Priority 1 from the Multiple Sclerosis PSP

UNCERTAINTY: Which treatments are effective to slow, stop or reverse the accumulation of disability associated with Multiple Sclerosis? (JLA PSP Priority 1)
Overall ranking	1
JLA question ID	0016/1
Explanatory note	Reliable up-to-date systematic reviews have revealed important continuing uncertainties about treatment effects
Evidence	He D, Xu Z, Dong S, Zhang H, Zhou H, Wang L, Zhang S. Teriflunomide for multiple sclerosis. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD009882. DOI: 10.1002/14651858.CD009882.pub2. La Mantia L, Vacchi L, Di Pietrantonj C, Ebers G, Rovaris M, Fredrikson S, Filippini G. Interferon beta for secondary progressive multiple sclerosis. Cochrane Database of Systematic Reviews 2012, Issue 1. Art. No.: CD005181. DOI: 10.1002/14651858.CD005181.pub3. Martinelli Boneschi F, Vacchi L, Rovaris M, Capra R, Comi G. Mitoxantrone for multiple sclerosis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD002127. DOI: 10.1002/14651858.CD002127.pub3. He D, Zhou H, Han W, Zhang S. Rituximab for relapsing-remitting multiple sclerosis. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD009130. DOI: 10.1002/14651858.CD009130.pub2. Liu J, Wang L, Zhan SY, Xia Y. Daclizumab for relapsing remitting multiple sclerosis. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD008127. DOI: 10.1002/14651858.CD008127.pub3. Pucci E, Giuliani G, Solari A, Simi S, Minozzi S, Di Pietrantonj C, Galea I. Natalizumab for relapsing remitting multiple sclerosis. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007621. DOI: 10.1002/14651858.CD007621.pub2 Filippini G, Del Giovane C, Vacchi L, D'Amico R, Di Pietrantonj C, Beecher D, Salanti G. Immunomodulators and immunosuppressants for multiple sclerosis: a network meta-analysis. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD008933. DOI: 10.1002/14651858.CD008933.pub2. He D, Han K, Gao X, Dong S, Chu L, Feng Z, Wu S. Laquinimod for multiple sclerosis. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD010475. DOI: 10.1002/14651858.CD010475.pub2.
Systematic reviews that need extending or updating	La Mantia L, Munari LM, Lovati R. Glatiramer acetate for multiple sclerosis. Cochrane Database of Systematic Reviews 2010, Issue 5. Art. No.: CD004678. DOI: 10.1002/14651858.CD004678.pub2. Rojas JI, Romano M, Ciapponi A, Patrucco L, Cristiano E. Interferon Beta for Primary Progressive Multiple Sclerosis. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD006643. DOI: 10.1002/14651858.CD006643.pub3
Systematic reviews in preparation	Shaneh Saz A, Firwana BM, Hasan R, Kojan S, La Mantia L, Filippini G. Fingolimod for relapsing remitting multiple sclerosis (Protocol). Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD009371. DOI: 10.1002/14651858.CD009371. Casetta I, Ciucci G, Galea I. Plasma exchange for multiple sclerosis (Protocol). Cochrane Database of Systematic Reviews 2010, issue 4. Art. No.: CD008480. DOI: 10.1002/14651858.CD008480. Yang C, Zhang L, Hao Z, Zeng L, Wen J. Sodium channel blockers for neuroprotection in multiple sclerosis (Protocol). Cochrane Database of Systematic Reviews 2013, Issue 3. Art. No.: CD010422. DOI: 10.1002/14651858.CD010422.
Ongoing controlled trials	Vestibular Rehabilitation for Persons With Multiple Sclerosis: Who Benefits the Most? (MSVR3trial) NCT01698086 Brain Functional Connectivity Changes Following Cognitive Rehabilitation in Multiple Sclerosis: an fMRI Study NCT01628276 Development and Evaluation of a Cognitive Rehabilitation Program for Persons With Multiple Sclerosis NCT01303770
Health Research Classification System category	Neurological

Extra information provided by this PSP
Original uncertainty examples	No examples provided. This is an indicative uncertainty and several submissions were merged to form this one.
Submitted by	39 patients ~ 21 carers ~ 11 clinicians
Outcomes to be measured	Management and or change of multiple sclerosis symptoms; adverse effects or complications; acceptability to patients or carers; time to return to work or normal activity; time in hospital and or needing health or social care services; health related quality of life; and costs

PSP information
PSP unique ID	0016
PSP name	Multiple Sclerosis
Total number of uncertainties identified by this PSP.	82 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	July 2013