By-Devanshu Sandeep Ganje, Dr. Tharaka Srinatha Dunuwila, Samruddhi Ravindra Dige.-
Volume 1 Issue 1 (May-Aug) 2024, Article 1 (pp.1-10)
Key Points
Question:
What is the comparative efficacy and safety of B-Cell depleting therapies versus T-Cell modulating therapies in the treatment of Multiple Sclerosis?
Findings:
This systematic review analyzed data from randomized controlled trials and observational studies comparing B-Cell depleting therapies (e.g., Rituximab, Ocrelizumab) with T-Cell modulating therapies (e.g., Alemtuzumab, Fingolimod). The review found that B-Cell depleting therapies were associated with a lower relapse rate and fewer MRI-detected lesions, while T-Cell modulating therapies had a higher incidence of adverse events. The differences in primary outcomes were statistically significant.
Meaning:
B-Cell depleting therapies may offer better efficacy and safety profiles compared to T-Cell modulating therapies for treating Multiple Sclerosis, potentially making them a more favorable treatment option.
Abstract
Importance:
Multiple Sclerosis (MS) is a chronic, debilitating neurological disorder that necessitates effective long-term management strategies to mitigate disease progression and improve patient quality of life. The comparative efficacy and safety of B-cell depleting therapies versus T-cell modulating therapies remain critical in determining optimal treatment pathways.
Objective:
This systematic review aims to critically evaluate and compare the efficacy and safety profiles of B-cell depleting therapies, such as Rituximab and Ocrelizumab, against T-cell modulating therapies, including Alemtuzumab and Fingolimod, in patients diagnosed with Multiple Sclerosis. The review focuses on clinical outcomes such as relapse rates, MRI-detected lesion activity, and the incidence of adverse events.
Evidence Review:
A comprehensive literature search was conducted across databases including PubMed, Cochrane Library, Embase, and Web of Science, covering publications from the past 15 years. The search strategy incorporated keywords and medical subject headings (MeSH) related to B-cell and T-cell therapies, MS, efficacy, and safety. Studies were selected based on predetermined inclusion criteria, focusing on randomized controlled trials and observational studies directly comparing the two therapeutic approaches. The quality of included studies was rigorously assessed using the Cochrane Risk of Bias tool for RCTs and the Newcastle-Ottawa Scale for observational studies.
Findings:
The review included 25 studies, comprising 15 randomized controlled trials and 10 cohort studies, with a total of 12,000 MS patients. B-cell depleting therapies were associated with a statistically significant reduction in relapse rates and fewer new or enlarging MRI lesions compared to T-cell modulating therapies. However, T-cell modulating therapies were linked to a higher incidence of adverse events, including severe infections and autoimmune reactions. These findings underscore the superior efficacy of B-cell depleting therapies while highlighting the need for careful monitoring of adverse effects in T-cell modulating therapy patients.
Conclusions and Relevance:
B-cell depleting therapies demonstrate greater efficacy in controlling disease activity in Multiple Sclerosis, with a more favorable safety profile compared to T-cell modulating therapies. These findings suggest that B-cell depleting therapies may be more effective for long-term management of MS, though individualized treatment decisions should consider patient-specific risk factors and comorbidities.
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