Based on this natalizumab is best at 47%, followed by cladribine at 46% and the CRABS are 13-33%.
As you know I am not a fan of CRABS, I never have been and never will be...so yes I am biased, but yes I accept that some people can do well on them...many don't.
I think data generated from them simply muddy the water, because until the studies are done with the highly active agents we won't know the real answer
COI: I do not get support from any Pharma companies and mine is an opinion..others will disagree.
Alemtuzumab is not very good, I was told once that it was our fault:-(.. as too many different people did the EDSS assessments and they did not tie up. Maybe, but I think you asked about this because of the NEDA data in the 5 year extension studies
Havrdova E et al. Alemtuzumab CARE-MS I 5-year follow-up: Durable efficacy in the absence of continuous MS therapy.
Neurology. 2017;89(11):1107-1116.
How can a 33% NEDA over two years (see above) become 61.7% NEDA at year 3 60.2% NEDA at year 4 and 62.4% NEDA at year 5. It is a fudge of course and presenting the results this way hides the reality.
It says in any given year only about 40% had evidence of activity but it does not say that 60% of people were disease free of 5 years which is what we want to know.
Based on that presented previously as I don't have the paper result to hand but seem to remember it was only about 30% were disease free over this time, so if we look at the failures in the first two years the NEDA rate is much lower. In fact in the extension study the NEDA rate for the trial part was well over 60% how can that be?
Well there are a significant number of people who did not go into the extension study, so I suspect a number of these were failures in the original study, remove them and efficacy goes up.
It is simply bad refereeing that the authors get away with not reporting important aspects.
However, you say...HSCT is miles better
The pooled proportion of NEDA patients at 2 years was 83% (range 70%-92%) and at 5 years was 67% (range 59%-70%).
Yes it is or yes it appears to be that way. The pooled estimate of mortality due to the procedure was 2.1% (95% confidence interval [CI] 1.3%-3.4%).