Several disease-modifying treatments increase seizure risk in multiple sclerosis and meta-analyses of randomised trials do not really disagree on this In their JNNP meta-analysis Pozzilli et al concludes that sphingosine-1-phosphate receptor (S1PR) modulators substantially increase seizure risk in multiple sclerosis.1 Conversely, another meta-analysis by Dang et al2 recently concluded that ‘no evidence of association was found between disease-modifying therapy and seizure risk’. Both meta-analyses focused on randomised controlled trials, but used different selection criteria. Pozzilli et al were more restrictive in some regards (including large, long-term phase III trials rather than accepting any phase II or III trial); but less restrictive regarding comparisons (including not only placebo-controlled, but also active-controlled trials). Pozzilli et al furthermore performed meta-analysis of pairwise comparisons that involved a S1PR modulator, while Dang et al preferred network meta-analysis considering all treatments. One may debate which team made the best choices….
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This post is Copyright: Ioannidis, J. P. | June 17, 2024