协调在多发性硬化症中进展独立于复发活动的定义:系统性审查
Jannis Müller1,2,3, Alessandro Cagol1,2, Johannes Lorscheider1,3
1Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.
JAMA neurology
|October 2, 2023
概括
独立于复发活动的进展 (PIRA) 显著导致多发性硬化症 (MS) 的残疾. 一项拟议的协调定义旨在提高对这种常见的多发性硬化症表现的研究可比性.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 临床研究 临床研究
背景情况:
- 不依赖复发活动的进展 (PIRA) 越来越被认为是复发性复发性多发性硬化症 (RRMS) 长期残疾的主要驱动因素.
- 对PIRA缺乏标准化的定义,这阻碍了一致的研究和临床解释.
- 了解PIRA对于管理MS患者的残疾至关重要.
研究的目的:
- 系统地审查关于多发性硬化症PIRA的现有证据.
- 分析用于描述PIRA的各种术语.
- 为临床试验和实践提出PIRA的统一定义.
主要方法:
- 在主要数据库 (PubMed,Embase,Cochrane,Web of Science) 进行了全面的文献搜索.
- 搜索词包括"多发性硬化症"",PIRA"",不依赖复发活动的进展"",沉默的进展"和"与复发无关的进展".
- 分析了1990年1月至2022年12月期间发表的研究,其中包括48项符合条件的研究.
主要成果:
- 每年,PIRA约占RRMS病例的5%,并导致超过50%的残疾累积事件.
- PIRA对残疾的相对贡献随着患者的年龄和疾病持续时间的增加而增加.
- 高效的疾病修饰疗法,在抑制复发的同时,可能会增加与PIRA相关的残疾比例.
结论:
- PIRA是所有MS表型中残疾累积的最常见原因,包括临床隔离综合征和早期RRMS.
- 建议对PIRA进行统一的定义,以提高跨研究发现的可比性.
- 这种标准化定义将促进更一致的临床实践和未来的临床试验结果.
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