Objective: To assess factors used in treatment decision-making for relapsing-remitting multiple sclerosis in both the 5EU (UK/Germany/France/Italy/Spain) and the USA. Methods: Data were abstracted from the Ipsos Healthcare Global Multiple Sclerosis Therapy Monitor (data abstracted September–December, 2015–2017) a bi-annual online chart-review study of patients with multiple sclerosis. Results: Treatment choices were primarily due to efficacy for relapses while convenience factors, other than oral administration, were uncommon. Predominantly, the choice of disease modifying therapy at first line was jointly made, with patient involvement decreasing at later lines of treatment. Conclusion: Relapsing-remitting multiple sclerosis patients are highly engaged in their treatment decisions, particularly early in the pathway. The majority were made jointly between the physician and patient, driven by efficacy.

Endoscopic subureteral injection of Teflon was done in 34 potential renal transplant recipients to correct vesicoureteral reflux. Follow-up ranged from 6 to 24 months. After one injection reflux was corrected in 53.7% of the patients; this increased to 64.8% after a second injection. The procedure is simple, effective, without major morbidity, and avoids the risk of nephroureterectomy. However, efforts must be made to find an ideal substance with a higher biocompatibility and without risk of migration.

evidence were extracted. Results: Our search identified 19 submissions, all of which included a placebo-controlled trial, and all except dimethyl fumarate also included a head-to-head trial against one of the beta-interferons but not any other therapies. Indirect comparisons against old and newer DMTs were also included in the submissions. Approximately 90% of appraisals received positive recommendations; reasons for positive recommendations included recognition that there is a need for additional treatment options in MS, particularly for patients who do not have an adequate response to beta-interferons, and that oral DMTs represent an innovative step in the treatment of MS. However, submissions were generally criticised for trial design, scarcity of head-to-head trials, use of EDSS to measure disability, the uncertainty regarding long-term clinical and economic outcomes, and the heterogeneity of trial populations included in indirect comparisons. ConClusions: Due to the changing treatment landscape and the population included in MS trials, it is clear that placebo-controlled trials and the inclusion of beta-interferon trials in indirect comparisons are becoming less suitable for the evaluation of new MS treatments. Future HTA submissions will need to take into account the need to demonstrate superiority over comparators, and manufacturers and regulators will need to work together to develop new and reliable measures that can evaluate MS symptoms and impairments in the context of DMTs.objeCtives: Health technology assessment and decision making process lean on evidences provided by RCTs. Our aim was to compare the characteristics of Hungarian patients with multiple sclerosis to the participants enrolled in pivotal trials of first-line DMTs. Methods: The database of the National Health Insurance Fund was used for analyze the attributes of all MS patients starting first-line DMTs between 2008 and 2013. We investigated the following characteristics: 1. age, 2. gender ratio, 3. time since first MS symptoms, 4. time since first MS diagnosis, 5. number of relapses in 2 years prior to therapy. For the comparison we summarized phase III RCTs of interferon beta-1a and 1b, glatiramer-acetate, teriflunomide and dimethyl-fumarate. Results: A total of 3877 Hungarian MS patients were involved and 1670 were selected for analysis after excluding the population of the year of DMT inclusion. The mean age was 36.18±9.96 years which resembles to the participants of old immunomodulatory drugs (≈36 years) and slightly younger than the patients of the trials with new therapies (≈38 years). There was no difference in gender ratio (≈70% female). While in the RCTs the mean time since first symptoms was longer than the mean time since first diagnosis (≈7-8 vs ≈5.5 years), in the Hungarian patients these two values did not differ significantly (3.30±3.80 vs 3.17±3.77 years). We suspect that the reason for this unexpected difference can be explained by the imprecise use of ICD codes in Hungarian clinical practice. The relapse rate per 2 year...

Endoscopic subureteral injection of Teflon was done in 34 potential renal transplant recipients to correct vesicoureteral reflux. Follow-up ranged from 6 to 24 months. After one injection reflux was corrected in 53.7% of the patients; this increased to 64.8% after a second injection. The procedure is simple, effective, without major morbidity, and avoids the risk of nephroureterectomy. However, efforts must be made to find an ideal substance with a higher biocompatibility and without risk of migration.

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