Objectives:
To identify the drug treatments currently
available for the management of spasticity and pain in
multiple sclerosis (MS), and to evaluate their clinical and
cost-effectiveness.
Data sources:
Electronic bibliographic databases,
National Research Register, MRC Clinical Trials Register
and the US National Institutes of Health Clinical Trials
Register.
Review methods:
Systematic searches identified 15
interventions for the treatment of spasticity and 15
interventions for treatment of pain. The quality and
outcomes of the studies were evaluated. Reviews of
the treatment of spasticity and pain when due to other
aetiologies were also sought.
Results:
There is limited evidence of the effectiveness
of four oral drugs for spasticity: baclofen, dantrolene,
diazepam and tizanidine. Tizanidine appears to be no
more effective than comparator drugs such as baclofen
and has a slightly different side-effects profile. Despite
claims that it causes less muscle weakness, there was
very little evidence that tizanidine performed any
better in this respect than other drugs, although it is
more expensive. The findings of this review are
consistent with reviews of the same treatments for
spasticity derived from other aetiologies. There is good
evidence that both botulinum toxin (BT) and intrathecal
baclofen are effective in reducing spasticity, and both
are associated with functional benefit. However, they
are invasive, and substantially more expensive. None of
the studies included in the review of pain were
designed specifically to evaluate the alleviation of pain
in patients with MS and there was no consistency
regarding the use of validated outcome measures. It
was suggested that, although expensive, the use of
intrathecal baclofen may be associated with significant
savings in hospitalisation costs in relation to bed-bound
patients who are at risk of developing pressure sores,
thus enhancing its cost-effectiveness. No studies of
cost-effectiveness were identified in the review
of pain. There is evidence, albeit limited, of the
clinical effectiveness of baclofen, dantrolene,
diazepam, tizanidine, intrathecal baclofen and BT
and of the potential cost-effectiveness of intrathecal
baclofen in the treatment of spasticity
in MS.
Conclusions:
Many of the interventions identified are
not licensed for the alleviation of pain or spasticity in
MS and the lack of evidence relating to their
effectiveness may also limit their widespread use.
Indeed, forthcoming information relating to the use of
cannabinoids in MS may result in there being better
evidence of the effectiveness of new treatments than of
any of the currently used drugs. It may therefore be of
value to carry out double-blind randomised controlled
trials of interventions used in current practice, where
outcomes could include functional benefit and impact
on quality of life. Further research into the
development and validation of outcomes measures for
pain and spasticity may also be useful, as perhaps would
cost–utility studies
Is data on this page outdated, violates copyrights or anything else? Report the problem now and we will take corresponding actions after reviewing your request.