A systematic review of the effects of modifiable risk factor interventions on the progression of multiple sclerosis. (April 2017)

• Record Type: Journal Article
• Authors: Hempel, Susanne; Graham, Glenn D; Fu, Ning; Estrada, Elena; Chen, Annie Y; Miake-Lye, Isomi; Miles, Jeremy N V; Shanman, Roberta; Shekelle, Paul G; Beroes, Jessica M; Wallin, Mitchell T
• Is Part Of: Multiple sclerosis. Volume 23:Number 4(2017)
• Page Start: 513
• Page End: 524
• Publication Date: 2017-04
• Subjects: Multiple sclerosis -- MS progression -- risk factors -- randomized controlled trial -- systematic review; Central nervous system -- Diseases -- Periodicals; Myelin sheath -- Diseases -- Periodicals; Inflammation -- Periodicals; Multiple sclerosis -- Periodicals; Central Nervous System Diseases -- Periodicals; Demyelinating Diseases -- Periodicals; Inflammation -- Periodicals; Multiple Sclerosis -- Periodicals; Système nerveux central -- Maladies -- Périodiques; Gaine de myéline -- Maladies -- Périodiques; Inflammation (Pathologie) -- Périodiques; Sclérose en plaques -- Périodiques; Electronic journals; 616.834005
• DOI: 10.1177/1352458517690271
• Languages: English
• ISSNs: 1352-4585

Abstract

Background: Several risk factors are associated with multiple sclerosis (MS) progression and may be amenable to intervention. Objective: To systematically review the evidence for interventions targeting risk factors for MS progression. Methods: We searched six databases and existing reviews till March 2015 and consulted with experts to identify randomized controlled trials (RCTs) of interventions targeting MS risk factors (PROSPERO 2015:CRD42015016461). Results: In total, 37 RCTs met inclusion criteria. Expanded Disability Status Scale (EDSS) scores after exercise interventions did not differ compared with untreated controls (standardized mean differences (SMDs): 0.02; confidence interval (CI): −0.40, 0.44; I 2 : 0%; seven RCTs; very low quality of evidence (QoE)). Dietary interventions did not show a statistically significant effect on the relative risk (RR) of progression (RR: 0.86; CI: 0.67, 1.05; I 2 : 0%; four RCTs; moderate QoE) compared to placebo. EDSS scores after vitamin D supplementation were not significantly different from placebo (SMD: −0.15; CI: −0.33, 0.02; I 2 : 0%; five RCTs; very low QoE). Conclusion: We did not identify any risk factor interventions with significant effects on MS progression, but the overall QoE was limited. More adequately powered trials are needed on vitamin D supplementation, long-term exercise, and smoking cessation.