Condition

Multiple sclerosis

Clinical trials and treatment information for Multiple sclerosis

1.9M
People Affected
50
Active Trials
28K
New Cases/Year
16K
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Alemtuzumab
93% Effectiveness• 93% Confidence• 30% Safety• 46 trials• 1.5K participants
HIGH EvidencePoor ValueDose: 12mg IV daily for 5 days; then 12mg IV daily for 3 days 12 months later
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Comparative Safety Scale(Higher is safer)

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30
DangerousModerateSafe

Time to Effect

1-3 months

Duration

Two courses, then monitoring (long-term effect)

Response Rate

90%

Remission Rate

50%

Number Needed to Treat (NNT)

3

Number Needed to Harm (NNH)

3

Common Side Effects:

Infusion reactions: 90%
Headache: 52%
Nasopharyngitis: 39%
Autoimmune thyroid disorders: 35%
Immune thrombocytopenic purpura (ITP): 1%

Annual Cost of Care

Drug Cost

$100,000

Monitoring

$7,000

Side Effects

$7,500

Total Annual

$114,500

Cost-Effectiveness

POOR

QALYs Gained

1

ICER

$300,000/QALY

Cost per Remission

$229,000

Cost per Responder

$127,222.22

Treatment Outcomes
Primary Outcomes
Annualized Relapse Rate0.40 relapses/year
-70% (-0.28 relapses/year)
Risk of 6-month Confirmed Disability Progression20% (over 2 years)
-42% (-8.4 percentage points)
New or Enlarging T2 Lesions on MRI1.0 lesions/year
-80% (-0.80 lesions/year)
Rate of Annualized Brain Volume Loss0.60% per year
-45% (-0.27% per year)
Secondary Benefits
Proportion of Patients with Confirmed Disability Improvement (CDI)8%
+125% (+10 percentage points)
MSIS-29 Physical Score45 points (scale 0-100, lower is better)
-15% (-6.75 points)
MSIS-29 Psychological Score35 points (scale 0-100, lower is better)
-10% (-3.5 points)
Common Side Effects
Infusion reactions
+90%
Headache
+52%
Nasopharyngitis
+39%

Clinical Trial Phases:

Phase 3Phase 4
2
Natalizumab
92% Effectiveness• 95% Confidence• 35% Safety• 126 trials• 2K participants
HIGH EvidencePoor ValueDose: 300mg IV every 4 weeks
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Comparative Safety Scale(Higher is safer)

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35
DangerousModerateSafe

Time to Effect

1-3 months

Duration

lifetime

Response Rate

88%

Remission Rate

48%

Number Needed to Treat (NNT)

3

Number Needed to Harm (NNH)

25

Common Side Effects:

Headache: 38%
Fatigue: 27%
Nasopharyngitis: 26%
Urinary tract infections: 21%
Progressive Multifocal Leukoencephalopathy (PML): 0.1%

Annual Cost of Care

Drug Cost

$85,000

Monitoring

$5,500

Side Effects

$1,500

Total Annual

$92,000

Cost-Effectiveness

POOR

QALYs Gained

0.95

ICER

$173,000/QALY

Cost per Remission

$191,666.67

Cost per Responder

$104,545.45

Treatment Outcomes
Primary Outcomes
Annualized Relapse Rate (ARR)1.2 relapses/year
-68% (-0.8 relapses/year)
Number of new or enlarging T2 lesions (MRI)8 new lesions/year
-83% (-6.6 new lesions/year)
Number of Gadolinium-enhancing lesions (MRI)2 new lesions/year
-92% (-1.8 new lesions/year)
Risk of Confirmed Disability Progression (EDSS)Annual risk: 15%
-42% (-6.3 percentage points)
Secondary Benefits
Annual Brain Volume Loss0.8% annually
-25% (-0.2% annually)
Fatigue Impact Scale (FIS-29)FIS-29 score: 45
-12% (-5.4 points)
Multiple Sclerosis Impact Scale (MSIS-29) Physical ScoreMSIS-29 Physical score: 55
-10% (-5.5 points)
Common Side Effects
Headache
+38%
Fatigue
+27%
Nasopharyngitis
+26%

Clinical Trial Phases:

Phase 3Phase 4
3
Ocrelizumab
90% Effectiveness• 95% Confidence• 45% Safety• 121 trials• 5K participants
HIGH EvidenceModerate ValueDose: 600mg IV every 6 months (after initial loading doses)
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Comparative Safety Scale(Higher is safer)

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45
DangerousModerateSafe

Time to Effect

3-6 months

Duration

lifetime

Response Rate

85%

Remission Rate

45%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

20

Common Side Effects:

Infusion reactions: 37%
Upper respiratory tract infections: 44%
Nasopharyngitis: 13%
Urinary tract infections: 10%
Oral herpes: 7%

Annual Cost of Care

Drug Cost

$65,000

Monitoring

$5,000

Side Effects

$1,500

Total Annual

$71,500

Cost-Effectiveness

MODERATE

QALYs Gained

1.2

ICER

$118,000/QALY

Cost per Remission

$158,888.89

Cost per Responder

$84,117.65

Treatment Outcomes
Primary Outcomes
Annualized Relapse Rate (ARR)0.98 relapses/year
-46% (-0.45 relapses/year)
Risk of 3-month Confirmed Disability Progression15% risk of progression over 3 months
-40% (-6% absolute risk reduction)
T1 Gadolinium-enhancing Lesions (cumulative)1.4 lesions/scan
-94% (-1.32 lesions/scan)
New or Enlarging T2 Lesions (cumulative)3.5 lesions/scan
-90% (-3.15 lesions/scan)
Secondary Benefits
Brain Volume Loss Rate (annualized)0.4% annual brain volume loss
-20% (-0.08% annual loss)
MSIS-29 Physical Score35 points (MSIS-29 Physical, 0-64 scale)
-15% (-5.25 points)
MSIS-29 Psychological Score28 points (MSIS-29 Psychological, 0-64 scale)
-12% (-3.36 points)
Common Side Effects
Infusion reactions
+37%
Upper respiratory tract infections
+44%
Nasopharyngitis
+13%

Clinical Trial Phases:

Phase 3Phase 4
4
Cladribine
87% Effectiveness• 90% Confidence• 40% Safety• 42 trials• 1.9K participants
HIGH EvidencePoor ValueDose: 10mg/kg total cumulative dose over 2 years
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Comparative Safety Scale(Higher is safer)

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40
DangerousModerateSafe

Time to Effect

3-6 months

Duration

Two annual treatment courses (lifetime effect)

Response Rate

82%

Remission Rate

45%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

5

Common Side Effects:

Lymphopenia (Grade 3/4): 25%
Headache: 21%
Nasopharyngitis: 18%
Upper respiratory tract infection: 16%
Herpes zoster: 2.1%

Annual Cost of Care

Drug Cost

$80,000

Monitoring

$4,000

Side Effects

$1,000

Total Annual

$85,000

Cost-Effectiveness

POOR

QALYs Gained

1

ICER

$240,000/QALY

Cost per Remission

$188,888.89

Cost per Responder

$103,658.54

Treatment Outcomes
Primary Outcomes
Annualized Relapse Rate (ARR)0.33 relapses/year
-58% (-0.19 relapses/year)
Risk of 3-month Confirmed Disability Progression (CDP)20% over 2 years
-33% (-6.6 percentage points reduction in risk)
Number of Gadolinium-enhancing (Gd+) T1 lesions0.9 lesions/MRI scan
-86% (-0.77 lesions/MRI scan)
Number of New or Enlarging T2 lesions8.6 lesions/MRI scan
-73% (-6.28 lesions/MRI scan)
Secondary Benefits
Risk of 6-month Confirmed Disability Progression (CDP)15% over 2 years
-33% (-5 percentage points reduction in risk)
Annualized Brain Volume Loss (ABVL)-0.6% per year
+30% (+0.18 percentage points per year)
Multiple Sclerosis Functional Composite (MSFC) Score-0.3 standard deviation units
+23% (+0.07 standard deviation units)
Common Side Effects
Lymphopenia (Grade 3/4)
+25%
Headache
+21%
Nasopharyngitis
+18%

Clinical Trial Phases:

Phase 3Phase 4
5
Fingolimod
85% Effectiveness• 92% Confidence• 38% Safety• 101 trials• 4K participants
HIGH EvidenceModerate ValueDose: 0.5mg oral once daily
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Comparative Safety Scale(Higher is safer)

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38
DangerousModerateSafe

Time to Effect

1-2 months

Duration

lifetime

Response Rate

80%

Remission Rate

35%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

17

Common Side Effects:

Headache: 25%
Influenza: 20%
Diarrhea: 18%
Elevated liver enzymes: 15%
Bradycardia/AV block (first dose): 6%

Annual Cost of Care

Drug Cost

$85,000

Monitoring

$4,000

Side Effects

$1,500

Total Annual

$90,500

Cost-Effectiveness

MODERATE

QALYs Gained

0.8

ICER

$120,000/QALY

Cost per Remission

$258,571.43

Cost per Responder

$113,125

Treatment Outcomes
Primary Outcomes
Annualized Relapse Rate0.4 relapses/year
-54% (-0.216 relapses/year)
Risk of 3-month Confirmed Disability Progression (EDSS)25% over 2 years
-30% (-7.5% of patients)
New or Enlarging T2 Lesions (MRI)5.0 lesions/year
-80% (-4.0 lesions/year)
Gadolinium-Enhancing Lesions (MRI)1.5 lesions/year
-90% (-1.35 lesions/year)
Secondary Benefits
Brain Volume Loss0.8% per year
-40% (-0.32% per year)
Timed 25-Foot Walk (T25FW)7.5 seconds
-8% (-0.6 seconds)
MSQOL-54 Composite Score60 points (0-100 scale)
+5% (+3 points)
Common Side Effects
Headache
+25%
Influenza
+20%
Diarrhea
+18%

Clinical Trial Phases:

Phase 3Phase 4
6
Dimethyl Fumarate
82% Effectiveness• 90% Confidence• 42% Safety• 103 trials• 2.6K participants
HIGH EvidenceModerate ValueDose: 120mg oral twice daily for 7 days, then 240mg oral twice daily
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Comparative Safety Scale(Higher is safer)

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42
DangerousModerateSafe

Time to Effect

2-3 months

Duration

lifetime

Response Rate

78%

Remission Rate

30%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

3

Common Side Effects:

Flushing: 40%
Abdominal pain: 18%
Diarrhea: 14%
Nausea: 12%
Lymphopenia (Grade 3/4): 2%

Annual Cost of Care

Drug Cost

$85,000

Monitoring

$4,000

Side Effects

$500

Total Annual

$89,500

Cost-Effectiveness

MODERATE

QALYs Gained

0.8

ICER

$110,000/QALY

Cost per Remission

$298,333.33

Cost per Responder

$114,743.59

Treatment Outcomes
Primary Outcomes
Annualized Relapse Rate (ARR)0.8 relapses/year
-47% (-0.38 relapses/year)
Risk of 3-month Confirmed Disability Progression27% over 2 years (placebo rate)
-34% (Reduced risk by 9 percentage points over 2 years (e.g., from 27% to 18%))
New or Enlarging T2 Lesions on MRI4.0 lesions/year
-71% (-2.84 lesions/year)
Gadolinium-enhancing (Gd+) Lesions on MRI1.5 lesions/scan
-82% (-1.23 lesions/scan)
Secondary Benefits
Annual Brain Volume Loss0.8% annual loss
-22% (-0.18 percentage points (e.g., from 0.8% to 0.62% annual loss))
Fatigue Impact (Modified Fatigue Impact Scale)MFIS score: 45/84
-13.3% (-6 points)
Health-Related Quality of Life (EQ-5D VAS)EQ-5D VAS score: 65/100
+7.7% (+5 points)
Common Side Effects
Flushing
+40%
Abdominal pain
+18%
Diarrhea
+14%

Clinical Trial Phases:

Phase 3Phase 4
7
Glatiramer Acetate
70% Effectiveness• 90% Confidence• 60% Safety• 108 trials• 2K participants
HIGH EvidenceModerate ValueDose: 20mg subcutaneous daily or 40mg subcutaneous three times a week
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Comparative Safety Scale(Higher is safer)

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60
DangerousModerateSafe

Time to Effect

6-12 months

Duration

lifetime

Response Rate

65%

Remission Rate

20%

Number Needed to Treat (NNT)

6

Number Needed to Harm (NNH)

3

Common Side Effects:

Injection site reactions: 40%
Vasodilation (flushing): 20%
Post-injection reaction (flushing, chest pain, palpitations): 18%
Rash: 16%
Dyspnea: 14%

Annual Cost of Care

Drug Cost

$65,000

Monitoring

$2,500

Side Effects

$200

Total Annual

$67,700

Cost-Effectiveness

MODERATE

QALYs Gained

0.6

ICER

$120,000/QALY

Cost per Remission

$338,500

Cost per Responder

$104,153.85

Treatment Outcomes
Primary Outcomes
Annualized Relapse Rate (ARR)1.1 relapses per year
-31% (-0.34 relapses per year)
Number of new T1-gadolinium enhancing lesions on MRI2.0 lesions per scan
-50% (-1.0 lesions per scan)
Proportion of patients with confirmed disability progression (CDP)30% (over 2 years)
-25% (-7.5 percentage points)
Secondary Benefits
Number of new T2 lesions on MRI4.0 lesions per scan
-25% (-1.0 lesions per scan)
Annualized Brain Volume Loss rate0.7% per year
-25% (-0.175 percentage points per year)
MSIS-29 Physical Score45 points (range 0-100)
-11.1% (-5 points)
Common Side Effects
Injection site reactions
+40%
Vasodilation (flushing)
+20%
Post-injection reaction (flushing, chest pain, palpitations)
+18%

Clinical Trial Phases:

Phase 3Phase 4