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Disease-Modifying Drugs for Multiple Sclerosis: a Rapid and Systematic Review

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Health Technology Assessment 2000; Vol. 4: No. 9 Rapid review Disease-modifying drugs for multiple sclerosis: a rapid and systematic review A Clegg J Bryant R Milne Health Technology Assessment NHS R&D HTA Programme HTA Standing Group on Health Technology Current members Chair: Professor John Gabbay Dr Jeremy Metters Dr John Tripp Professor Kent Woods Director, Wessex Institute Deputy Chief Medical Officer, Senior Lecturer in Child Professor of Therapeutics, for Health Research Department of Health Health, Royal Devon and Exeter University of Leicester & Development Professor Maggie Pearson Healthcare NHS Trust Regional Director of R&D, Professor Sir John Professor Tom Walley Professor Martin Buxton NHS Executive North West Grimley Evans Director, Director & Professor of Professor of Clinical Geratology, Mr Hugh Ross Prescribing Research Group, Health Economics, Radcliffe Infirmary, Chief Executive, University of Liverpool Health Economics Oxford The United Bristol Research Group, Healthcare NHS Trust Dr Julie Woodin Brunel University Dr Tony Hope Professor Trevor Sheldon Clinical Reader in Medicine, Chief Executive, Professor Shah Ebrahim Joint Director, York Health Nuffield Department of Nottingham Health Authority Professor of Epidemiology Policy Group, University of York Clinical Medicine, of Ageing, University of Bristol University of Oxford Professor Mike Smith Professor Francis H Creed Faculty Dean of Research Professor of Professor Richard Lilford for Medicine, Dentistry, Psychological Medicine, Regional Director of R&D, Psychology & Health, Manchester Royal Infirmary NHS Executive West Midlands University of Leeds Past members Professor Sir Miles Irving* Professor John Farndon Professor Michael Maisey Professor Martin Roland Professor of Surgery, Professor of Surgery, Professor of Professor of General Practice, University of Manchester, University of Bristol Radiological Sciences, University of Manchester Hope Hospital, Salford Professor Charles Florey Guy’s, King’s & St Thomas’s School of Medicine & Dentistry, Professor Ian Russell Department of Epidemiology Dr Sheila Adam London Department of Health Sciences Department of Health & Public Health, Ninewells & Clinical Evaluation, Hospital & Medical School, Mrs Gloria Oates University of York Professor Angela Coulter University of Dundee Chief Executive, Director, King’s Fund, Professor Howard Oldham NHS Trust Dr Charles Swan London Glennester Consultant Gastroenterologist, North Staffordshire Professor of Social Science Dr George Poste Royal Infirmary Professor Anthony Culyer & Administration, London Chief Science & Technology Deputy Vice-Chancellor, School of Economics & Officer, SmithKline Beecham University of York Political Science Professor Michael Rawlins Dr Peter Doyle Mr John H James Wolfson Unit of Executive Director, Zeneca Ltd, Chief Executive, Clinical Pharmacology, ACOST Committee on Medical Kensington, Chelsea & University of Newcastle- Research & Health Westminster Health Authority upon-Tyne * Previous Chair Details of the membership of the HTA panels, the NCCHTA Advisory Group and the HTA Commissioning Board are given at the end of this report. HTA How to obtain copies of this and other HTA Programme reports. An electronic version of this publication, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (http://www.hta.ac.uk). A fully searchable CD-ROM is also available (see below). Printed copies of HTA monographs cost £20 each (post and packing free in the UK) to both public and private sector purchasers from our Despatch Agents. Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph. You can order HTA monographs from our Despatch Agents: – fax (with credit card or official purchase order) – post (with credit card or official purchase order or cheque) – phone during office hours (credit card only). Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. Contact details are as follows: HTA Despatch Email: [email protected] c/o Direct Mail Works Ltd Tel: 02392 492 000 4 Oakwood Business Centre Fax: 02392 478 555 Downley, HAVANT PO9 2NP, UK Fax from outside the UK: +44 2392 478 555 NHS libraries can subscribe free of charge. Public libraries can subscribe at a very reduced cost of £100 for each volume (normally comprising 30–40 titles). The commercial subscription rate is £300 per volume. Please see our website for details. Subscriptions can only be purchased for the current or forthcoming volume. Payment methods Paying by cheque If you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit card The following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase order You can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD? Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide. The website also provides information about the HTA Programme and lists the membership of the various committees. Disease-modifying drugs for multiple sclerosis: a rapid and systematic review A Clegg* J Bryant R Milne Wessex Institute for Health Research and Development, University of Southampton, UK * Corresponding author Competing interests: none declared Published May 2000 This report should be referenced as follows: Clegg A, Bryant J, Milne R. Disease-modifying drugs for multiple sclerosis: a rapid and systematic review. Health Technol Assess 2000;4(9). Health Technology Assessment is indexed in Index Medicus/MEDLINE and Excerpta Medica/ EMBASE. Copies of the Executive Summaries are available from the NCCHTA web site (see overleaf). NHS R&D HTA Programme he overall aim of the NHS R&D Health Technology Assessment (HTA) programme is to ensure T that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and work in the NHS. Research is undertaken in those areas where the evidence will lead to the greatest benefits to patients, either through improved patient outcomes or the most efficient use of NHS resources. The Standing Group on Health Technology advises on national priorities for health technology assessment. Six advisory panels assist the Standing Group in identifying and prioritising projects. These priorities are then considered by the HTA Commissioning Board supported by the National Coordinating Centre for HTA (NCCHTA). The research reported in this monograph was commissioned by the HTA programme (project number 99/05/01) on behalf of the National Institute for Clinical Excellence (NICE). Rapid reviews are completed in a limited time to inform the appraisal and guideline development processes managed by NICE. The review brings together evidence on key aspects of the use of the technology concerned. However, appraisals and guidelines produced by NICE are informed by a wide range of sources. Any views expressed in this rapid review are therefore those of the authors and not necessarily those of the HTA programme, NICE or the Department of Health. Reviews in Health Technology Assessment are termed ‘systematic’ when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. Criteria for inclusion in the HTA monograph series Reports are published in the HTA monograph series if (1) they have resulted from work either prioritised by the Standing Group on Health Technology, or otherwise commissioned for the HTA Programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors. Series Editors: Andrew Stevens, Ruairidh Milne, Ken Stein and John Gabbay Monograph Editorial Manager: Melanie Corris The editors have tried to ensure the accuracy of this report but cannot accept responsibility for any errors or omissions. ISSN 1366-5278 © Crown copyright 2000 Enquiries relating to copyright should be addressed to the NCCHTA (see address given below). Published by Core Research, Alton, on behalf of the NCCHTA. Printed on acid-free paper in the UK by The Basingstoke Press, Basingstoke. Copies of this report can be obtained from: The National Coordinating Centre for Health Technology Assessment, Mailpoint 728, Boldrewood, University of Southampton, Southampton, SO16 7PX, UK. Fax: +44 (0) 23 8059 5639 Email: [email protected] http://www.ncchta.org Health Technology Assessment 2000; Vol. 4: No. 9 Contents Glossary and list of abbreviations ............. i Appendix 4 Functional systems and EDSS ........................................................ 45 Executive summary ..................................... iii 1 Introduction .................................................. 1 Appendix 5 Summary of trials of Aim of the review ........................................... 1 azathioprine in MS .......................................
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