在 Natalizumab 停用后,Dimethyl Fumarate,Fingolimod 和 Ocrelizumab 之间的比较
Chao Zhu1, Tomas Kalincik2,3, Dana Horakova4
1Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
JAMA neurology
|June 5, 2023
概括
在复发性缓解性多发性硬化症 (RRMS) 中,从纳塔利祖马布转换为奥克雷祖马布与更低的复发率和停止治疗有关. 与二甲基烟酸和fingolimod相比,ocrelizumab显示出更高的有效性.
科学领域:
- 神经科学是一个神经科学.
- 免疫学 免疫学 免疫学
- 药理学 药理学是指药理学的学科.
背景情况:
- 在复发性缓解性多发性硬化症 (RRMS) 中,停止使用纳塔利祖马布会带来反弹性疾病活动的风险.
- 鉴定最佳的疾病修饰疗法 (DMT) 策略后natalizumab对于减轻严重复发风险至关重要.
研究的目的:
- 为了比较二甲基 fumarate,fingolimod和ocrelizumab在停止治疗natalizumab的RRMS患者中的有效性和持久性.
- 评估每年复发率 (ARR),第一次复发的时间,以及切换DMT后的残疾进展.
主要方法:
- 使用MSBase注册表的观察队列研究 (2010年6月~2021年7月),随访时间中位数为2.7年.
- 包括1386名RRMS患者在3个月内从纳塔利祖马布转换为二甲基 fumarate,fingolimod或ocrelizumab.
- 使用治疗权重的逆概率来平衡分析结果的共变量,例如ARR和复发时间.
主要成果:
- 与fingolimod (0.26) 和dymethyl fumarate (0.27) 相比,ocrelizumab显示了最低的ARR (0.06).与fingolimod (0.26) 和dimethyl fumarate (0.27) 相比,ocrelizumab显示了最低的ARR (0.06).与fingolimod (0.26) 和dimethyl fumarate (0.27) 相比,ocrelizumab显示了最低的ARR.
- 接受ocrelizumab治疗的患者比接受fingolimod或dimethyl fumarate的患者有显著更长的时间来首次复发和更低的断药率.
- 与ocrelizumab相比,使用fingolimod与残疾累积风险增加49%有关.
结论:
- 使用ocrelizumab与卓越的有效性有关,以最低的ARR,最长的第一次复发时间和减少的停药率为证据.
- 这些发现表明,ocrelizumab是RRMS患者从纳塔利祖马布过渡的潜在更有效的DMT选择.
- 这些结果对于指导在纳塔利祖马布治疗后管理RRMS患者的临床决策至关重要.
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