55岁以上多发性硬化症患者:来自德国多发性硬化症注册表的分析
Yasemin Goereci1, David Ellenberger2, Paulus Rommer3,4
1Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Journal of neurology
|March 22, 2024
概括
患有多发性硬化症 (MS) 的老年人经历了更大的残疾和更少的治疗. 这项研究强调了在这个代表性不足的人群中,对有效治疗的需求尚未得到满足.
科学领域:
- 神经学 神经学
- 临床研究 临床研究
- 流行病学 流行病学
背景情况:
- 55岁及以上的多发性硬化症患者在临床试验中代表性不足.
- 这种缺乏代表性导致关于其特定需求和治疗结果的证据不足.
研究的目的:
- 为了比较55岁及以上的多发性硬化症患者和55岁以下患者的特征.
- 分析老年多发性硬化患者的残疾,症状,疾病活性和治疗,使用德国多发性硬化注册表.
主要方法:
- 分析了德国多发性硬化病登记册中40428名多发性硬化病患者 (PwMS) 的数据.
- 55岁以上的PwMS与55岁以下的PwMS的比较.
- 评估残疾 (扩展残疾状态量表),主要症状,临床和MRI活动,以及疾病修饰疗法使用情况.
主要成果:
- 较老的PwMS (≥55岁) 呈现出更高的残疾分数 (EDSS平均值为≥65的5.3,55-64的4.2,相对于<55的2.7).
- 较少比例的老年PwMS使用疾病修饰疗法 (42.6%为≥65,60.9%为55-64vs76.7%为<55).
- 渐进性MS,职业残疾 (38.8%在55-64组),步态障碍,疲劳,膀功能障碍和性在老年PwMS中更为普遍.
结论:
- 55岁及以上的多发性硬化症患者面临重大残疾.
- 相当数量的老年多发性硬化症患者没有接受疾病修饰疗法,这表明存在严重的未满足的医疗需求.
- 对这一群体需要进一步的研究和量身定制的治疗策略.
相关概念视频
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Absorption
868
As individuals age, their body's physiology evolves, affecting drug pharmacokinetics. The most apparent changes occur in the gastrointestinal tract, where an increase in gastric pH, a delay in gastric emptying, and a reduction in gastrointestinal motility are observed. Remarkably, these changes do not substantially modify the absorption of orally administered drugs, particularly those absorbed via passive diffusion.Transdermal drug delivery emerges as a highly viable method for older adults due...
868
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Distribution
387
Drug distribution in the human body is influenced by several factors, including plasma protein concentration, body composition, blood flow, tissue-protein concentration, and tissue fluid pH. Among these, changes in plasma protein concentration and body composition due to aging significantly affect how drugs are distributed within the body. Specifically, aging is associated with a decrease in albumin levels by about 10% and an increase in α1-acid glycoprotein levels. These alterations are...
387
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Metabolism
405
Geriatric patients show significant variation in how their bodies process medications, which can change how effective and safe treatments are. The liver is the primary organ where drug metabolism occurs, involving two main types of chemical reactions: phase I and II. Phase I metabolism is driven by the cytochrome P450 enzyme system, which includes key types such as CYP3A, CYP2D6, and CYP2C9. Research indicates that while aging doesn't notably alter the levels or activity of these enzymes, it...
405
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
358
In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
358
Pharmacodynamics in Geriatric Patients: Effects of Age
376
Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...
376
Multiple Sclerosis l: Introduction
31
Multiple sclerosis is a chronic autoimmune disease of the central nervous system (CNS) that affects the brain, spinal cord, and optic nerves. It is an inflammatory demyelinating disorder and a leading cause of neurological disability in young adults.EpidemiologyMS commonly begins between 20 and 40 years of age and is twice as common in women. Its exact cause remains unclear, but genetic susceptibility contributes, with higher risk in first-degree relatives and identical twins. A greater...
31


