医院治疗的感染和残疾风险在多发性硬化症中恶化
Yihan Hu1, Thomas Frisell2, Peter Alping2
1Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Annals of neurology
|July 10, 2024
概括
与干扰素-β/格拉提拉默酸盐 (IFN/GA) 相比,利图西马布增加了两倍的感染风险,但降低了多发性硬化症 (MS) 患者的残疾恶化. 感染风险管理是改善MS长期结果的关键.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 临床研究 临床研究
背景情况:
- 多发性硬化症 (MS) 管理包括针对B细胞枯竭或免疫调节的疗法.
- 了解感染对接受不同治疗的多发性硬化患者残疾进展的影响至关重要.
研究的目的:
- 为了研究感染和MS患者治疗rituximab与干扰素-β/格拉提拉默酸盐 (IFN/GA) 治疗的残疾恶化之间的联系.
主要方法:
- 一项瑞典队列研究 (2000-2021) 分析了来自8,759例rituximab和7,561例IFN/GA治疗事件的数据.
- 多变量考克斯模型估计了感染风险;通用估计方程评估了感染-残疾恶化相关性.
- 分析了残疾恶化的事件,使用了分片指数模型,控制复发和MRI活动.
主要成果:
- 与IFN/GA相比,利图西马布治疗与住院和门诊感染的风险更高.
- 在医院治疗的感染使扩展残疾状况量表 (EDSS) 的得分增加了0.19个单位.
- 在控制复发和MRI活动后,感染导致IFN/GA治疗的复发性复发性MS患者的残疾恶化,但不是rituximab.
结论:
- 与IFN/GA相比,利图西马布会使感染风险增加一倍,但会减少随后的残疾恶化.
- 进展性多发性硬化症在医院治疗感染后恶化的风险比复发性缓解性多发性硬化症更大.
- 考虑到感染风险对于改善MS患者的长期结果至关重要.
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