年龄和疾病修饰治疗之间的相互作用影响了多发性硬化症感染风险
Sarah Lena Susanna Jacober1,2, Giulio Disanto1, Rosaria Sacco1
1Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.
多发性硬化症 (MS) 的疾病修饰疗法 (DMT) 增加了感染风险,特别是单克隆抗体 (MAB) 和口服DMT在年轻患者中. 更高的残疾预测严重的感染,无论治疗.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 传染性疾病 传染性疾病
背景情况:
- 多发性硬化症 (MS) 的疾病修饰治疗 (DMT) 可以提高感染风险.
- 免疫抑制性DMT在老年多发性硬化症患者的安全性是不确定的,因为试验排除.
研究的目的:
- 调查DMT,衰老和其他临床因素与MS患者感染风险之间的关联.
- 分析感染发病率,类型和严重程度,与特定的DMT和患者人口统计学相关.
主要方法:
- 在单个多发性硬化中心进行前性观察研究.
- 包括503名多发性硬化患者,按治疗分类:注射剂/未治疗,口服DMT和单克隆抗体 (MAB).
- 使用多变量Poisson和Cox回归来评估感染风险因素的统计分析.
主要成果:
- 单克隆抗体 (MAB) 和口服DMT与注射剂/未治疗药物 (IRR分别为2.32和1.95) 相比,与感染发病率有显著的积极关联.
- 与MABs相关的感染风险在50岁以下的患者中明显更强 (IRR=5.90),而不是老年患者 (IRR=1.95),在排除COVID-19病例后.
- 更高的残疾和男性性别被确定为严重感染的唯一预测因素.
结论:
- 用MAB和口服DMT治疗与MS患者感染的发病率增加有关.
- 年轻的多发性硬化症患者 (<50岁) 在接受MAB治疗时,感染风险增加得更明显.
- 患者的残疾水平是严重感染风险的主要决定因素,独立于使用的特定DMT.
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