多发性硬化症,疾病修饰疗法和感染
Annette M Langer-Gould1, Jessica B Smith2, Edlin G Gonzales2
1From the Department of Neurology (A.M.L.-G.), Los Angeles Medical Center, Southern California Permanente Medical Group; Department of Research and Evaluation (J.B.S., E.G.G., B.H.L.), Southern California Permanente Medical Group, Pasadena; and Department of Clinical Neuroscience (F.P.), Karolinska Institute, Stockholm, Sweden. annette.m.langer-gould@kp.org.
多发性硬化症 (MS) 患者面临更高的感染风险,某些疾病修饰疗法 (DMT),如rituximab和fingolimod,增加了门诊感染风险. 与干扰素-β / 格拉提拉默酸盐相比,与rituximab和natalizumab相比,严重感染的风险增加.
科学领域:
- 神经学 神经学
- 传染病流行病学 传染病流行病学
- 药物监督 药物监督 药物监督
背景情况:
- 越来越多地使用高效的多发性硬化症 (MS) 疾病修饰疗法 (DMT).
- 对与各种MS DMTs相关的真实世界感染风险的有限理解.
- 需要区分DMT所带来的风险与MS本身或其他因素的风险.
研究的目的:
- 为了比较不同MS DMTs的门诊和严重感染的真实风险.
- 评估感染风险是否与特定的DMT,多发性硬化或其他患者因素有关.
主要方法:
- 一项回顾性队列研究,使用来自南加利福尼亚州凯泽永久医院 (2008-2020) 的电子健康记录.
- 包括多发性硬化症患者和匹配的非MS对照.
- 分析MS治疗,门诊和严重感染以及使用Cox和Poisson回归的共变量.
主要成果:
- 与对照组相比,患有多发性硬化症的患者表现出更高的门诊和严重感染风险.
- 特定的DMT显示出不同的感染风险:瑞图西马布和芬戈利莫德增加了门诊感染风险,而瑞图西马布和纳塔利祖马布与干扰素-β/格拉提拉默酸盐 (IFN/GLAT) 相比,增加了严重感染风险.
- 芬戈利莫德与门诊疹感染有独特的关联;并发病和先前住院病例独立地增加了严重感染风险.
结论:
- 患有多发性硬化症的患者患有感染的风险较高,受特定的DMT的影响.
- 降低风险的策略包括优化膀护理,管理并发病,接种疫苗,以及在高风险患者中仔细考虑DMT.
- 调查结果强调在选择MS DMTs时需要个性化风险评估.
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