Date of Award

2018

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Department Chair

John Cavenagh, MBA, PhD, PA-C

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine whether or not mesenchymal stem cell therapy decreased the number of relapses in patients with multiple sclerosis.

STUDY DESIGN: Review of three randomized controlled trials from 2006-2016.

DATA SOURCES: Two randomized control trials and one case series were found searching PubMed. The randomized control trials compared the number of relapses of patients undergoing stem cell therapy against placebo and anti-inflammatory treatment (IV methylprednisolone and oral prednisone). The case series compared the number of relapses patients experienced before and after stem cell therapy.

OUTCOMES MEASURED: Clinical outcomes included the number of relapses patients experienced measured by onset of new neurological symptoms or by the presence of new gadolinium enhancing lesions (GELs) on MRI.

RESULTS: Li J, Zhang D, Geng T, et al. demonstrated that recurrence frequency was significantly different between the two groups (p < 0.038).5 After dichotamization of the relapse data, it was found that for every two patients treated with human umbilical cord derived mesenchymal stem cells therapy for 6 weeks, 2 or more relapses were prevented when compared to steroid therapy (NNT = 2). Llufriu S, Sepulveda M, Blanco Y, et al. found a decrease in mean number of GEL between the BM-MSC group and placebo group (-2.78 + 5.89 vs 3 + 5.36, p = 0.075).6 The relapse frequency data was evaluated as NNT and found that for every patient with multiple sclerosis treated with bone marrow derived stem cells for 12 months, no additional relapses will be prevented when compared to the placebo group (NNT = 0). Lu Z, Zhao H, Xu J, Zhang Z, Zhang X, et al. study suggested that HUC-MSC reduced relapse rate in MS patients by 36.4% at 18 months post treatment compared to before treatment (1.2 + 0.5 vs 3.3 + 0.7, p < 0.05).7

CONCLUSIONS: The results of two RCTs and one case studies showed a decrease in the number of relapses patients with MS experienced after being treated with MSCs compared to steroids, placebo, and before therapy.

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