在50岁及以上非活跃多发性硬化症患者中,高效疗法中止与继续
Guillaume Jouvenot1,2, Guilhem Courbon3, Mathilde Lefort4
1Center for Clinical Investigation, INSERM U1434, Strasbourg, France.
JAMA neurology
|March 25, 2024
概括
在不活跃多发性硬化症 (MS) 的老年人中,停止使用像纳塔利祖马布和芬戈利莫德这样的高效疗法 (HET) 会显著增加复发风险. 停止抗CD20疗法没有显著增加风险,为MS管理提供了更安全的选择.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 临床试验 临床试验
背景情况:
- 停止中等效率疗法可能适用于不活跃多发性硬化症 (MS) 的老年患者.
- 关于在这个人群中停止高效疗法 (HETs) 的安全性数据有限.
- 停止服用纳塔利祖马布和芬戈利莫德的年轻患者面临反弹疾病活动的风险.
研究的目的:
- 研究停止HETs与50岁及以上非活跃多发性硬化症患者复发风险之间的关联.
- 为了比较停止HET治疗的患者与继续治疗的患者的复发风险.
主要方法:
- 一个观察性队列研究,利用来自法国MS注册表 (OFSEP) 的数据.
- 1620名年龄在50岁以上的非活跃复发性复发性多发性硬化症患者在HET上与1:1匹配,基于倾向性得分.
- 随访时间平均为5.1年,首次复发的时间是主要的结果指标.
主要成果:
- 停止HET与明显增加复发风险相关 (HR,4.1;P<.001).
- 对于影响免疫细胞贩运的纳塔利祖马布 (HR,7.2) 和芬戈利莫德 (HR,4.5),风险增加显著.
- 在停止抗CD20疗法 (rituximab,ocrelizumab) 后没有观察到显著的风险增加.
结论:
- 停止影响免疫细胞贩运的HETs (natalizumab,fingolimod) 会增加不活跃MS的老年患者复发的风险.
- 停止抗CD20疗法似乎不会显著增加这一群体的复发风险.
- 这些发现可以为有关老年多发性硬化症患者中断HET的临床决策提供信息.
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