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Can we measure long-term treatment effects in multiple sclerosis?

Nature Reviews Neurology volume 11, pages 176–182 (2015)Cite this article

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Abstract

The gold standard for measuring treatment effects is the randomized controlled trial. In patients with multiple sclerosis (MS), trial durations are typically 2–3 years, and the long-term effects of drugs for MS can only be assessed through trial extensions or observational studies that take advantage of data from registries or large single-centre databases. The main limitation of observational studies is an unavoidable selection bias that is introduced through nonrandom assignment of the intervention. Propensity score methods can mitigate this bias by balancing the groups with respect to baseline covariates, but this approach cannot correct for unmeasurable confounding factors. Extensions of clinical trials are free from selection biases because of the initial randomization, but they can only provide an assessment of early versus delayed treatment effects. Here, we discuss these methodological issues and analyse how they have been managed in studies of the long-term effects of IFN-β in patients with MS.

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Figure 1: Adjusting for baseline covariates.

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Authors and Affiliations

  1. Department of Health Sciences (DISSAL), University of Genoa, Via Pastore 1, Genoa, 16132, Italy

    Maria Pia Sormani

  2. Unit of Clinical Epidemiology IRCCS San Marino–IST, National Cancer Research Institute, Largo Rosanna Benzi, Genoa, 16132, Italy

    Paolo Bruzzi

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  1. Maria Pia Sormani
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  2. Paolo Bruzzi
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Both authors researched data for the article, discussed the content, wrote the article, and reviewed and edited the manuscript before submission.

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Correspondence to Maria Pia Sormani.

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Competing interests

M.P.S. has acted as a consultant for Actelion, Biogen Idec, Genzyme, Merck Serono, Novartis, Roche, Synthon and Teva. P.B. has consulted for Novartis, and provided teaching courses for Merck Serono and Roche.

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Sormani, M., Bruzzi, P. Can we measure long-term treatment effects in multiple sclerosis?. Nat Rev Neurol 11, 176–182 (2015). https://doi.org/10.1038/nrneurol.2014.237

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