Alemtuzumab, Cladribine, Fingolimod, Natalizumab, and Rituximab as First-Line Treatments in Adults With Highly Active Relapsing-Remitting Multiple Sclerosis

Table of Contents

• Abbreviations 7
• Executive Summary 8
• Background and Policy Context 8
• Clinical Evidence 8
• Limitations 9
• Conclusions and Implications for Decision- or Policy-Making 9
• Introduction and Rationale 9
• Background and Rationale 9
• Clinical Review Methods 15
• Project Scope 15
• Objective 15
• Policy Question 15
• Research Question 15
• Review Conduct 16
• Eligibility Criteria 16
• Literature Search Methods 19
• Study Selection Process 19
• Data Extraction 20
• Risk of Bias Assessments 21
• Data Analysis and Synthesis 21
• Results of Clinical Evaluation 22
• Selection of Primary Studies 22
• Study and Patient Characteristics 23
• Summary of Risk of Bias Assessment 28
• Data Analysis and Synthesis 30
• Discussion 38
• Summary of the Evidence 38
• Interpretation of Clinical Results From the Systematic Review 39
• Additional Considerations 41
• Strengths and Limitations of the Systematic Review 44
• Conclusions and Implications for Decision- or Policy-Making 45
• References 47
• Appendix 1: Literature Search Strategy 51
• Appendix 2: List of Included Studies 63
• Appendix 3: List of Excluded Studies 65
• Appendix 4: Summary of Study Characteristics 76
• Appendix 5: Risk of Bias Assessment 81