在大多发性硬化症数据网络中,治疗转换的预测因素
Tim Spelman1,2, Melinda Magyari3,4, Helmut Butzkueven2,5
1Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
Frontiers in neurology
|January 8, 2024
概括
多发性硬化症 (MS) 的治疗转换受残疾,女性性别和年龄的影响. 随着更多可用的疾病修饰疗法 (DMT),切换率显著增加.
科学领域:
- 神经学 神经学
- 临床流行病学临床流行病学
- 现实世界的证据 现实世界的证据
背景情况:
- 治疗转换是治疗多发性硬化症 (MS) 的常见现象.
- 越来越多的疾病修饰治疗 (DMT) 需要了解切换的预测因素.
- 识别这些预测因素对于优化不同环境中的患者护理至关重要.
研究的目的:
- 确定在复发性复发性多发性硬化症 (RRMS) 患者中治疗转换的独立预测因素.
- 用多个国际多发性硬化病登记处的数据分析治疗转换模式.
- 在现实世界的临床实践中,提供对影响治疗决策的因素的见解.
主要方法:
- 这是一项回顾性,观察性队列研究,利用了五个国家临床注册表 (1997-2018) 的数据.
- 在110,326名RRMS患者中对269,822个治疗情节进行了聚合分析,这些患者开始使用DMT.
- 多层混合效应共享脆弱的时间到事件模型,以确定治疗转换的独立预测因素.
主要成果:
- 治疗开始时增加扩展残疾状态量表 (EDSS) 评分预测更高的转换率 (aHR 1.08).
- 女性性别 (aHR 1.11) 和年龄较大与治疗转换的增加有关.
- 随着时间的推移,治疗转换率显著增加,从2013年开始的DMT显示出更高的转换率 (aHR 8.09与1996-2006相比).
结论:
- 在MS中治疗转换与基线残疾,女性性别和年龄有关.
- 由于扩大了治疗选择,DMT切换的频率明显增加.
- 个性化风险和耐受性概况对于在不断变化的治疗环境中选择合适的治疗方法至关重要.
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