最初的疾病修饰疗法与后来转化为次级渐进性多发性硬化症的关联
J William L Brown1,2,3, Alasdair Coles1, Dana Horakova4,5
1Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.
JAMA
|January 16, 2019
概括
疾病修饰治疗 (DMT) 显著降低了继发性多发性硬化症 (MS) 转变的风险. 像fingolimod, alemtuzumab和natalizumab这样的新型DMT显示出比旧型治疗更高的疗效,为最佳的MS治疗策略提供了信息.
科学领域:
- 神经学
- 临床治疗方法
- 流行病学
背景情况:
- 复发性缓解性多发性硬化症 (MS) 往往会发展为二级渐进性多发性硬化症 (SPMS),其特征是不可逆转的残疾累积.
- 疾病修饰治疗 (DMT) 对SPMS转化率的影响尚未得到充分研究,特别是使用验证的定义.
研究的目的:
- 研究DMT的使用,类型和时间与转化为SPMS的风险之间的关联.
- 使用已验证的SPMS诊断定义以确保对治疗效果的准确评估.
主要方法:
- 这是一项前性队列研究,涉及21个国家的68个中心的1555名复发性复发性多发性硬化症患者.
- 在1988年至2012年期间,患者开始接受DMT (干扰素β,格拉蒂拉默酸盐,芬戈利莫德,纳塔利祖马布,阿勒姆图祖马布) 或临床监测.
- 使用倾向性得分匹配来控制混因素,随访时间至少为4年.
主要成果:
- 与格拉蒂拉默酸盐或干扰素β相比,初始使用芬戈利莫德,阿勒姆图祖马布或纳塔利祖马布的转化风险显著降低.
- 与较晚开始相比,较早开始使用格拉蒂拉默酸盐或干扰素β (在发病后5年内) 降低了转化风险.
- 在5年内从格拉蒂拉默酸盐或干扰素β升级为芬戈利莫德,阿勒姆图祖马布或纳塔利祖马布也降低了转化风险.
结论:
- 在复发性复发性多发性硬化症患者中,初始DMT的选择显著影响转化为SPMS的风险.
- 与格拉蒂拉默酸盐和干扰素β相比,芬戈利莫德,阿勒姆图祖马布和纳塔利祖马布在防止SPMS转化方面表现出更高的疗效.
- 这些发现支持基于疗效,风险概况和治疗时间的个性化DMT选择,以优化MS治疗的长期结果.
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