在复发性多发性硬化症中治疗转换的驱动因素的评估:意大利多发性硬化症注册表的一项研究
Pietro Iaffaldano1, Giuseppe Lucisano1,2, Tommaso Guerra1
1Department of Translational Biomedicine and Neurosciences-DiBraiN, University of Bari "Aldo Moro", Piazza G. Cesare 11, 70124, Bari, Italy.
Journal of neurology
|December 22, 2023
概括
高效的疾病修饰疗法 (DMT),特别是抗CD20药物,显著减少了复发性多发性硬化症 (MS) 患者经历疾病活动的治疗切换. 这一发现强调了先进疗法在控制多发性硬化症进展方面的重要性.
科学领域:
- 神经学 神经学
- 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:
- 复发性复发性 (RR) 和继发性进展性 (SP) 多发性硬化症 (MS) 被统称为复发性MS (RMS).
- 了解导致RMS临床复发导致治疗变化的因素对于优化患者管理至关重要.
- 意大利MS和相关疾病注册表 (I-MS&RD) 为此类调查提供了有价值的数据集.
研究的目的:
- 为了确定关键因素,与转换疾病修饰疗法 (DMT) 相关的由于临床复发在大量的RMS患者队列.
- 评估不同类型的DMT,包括中等效率 (ME),高效率 (HE) 和抗CD20疗法,对治疗转换的影响.
- 分析RMS患者的人口统计和临床特征,转换DMT的人与不转换DMT的人.
主要方法:
- 一项采用I-MS&RD数据的横截面研究,包括4739名RMS患者 (4161名RRMS,578名SPMS).
- 如果患者在数据提取之前的两年内至少发生过一次复发,则被定义为RMS.
- 采用多变量逻辑回归模型来评估与DMT切换相关的因素,考虑最近记录的DMT及其类 (ME,HE,anti-CD20).
主要成果:
- 超过50%的RMS患者 (4739人中有2694人) 由于复发而转换DMT.
- 转换患者显著年轻,残疾较小,患RRMS病程的可能性更高.
- 暴露于特定的HE DMT,包括Alemtuzumab,Natalizumab,Ocrelizumab和Rituximab,证明了对治疗转换的保护作用.
- 与ME DMT相比,使用HE DMT,特别是抗CD20药物,显著降低了转换的可能性.
结论:
- 高效的DMT,特别是抗CD20疗法,与RMS患者因疾病活性而导致治疗中止的风险明显降低.
- 这些发现强调了先进疗法在稳定疾病进程和减少复发性多发性硬化症治疗变化的必要性方面的有效性.
- 优化DMT选择,酌情优先考虑HE疗法,可以改善RMS的长期管理和患者结果.
相关概念视频
Drug Therapy
45
The advent of drug therapy has profoundly shaped modern mental health care, providing targeted treatments for a range of psychological disorders. Psychotherapeutic drugs, classified into antianxiety, antidepressant, and antipsychotic medications, address symptoms across anxiety disorders, mood disorders, and schizophrenia. While these medications have transformed patient outcomes, they require careful management due to their potential side effects and limitations.
Antianxiety Medications
Antianxiety Medications
45
Psychosis: Goals of Pharmacotherapy
141
Antipsychotic drugs are a crucial treatment method for acute and chronic psychoses, bipolar illness, and behavioral disorders. The selection of these drugs depends on several factors, including the state of the disease, clinical judgment, possible drug interactions, and the patient's sensitivity to adverse effects. In immediate scenarios, such as delirium and dementia, short-term treatment with low doses of high-potency typical or atypical agents can effectively manage symptom exacerbation.
141
Psychological and Sociocultural Causes of Schizophrenia
91
Schizophrenia, a complex psychiatric disorder, has been historically misunderstood. Early psychological theories attributed its origins to childhood trauma and unresponsive parenting. However, contemporary research largely rejects these notions, favoring the vulnerability-stress hypothesis. This model proposes that individuals with a genetic predisposition to schizophrenia may develop the disorder following exposure to significant environmental stressors. Notably, studies on high-risk...
91
Antidepressant Drugs: MAOIs and Other Agents
241
Atypical antidepressants, including bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel), and vilazodone (Viibryd), offer unique mechanisms of action. Bupropion weakly inhibits dopamine and norepinephrine reuptake, aiding depression treatment and smoking cessation, with a low risk of sexual dysfunction. Mirtazapine enhances serotonin and norepinephrine neurotransmission, leading to sedation, increased appetite, and weight gain. As a result, it helps treat...
241
Psychosis and Antipsychotic Drugs: Overview
280
The term "psychosis" refers to a spectrum of mental disorders characterized by abnormal thoughts, perceptions, and behaviors. It can manifest as mood disorders, dementia, delirium with psychotic features, substance-induced psychosis with psychotic features, brief psychotic disorder, delusional disorder, schizoaffective disorder, and schizophrenia. Among all these disorders, schizophrenia is the most common psychotic disorder, affecting 1% of the worldwide population. Psychotic...
280


