Abstract Details

Title Comparative Efficacy of 35 Disease-modifying Therapies in Relapsing-remitting MS: A Network Meta-analysis Identifying Top Performers for Relapse, MRI Activity, and Disability Progression

Topic Multiple Sclerosis

Presentation(s) P4 - Poster Session 4 (8:00 AM-9:00 AM)

Poster/Presentation
Number 20-001

Objective This network meta-analysis evaluates the comparative efficacy of 35 DMTs in addressing relapses, reducing radiological burden, and mitigating disability progression.

Background Relapsing-remitting multiple sclerosis (RR-MS) is an immune-mediated inflammatory demyelinating disease. The broad spectrum of disease-modifying therapies (DMTs) reflects a trajectory toward personalized treatment.

Design/Methods A systematic literature search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library for relevant studies published up to August 2025. Two independent reviewers extracted data from the eligible studies, extracting baseline data, treatment protocols, follow-up duration, and clinical and radiological outcomes (EDSS and T1/T2 lesion counts). The statistical analyses were performed using R v4.3.3.

Results

We collected 5,627 records from four databases after excluding 577 duplicates, with 67 articles included in the final analysis. Among the 35 studied DMTs, Alemtuzumab was superior in reducing relapse rates at 24 months (MD -1.02) and in maintaining a 12-month relapse-free state compared to placebo (RR 3.28) and other DMTs. Compared to placebo, the top-tier DMTs for relapse reduction were Alemtuzumab, Biosimilar Ocrelizumab (MD -0.84), Originator Ocrelizumab (MD -0.80), and Mitoxantrone (MD -0.73). For MRI outcomes, the combination of Ponesimod and DMF was most effective at reducing T1 lesions (MD -2.15), while Biosimilar Natalizumab (RR 2.86) and its originator (RR 2.66) were the best for preventing new T2 lesions. Disability progression varied by time. At 6 months, SC IFNbeta-1b (RR 0.14) and SC Ofatumumab (RR 0.33) were associated with the lowest disability progression. At 12 and 24 months, Mitoxantrone was associated with the lowest risk (RR 0.06 for both) of disability progression. Alemtuzumab was also the most effective at reducing EDSS at 6 and 12 months.

Conclusions Alemtuzumab and the Ocrelizumab formulations were highly effective for relapse prevention, while Ponesimod + DMF and Natalizumab formulations reduced MRI lesions. Mitoxantrone was associated with long-term prevention of disability progression.

Authors/Disclosures
Mohamed Mamdouh PRESENTER	Mr. Mamdouh has nothing to disclose.
Ahmed H. Fathallah, MBBS	Dr. Fathallah has nothing to disclose.
Ibrahim Kamal, MD	Dr. Kamal has nothing to disclose.
Mohamed N. Galal	Dr. Galal has nothing to disclose.
Mohamed Nasser Elshabrawi, MBBS	Dr. Elshabrawi has nothing to disclose.
Abdulrahman A. Albalasy, MD	Mr. Albalasy has nothing to disclose.
John M. Daniel, MBBS	Dr. Daniel has nothing to disclose.
Omar F. Abbas	Omar F. Abbas has nothing to disclose.
Esraa H. Ragaey, Medical Intern	Miss Ragaey has nothing to disclose.
Hossam T. Ali, MD (Qena Faculty of Medicine)	Dr. Ali has nothing to disclose.
Dalia A. Abouda	Dr. Abouda has nothing to disclose.
Mahmoud A. Abdelhameed Ahmed	Dr. Abdelhameed Ahmed has nothing to disclose.
Mohamed Nabil Nady, MBBS	Dr. Nabil Nady has nothing to disclose.

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