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Cognitive Efficacy of Pharmacologic Treatments in Multiple Sclerosis: A Systematic Review

INTRODUCTION: Cognitive impairment is prevalent and debilitating among persons with multiple sclerosis (MS). While many pharmacologic treatments have shown good efficacy in reducing clinical relapses, brain lesions, and improving certain physical symptoms, their efficacy for improving cognitive func...

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Autores principales: Chen, Michelle H., Goverover, Yael, Genova, Helen M., DeLuca, John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275014/
https://www.ncbi.nlm.nih.gov/pubmed/32361940
http://dx.doi.org/10.1007/s40263-020-00734-4
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author Chen, Michelle H.
Goverover, Yael
Genova, Helen M.
DeLuca, John
author_facet Chen, Michelle H.
Goverover, Yael
Genova, Helen M.
DeLuca, John
author_sort Chen, Michelle H.
collection PubMed
description INTRODUCTION: Cognitive impairment is prevalent and debilitating among persons with multiple sclerosis (MS). While many pharmacologic treatments have shown good efficacy in reducing clinical relapses, brain lesions, and improving certain physical symptoms, their efficacy for improving cognitive function is not well understood. OBJECTIVES: The current systematic review aimed to evaluate the efficacy of pharmacologic treatments for improving cognitive function among persons with MS. METHODS: A literature search was conducted through the PubMed and PsycINFO databases. Two independent reviewers assessed each paper, and a third reviewer weighed in if the two reviewers could not reach a consensus. Classification of evidence was determined using the 2017 American Academy of Neurology (AAN) criteria for therapeutic trials. Standardized effect sizes (Cohen’s d) were calculated to compare across studies. RESULTS: Eighty-seven journal articles published between 1990 and January 2020 were included in the current review. Overall, there is insufficient evidence to support the use of pharmacologic treatments to improve cognitive function in persons with MS. There were many contradictory findings observed in this review, which may be due to possible unidentified moderating treatment response variables and/or lack of standardization in assessment procedures. There was also an overreliance on statistical significance (most papers did not provide sizes of treatment effects), which may not be clinically meaningful. CONCLUSIONS: Higher-quality randomized controlled trials are needed to establish the cognitive efficacy of pharmacologic treatments for MS-related cognitive dysfunction, with cognition as the primary endpoint. Researchers are urged to use standardized criteria (such as the AAN criteria) to guide their research designs. Clinicians should consider effect sizes of studies before deciding whether to prescribe certain medications to ameliorate cognitive symptoms. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40263-020-00734-4) contains supplementary material, which is available to authorized users.
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spelling pubmed-72750142020-06-16 Cognitive Efficacy of Pharmacologic Treatments in Multiple Sclerosis: A Systematic Review Chen, Michelle H. Goverover, Yael Genova, Helen M. DeLuca, John CNS Drugs Systematic Review INTRODUCTION: Cognitive impairment is prevalent and debilitating among persons with multiple sclerosis (MS). While many pharmacologic treatments have shown good efficacy in reducing clinical relapses, brain lesions, and improving certain physical symptoms, their efficacy for improving cognitive function is not well understood. OBJECTIVES: The current systematic review aimed to evaluate the efficacy of pharmacologic treatments for improving cognitive function among persons with MS. METHODS: A literature search was conducted through the PubMed and PsycINFO databases. Two independent reviewers assessed each paper, and a third reviewer weighed in if the two reviewers could not reach a consensus. Classification of evidence was determined using the 2017 American Academy of Neurology (AAN) criteria for therapeutic trials. Standardized effect sizes (Cohen’s d) were calculated to compare across studies. RESULTS: Eighty-seven journal articles published between 1990 and January 2020 were included in the current review. Overall, there is insufficient evidence to support the use of pharmacologic treatments to improve cognitive function in persons with MS. There were many contradictory findings observed in this review, which may be due to possible unidentified moderating treatment response variables and/or lack of standardization in assessment procedures. There was also an overreliance on statistical significance (most papers did not provide sizes of treatment effects), which may not be clinically meaningful. CONCLUSIONS: Higher-quality randomized controlled trials are needed to establish the cognitive efficacy of pharmacologic treatments for MS-related cognitive dysfunction, with cognition as the primary endpoint. Researchers are urged to use standardized criteria (such as the AAN criteria) to guide their research designs. Clinicians should consider effect sizes of studies before deciding whether to prescribe certain medications to ameliorate cognitive symptoms. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s40263-020-00734-4) contains supplementary material, which is available to authorized users. Springer International Publishing 2020-05-02 2020 /pmc/articles/PMC7275014/ /pubmed/32361940 http://dx.doi.org/10.1007/s40263-020-00734-4 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Systematic Review
Chen, Michelle H.
Goverover, Yael
Genova, Helen M.
DeLuca, John
Cognitive Efficacy of Pharmacologic Treatments in Multiple Sclerosis: A Systematic Review
title Cognitive Efficacy of Pharmacologic Treatments in Multiple Sclerosis: A Systematic Review
title_full Cognitive Efficacy of Pharmacologic Treatments in Multiple Sclerosis: A Systematic Review
title_fullStr Cognitive Efficacy of Pharmacologic Treatments in Multiple Sclerosis: A Systematic Review
title_full_unstemmed Cognitive Efficacy of Pharmacologic Treatments in Multiple Sclerosis: A Systematic Review
title_short Cognitive Efficacy of Pharmacologic Treatments in Multiple Sclerosis: A Systematic Review
title_sort cognitive efficacy of pharmacologic treatments in multiple sclerosis: a systematic review
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7275014/
https://www.ncbi.nlm.nih.gov/pubmed/32361940
http://dx.doi.org/10.1007/s40263-020-00734-4
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