随着时间的推移:患有多发性硬化症的老年人的治疗挑战
Stefano Gelibter1, Lorenzo Saraceno1, Fiammetta Pirro1
1Department of Neurosciences, Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Journal of neuroimmunology
|May 18, 2024
概括
随着多发性硬化症 (pwMS) 患者的年龄增长,疾病修饰疗法 (DMT) 的有效性降低,特别是高效疗法 (HET). 迫切需要更多的研究来优化老年pwMS和晚发性MS (LOMS) 的治疗策略.
科学领域:
- 神经学 神经学
- 老年病的医生 老年病的医生
- 药理学 药理学是指药理学的学科.
背景情况:
- 多发性硬化症 (MS) 人口结构正在转变,有更多的老年人和晚发性MS (LOMS) 病例.
- 随着年龄的增长,MS治疗变得更加复杂,因为免疫和疾病修饰疗法 (DMT) 之间的风险增加和潜在相互作用.
研究的目的:
- 系统地审查有关老龄化和老年多发性硬化 (pwMS) 患者治疗管理的现有证据.
- 确定有关老年多发性硬化症患者的DMT疗效,停药和降级策略的知识差距.
主要方法:
- 35项原始研究的系统文献综述.
- 从观察性研究和随机临床试验 (RCT) 的元分析分析证据的分析.
主要成果:
- 在较老的pwMS中,DMT的疗效降低,而HET的疗效比中低疗效的选择更少.
- 停止治疗似乎对老年DMT的稳定疾病相对安全,但RCT显示MRI活性有矛盾的结果.
- 有限的数据存在于新的DMT,抗CD20疗法和老年 pwMS 的缓解策略.
结论:
- 目前的证据表明,DMT在老年 pwMS 的疗效降低,需要量身定制的治疗方法.
- 迫切需要进行强有力的研究,以开发优化,数据驱动的治疗策略,用于老龄化pwMS和LOMS.
相关概念视频
Alzheimer's Disease: Treatment
180
Alzheimer's Disease (AD), a neurodegenerative disorder, is pathologically identified by amyloid plaques and neurofibrillary tangles composed of tau protein. AD pharmacotherapy aims to manage cognitive symptoms, delay disease progression, and treat behavioral symptoms. The treatment is primarily symptomatic and palliative, with no definitive disease-modifying therapy available. Cholinesterase inhibitors, including donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne), are...
180
Myasthenia Gravis: Overview and Treatment
1.4K
Myasthenia gravis is a neuromuscular transmission disorder characterized by weakness and increased fatigability of skeletal muscles. It is an autoimmune disease affecting approximately one in 2000 people, where antibodies against the α1 subunit of nicotinic acetylcholine receptors are produced.
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which...
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which...
1.4K
Parkinson's Disease: Treatment
261
Neurodegenerative disorders, such as Parkinson's Disease (PD), involve the gradual and irreversible destruction of neurons in particular brain areas. These disorders exhibit standard features like proteinopathies, selective vulnerability of some neurons, and an interaction of intrinsic properties, genetics, and environmental influences in neural injury.
Parkinson's Disease is primarily a result of the loss of dopaminergic neurons in the substantia nigra pars compacta. The cornerstone of...
Parkinson's Disease is primarily a result of the loss of dopaminergic neurons in the substantia nigra pars compacta. The cornerstone of...
261
Parkinson's Disease: Overview
528
Neurodegenerative disorders are progressive diseases that cause irreversible damage and loss to neurons in specific brain areas. Examples of these disorders include Parkinson's disease, Alzheimer's disease, Multiple Sclerosis (MS), and Amyotrophic Lateral Sclerosis (ALS). These disorders share characteristics such as proteinopathies, selective neuronal vulnerability, and a complex interplay between genetic and environmental factors. The primary therapeutic goal for these conditions is...
528
Drug Therapy
42
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
42
Psychosis: Goals of Pharmacotherapy
123
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.
123


