停止多发性硬化症疾病修饰治疗:对现实世界的研究进行系统审查和元分析
Luca Prosperini1, Shalom Haggiag2, Serena Ruggieri3,4
1Department of Neurology, S. Camillo-Forlanini Hospital, C.ne Gianicolense 87, 00152, Rome, Italy. luca.prosperini@gmail.com.
CNS drugs
|September 23, 2023
概括
停止多发性硬化症 (MS) 的疾病修饰疗法 (DMT) 可能对某些患者是安全的,特别是患有稳定疾病的老年人. 这一元分析表明,在特定条件下停止使用DMT后,复发风险很低.
科学领域:
- 神经免疫学 神经免疫学
- 临床神经学 临床神经学
- 药物治疗 药物治疗
背景情况:
- 对多发性硬化症 (MS) 的终身疾病修饰治疗 (DMT) 的必要性进行了辩论.
- 有限的综合证据存在关于停止DMT的安全性,特别是在老年患者稳定的MS.
- 在MS患者中切断DMT的现实数据产生了不一致的结果.
研究的目的:
- 评估在多发性硬化症 (MS) 患者中停止使用DMT后疾病重新激活的速度.
- 为了确定DMT停止后与疾病复发相关的风险因素.
- 分析磁共振成像 (MRI) 活动和停止后的治疗再启动率.
主要方法:
- 在PubMed/MEDLINE,Scopus和谷歌学者中进行了系统的文献搜索,寻找到2023年7月的现实研究.
- 使用元分析,子组分析和元回归模型,对复发和残疾事件的估计进行了汇总.
- 排除了那些与怀孕或治疗转换相关的停药研究;结果包括复发,残疾累积,MRI活动和重新治疗.
主要成果:
- 分析了22篇文章,包括2942名多发性硬化症患者,随访时间从1年到7年.
- 复发和残疾事件的汇总率分别为每100个患者年6.7和5.8.
- 在老年患者,更长时间暴露于DMT的患者和更长的疾病稳定期患者中观察到较低的复发风险,估计在60岁左右,经过10年的DMT或8年的稳定后,复发风险可以忽略不计.
结论:
- 根据现实世界的数据合成,在选择的多发性硬化症患者中,停止DMT似乎是可行的,并且具有很高的确定性.
- 对于复发事件来说,这些发现是强有力的,但需要进一步的研究来评估隔离的残疾累积后停药.
- 临床试验数据仍然有必要,以最终回答关于长期DMT必要性的问题.
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