Excerpt

Evidence-informed recommendations were developed by the Canadian Drug Expert Committee (CDEC) to address the following policy questions:

1. For patients with relapsing-remitting multiple sclerosis (RRMS), what are the preferred initial pharmacological treatment strategies?
2. For patients with RRMS, what are the pharmacological strategies for patients not adequately controlled on initial pharmacotherapy?
3. Should combination strategies be considered for treatment of patients with RRMS? If so, what are the appropriate treatment options?

Contents

• ABBREVIATIONS
• BACKGROUND
• SUMMARY OF RECOMMENDATIONS
  • CDEC Values and Preferences
• RECOMMENDATIONS
• PATIENT-GROUP INPUT
• SUMMARY OF THE EVIDENCE
  • Clinical Evidence
  • Economic Evidence
  • Limitations of the Evidence
• DISCUSSION POINTS
  • Efficacy and Cost-Effectiveness
  • Safety
  • Patient Considerations
  • Other Discussion Points
• RESEARCH GAPS
  • Safety
  • Efficacy
  • Patient Factors
• REFERENCES

ABOUT THIS DOCUMENT: The Therapeutic Review Recommendations or Advice are formulated following a comprehensive evidence-based review of the medication’s efficacy or effectiveness and safety and an assessment of its cost-effectiveness. Therapeutic Review clinical and economic reports are based on published information available up to the time that CDEC made its recommendation. Input from stakeholders, such as drug manufacturers, patient groups, and health-related professional associations or organizations, is considered in the preparation of this recommendation document.

CDEC is a committee of the Canadian Agency for Drugs and Technologies in Health (CADTH). It makes recommendations and provides advice to Canadian jurisdictions to use in making informed decisions. It is made up of experts in drug evaluation and drug therapy, and public members.

The Final CDEC Therapeutic Review Recommendations or Advice neither takes the place of a medical professional providing care to a particular patient nor is it intended to replace professional advice.

CADTH is not legally responsible for any damages arising from the use or misuse of any information contained in or implied by the contents of this document.

The statements, conclusions, and views expressed herein do not necessarily represent the view of Health Canada or any provincial, territorial, or federal government, or the manufacturer.

Production of this report is made possible through a financial contribution from Health Canada and the governments of Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Nunavut, Ontario, Prince Edward Island, Saskatchewan, and Yukon.

The Therapeutic Review Framework describes the Therapeutic Review process in detail.⁴⁴

CDEC Members:: Dr. Robert Peterson (Chair), Dr. Lindsay Nicolle (Vice-Chair), Dr. Ahmed Bayoumi, Dr. Bruce Carleton, Ms. Cate Dobhran, Mr. Frank Gavin, Dr. John Hawboldt, Dr. Peter Jamieson, Dr. Kerry Mansell, Dr. Irvin Mayers, Dr. Yvonne Shevchuk, Dr. James Silvius, and Dr. Adil Virani

Regrets: One CDEC member was not available to participate in deliberations and voting.

Conflicts of Interest:: None.

One external Clinical Expert attended the meeting and participated in the discussion, but did not vote on the recommendations.