A systematic review of the effects of modifiable risk factor interventions on the progression of multiple sclerosis

Susanne Hempel; Glenn D Graham; Ning Fu; Elena Estrada; Annie Y Chen; Isomi Miake-Lye; Jeremy N V Miles; Roberta Shanman; Paul G Shekelle; Jessica M Beroes; Mitchell T Wallin

doi:10.1177/1352458517690271

A systematic review of the effects of modifiable risk factor interventions on the progression of multiple sclerosis

Mult Scler. 2017 Apr;23(4):513-524. doi: 10.1177/1352458517690271. Epub 2017 Feb 2.

Authors

Affiliations

¹ Southern California Evidence-based Practice Center, RAND Corporation, Santa Monica, CA, USA.
² Specialty Care Services, U.S. Department of Veterans Affairs, Washington, DC, USA/Department of Neurology, School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
³ Evidence-based Synthesis Program (ESP) Center, West Los Angeles VA Medical Center, Los Angeles, CA, USA.
⁴ Southern California Evidence-based Practice Center, RAND Corporation, Santa Monica, CA, USA/Evidence-based Synthesis Program (ESP) Center, West Los Angeles VA Medical Center, Los Angeles, CA, USA.
⁵ Multiple Sclerosis Centers of Excellence-East, U.S. Department of Veterans Affairs, Washington, DC, USA/Department of Neurology, School of Medicine, Georgetown University, Washington, DC, USA.

PMID: 28151074
DOI: 10.1177/1352458517690271

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; I²: 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; I²: 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; I²: 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.

Keywords: MS progression; Multiple sclerosis; randomized controlled trial; risk factors; systematic review.

Publication types

Review
Systematic Review

MeSH terms

Animals
Clinical Trials as Topic*
Dietary Supplements*
Disease Progression*
Exercise / physiology*
Humans
Multiple Sclerosis / etiology*
Risk Factors