacy of IFNs versus placebo in SPMS.


La Mantia L,Vacchi L,Di Pietrantonj C,Ebers G,Rovaris M,Fredrikson S,Filippini G




Has Abstract


2012-01-18 00:00:00








  • Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: a mixed methods systematic review.

    abstract:BACKGROUND:Evidence from disease epidemics shows that healthcare workers are at risk of developing short- and long-term mental health problems. The World Health Organization (WHO) has warned about the potential negative impact of the COVID-19 crisis on the mental well-being of health and social care professionals. Symp...

    journal_title:The Cochrane database of systematic reviews

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    authors: Pollock A,Campbell P,Cheyne J,Cowie J,Davis B,McCallum J,McGill K,Elders A,Hagen S,McClurg D,Torrens C,Maxwell M

    更新日期:2020-11-05 00:00:00

  • Interim PET-results for prognosis in adults with Hodgkin lymphoma: a systematic review and meta-analysis of prognostic factor studies.

    abstract:BACKGROUND:Hodgkin lymphoma (HL) is one of the most common haematological malignancies in young adults and, with cure rates of 90%, has become curable for the majority of individuals. Positron emission tomography (PET) is an imaging tool used to monitor a tumour's metabolic activity, stage and progression. Interim PET ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析


    authors: Aldin A,Umlauff L,Estcourt LJ,Collins G,Moons KG,Engert A,Kobe C,von Tresckow B,Haque M,Foroutan F,Kreuzberger N,Trivella M,Skoetz N

    更新日期:2020-01-13 00:00:00

  • Primary antifungal prophylaxis for cryptococcal disease in HIV-positive people.

    abstract:BACKGROUND:Cryptococcal disease remains one of the main causes of death in HIV-positive people who have low cluster of differentiation 4 (CD4) cell counts. Currently, the World Health Organization (WHO) recommends screening HIV-positive people with low CD4 counts for cryptococcal antigenaemia (CrAg), and treating those...

    journal_title:The Cochrane database of systematic reviews

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    authors: Awotiwon AA,Johnson S,Rutherford GW,Meintjes G,Eshun-Wilson I

    更新日期:2018-08-29 00:00:00

  • Multifocal versus monofocal intraocular lenses after cataract extraction.

    abstract:BACKGROUND:Good unaided distance visual acuity (VA) is now a realistic expectation following cataract surgery and intraocular lens (IOL) implantation. Near vision, however, still requires additional refractive power, usually in the form of reading glasses. Multiple optic (multifocal) IOLs are available which claim to a...

    journal_title:The Cochrane database of systematic reviews

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    authors: de Silva SR,Evans JR,Kirthi V,Ziaei M,Leyland M

    更新日期:2016-12-12 00:00:00

  • Rutosides for treatment of post-thrombotic syndrome.

    abstract:BACKGROUND:Post-thrombotic syndrome (PTS) is a long-term complication of deep venous thrombosis (DVT) that is characterised by pain, swelling, and skin changes in the affected limb. One in three patients with DVT will develop post-thrombotic sequelae within five years. Rutosides are a group of compounds derived from ho...

    journal_title:The Cochrane database of systematic reviews

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    authors: Morling JR,Yeoh SE,Kolbach DN

    更新日期:2013-04-30 00:00:00

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    abstract:BACKGROUND:Breathlessness is one of the most common symptoms experienced in the advanced stages of malignant and non-malignant disease. Benzodiazepines are widely used for the relief of breathlessness in advanced diseases and are regularly recommended in the literature. However, the evidence for their use for this symp...

    journal_title:The Cochrane database of systematic reviews

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    authors: Simon ST,Higginson IJ,Booth S,Harding R,Bausewein C

    更新日期:2010-01-20 00:00:00

  • Oral steroids for long-term use in cystic fibrosis.

    abstract:BACKGROUND:In cystic fibrosis (CF) airway obstruction and recurrent respiratory infection lead to inflammation, long-term lung damage, respiratory failure and death. Anti-inflammatory agents, e.g. oral corticosteroids are used since inflammation occurs early in disease. OBJECTIVES:To assess the effectiveness of oral c...

    journal_title:The Cochrane database of systematic reviews

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    authors: Cheng K,Ashby D,Smyth RL

    更新日期:2011-10-05 00:00:00

  • Automated monitoring compared to standard care for the early detection of sepsis in critically ill patients.

    abstract:BACKGROUND:Sepsis is a life-threatening condition that is usually diagnosed when a patient has a suspected or documented infection, and meets two or more criteria for systemic inflammatory response syndrome (SIRS). The incidence of sepsis is higher among people admitted to critical care settings such as the intensive c...

    journal_title:The Cochrane database of systematic reviews

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    authors: Warttig S,Alderson P,Evans DJ,Lewis SR,Kourbeti IS,Smith AF

    更新日期:2018-06-25 00:00:00

  • Interventions (other than pharmacological, psychosocial or psychological) for treating antenatal depression.

    abstract:BACKGROUND:Although pregnancy was once thought of as a time of emotional well-being for many women, conferring 'protection' against psychiatric disorders, a recent meta-analysis of 21 studies suggests the mean prevalence rate for depression across the antenatal period is 10.7%, ranging from 7.4% in the first trimester ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Dennis CL,Allen K

    更新日期:2008-10-08 00:00:00

  • Placebo interventions for all clinical conditions.

    abstract:BACKGROUND:Placebo interventions are often claimed to improve patient-reported and observer-reported outcomes, but this belief is not based on evidence from randomised trials that compare placebo with no treatment. OBJECTIVES:To assess the effect of placebo interventions. SEARCH STRATEGY:We searched the Cochrane Cent...

    journal_title:The Cochrane database of systematic reviews

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    authors: Hróbjartsson A,Gøtzsche PC

    更新日期:2004-01-01 00:00:00

  • Surgery versus thrombolysis for initial management of acute limb ischaemia.

    abstract:BACKGROUND:Both peripheral arterial thrombolysis and surgery can be used in the management of peripheral arterial ischaemia. Much is known about the indications, risks, and benefits of thrombolysis. However, whether thrombolysis works better than surgery for initial management of acute limb ischaemia remains unknown. T...

    journal_title:The Cochrane database of systematic reviews

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    authors: Darwood R,Berridge DC,Kessel DO,Robertson I,Forster R

    更新日期:2018-08-10 00:00:00

  • Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more).

    abstract:BACKGROUND:Prelabour rupture of membranes (PROM) at term is managed expectantly or by planned early birth. It is not clear if waiting for birth to occur spontaneously is better than intervening, e.g. by inducing labour. OBJECTIVES:The objective of this review is to assess the effects of planned early birth (immediate ...

    journal_title:The Cochrane database of systematic reviews

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    authors: Middleton P,Shepherd E,Flenady V,McBain RD,Crowther CA

    更新日期:2017-01-04 00:00:00

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    abstract:BACKGROUND:Usual-type vulval intraepithelial neoplasia (uVIN) is a pre-cancerous condition of the vulval skin. Also known as high-grade VIN, VIN 2/3 or high-grade vulval squamous intraepithelial lesion (HSIL), uVIN is associated with high-risk subtype human papilloma virus (HPV) infection. The condition causes distress...

    journal_title:The Cochrane database of systematic reviews

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    authors: Lawrie TA,Nordin A,Chakrabarti M,Bryant A,Kaushik S,Pepas L

    更新日期:2016-01-05 00:00:00

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    abstract:BACKGROUND:Thalassaemia is a recessively-inherited blood disorder that leads to anaemia of varying severity. In those affected by the more severe forms, regular blood transfusions are required which may lead to iron overload. Accumulated iron from blood transfusions may be deposited in vital organs including the heart,...

    journal_title:The Cochrane database of systematic reviews

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    authors: Ngim CF,Lai NM,Hong JY,Tan SL,Ramadas A,Muthukumarasamy P,Thong MK

    更新日期:2017-09-18 00:00:00

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    abstract:BACKGROUND:Proponents of therapeutic ultrasound suggest it can decrease pain by resolution of inflammation processes and reducing the pressure on pain sensitive structures by haematoma and oedema. OBJECTIVES:The objective of this review was to assess the effects of therapeutic ultrasound for treating acute perineal pa...

    journal_title:The Cochrane database of systematic reviews

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    authors: Hay-Smith EJ

    更新日期:2000-01-01 00:00:00

  • Vitamin E supplementation in people with cystic fibrosis.

    abstract:BACKGROUND:People with cystic fibrosis are at an increased risk of fat-soluble vitamin deficiency, including vitamin E. Vitamin E deficiency can cause a host of conditions such as haemolytic anaemia, cerebellar ataxia and cognitive difficulties. Vitamin E supplementation is widely recommended for people with cystic fib...

    journal_title:The Cochrane database of systematic reviews

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    authors: Okebukola PO,Kansra S,Barrett J

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  • Serenoa repens for benign prostatic hyperplasia.

    abstract:OBJECTIVES:This systematic review aimed to assess the effects of Serenoa repens in the treatment of Benign Prostatic Hyperplasia (BPH). SEARCH STRATEGY:Trials were searched in computerized general and specialized databases (MEDLINE, EMBASE, Cochrane Library, Phytodok), by checking bibliographies, and by contacting man...

    journal_title:The Cochrane database of systematic reviews

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    authors: Wilt T,Ishani A,Stark G,MacDonald R,Mulrow C,Lau J

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  • Chinese herbal medicine for schizophrenia.

    abstract:BACKGROUND:Traditional Chinese medicine (TCM) was the main form of treatment in China for psychiatric illnesses until the development of antipsychotic drugs in the 1950's. Antipsychotic drugs have become the primary intervention for schizophrenia, although herbal medicines can still form part of the treatment. OBJECTI...

    journal_title:The Cochrane database of systematic reviews

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    authors: Rathbone J,Zhang L,Zhang M,Xia J,Liu X,Yang Y

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  • Written action plans for asthma in children.

    abstract:BACKGROUND:While all asthma consensus statements recommend the use of written action plan (WAP) as a central part of asthma management, a recent systematic review of randomised trials highlighted the paucity of trials where the only difference between groups was the provision or not of a written action plan. OBJECTIVE...

    journal_title:The Cochrane database of systematic reviews

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    authors: Bhogal S,Zemek R,Ducharme FM

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    abstract:BACKGROUND:Reducing the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a global priority. Contact tracing identifies people who were recently in contact with an infected individual, in order to isolate them and reduce further transmission. Digital technology could be implemented to augm...

    journal_title:The Cochrane database of systematic reviews

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    authors: Anglemyer A,Moore TH,Parker L,Chambers T,Grady A,Chiu K,Parry M,Wilczynska M,Flemyng E,Bero L

    更新日期:2020-08-18 00:00:00

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    journal_title:The Cochrane database of systematic reviews

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    authors: Barsam A,Allan BD

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  • Bronchodilators delivered by nebuliser versus pMDI with spacer or DPI for exacerbations of COPD.

    abstract:BACKGROUND:Bronchodilators are a central component for treating exacerbations of chronic obstructive pulmonary disease (COPD) all over the world. Clinicians often use nebulisers as a mode of delivery, especially in the acute setting, and many patients seem to benefit from them. However, evidence supporting this choice ...

    journal_title:The Cochrane database of systematic reviews

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    authors: van Geffen WH,Douma WR,Slebos DJ,Kerstjens HA

    更新日期:2016-08-29 00:00:00

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    abstract:BACKGROUND:Unconditional cash transfers (UCTs) are a common social protection intervention that increases income, a key social determinant of health, in disaster contexts in low- and middle-income countries (LMICs). OBJECTIVES:To assess the effects of UCTs in improving health services use, health outcomes, social dete...

    journal_title:The Cochrane database of systematic reviews

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    authors: Pega F,Liu SY,Walter S,Lhachimi SK

    更新日期:2015-09-11 00:00:00

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    journal_title:The Cochrane database of systematic reviews

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    更新日期:2013-06-05 00:00:00

  • Gene therapy for sickle cell disease.

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    journal_title:The Cochrane database of systematic reviews

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    authors: Olowoyeye A,Okwundu CI

    更新日期:2010-08-04 00:00:00

  • Natalizumab for induction of remission in Crohn's disease.

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    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: MacDonald JK,McDonald JW

    更新日期:2007-01-24 00:00:00

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    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审


    authors: Lepine S,McDowell S,Searle LM,Kroon B,Glujovsky D,Yazdani A

    更新日期:2019-07-30 00:00:00

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    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Cluver C,Gyte GM,Sinclair M,Dowswell T,Hofmeyr GJ

    更新日期:2015-02-09 00:00:00

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    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审


    authors: Webster J,Pritchard MA

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    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析


    authors: Wolfenden L,Goldman S,Stacey FG,Grady A,Kingsland M,Williams CM,Wiggers J,Milat A,Rissel C,Bauman A,Farrell MM,Légaré F,Ben Charif A,Zomahoun HTV,Hodder RK,Jones J,Booth D,Parmenter B,Regan T,Yoong SL

    更新日期:2018-11-14 00:00:00