一项多中心纵向研究分析了COVID-19大流行期间多发性硬化症疾病修饰疗法处方模式
Anoushka P Lal1,2, Yi Chao Foong1,2,3, Paul G Sanfilippo1
1Department of Neuroscience, Central Clinical School, The Alfred, Melbourne, VIC, Australia.
Journal of neurology
|June 27, 2024
概括
临床医生在COVID-19后转移了多发性硬化症 (MS) 治疗,倾向于纳塔利祖马布和克拉迪宾而不是抗CD20单克隆抗体和fingolimod,以减少感知到的风险. 这种变化可能会影响MS患者的疾病进展.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 流行病学 流行病学
背景情况:
- 由于COVID-19的担忧,促使人们对多发性硬化症 (MS) 的疾病修饰疗法 (DMT) 进行调查.
- 特别关注的是抗CD20单克隆抗体 (mAbs) 和fingolimod,它们可能会使MS患者的COVID-19结果恶化 (pwMS).
研究的目的:
- 分析DMT处方趋势在COVID-19大流行之前和之后的变化.
- 了解临床关注如何影响全球卫生危机期间的治疗选择.
主要方法:
- 这是一项多中心的纵向研究,涉及来自MSBase注册表的8771名参与者.
- 两个时期的DMT处方数据的比较:大流行前 (2018年3月至2020年3月) 和大流行后 (2020年3月至2022年3月).
- 使用多变量混合效应逻辑回归的统计分析,以确定DMT启动和切换的趋势.
主要成果:
- 流行后,观察到纳塔利祖马布和克拉迪宾的启动和切换率显著增加.
- 抗CD20 mAb的使用最初出现下降,随后在流行后略有整体增加.
- 开始和切换fingolimod,干扰素-β和阿勒姆图祖马布显著下降.
结论:
- 临床医生在流行后优先开处方纳塔利祖马布和克拉德里宾,可能会平衡疗效与感知免疫抑制风险的降低.
- 这些处方转换可能会影响pwMS的长期疾病进展.
- 调查结果强调了在全球卫生挑战期间需要公平的DMT接入和基于证据的决策.
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