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多发性硬化症治疗降级:审查和评论

Krzysztof Selmaj^1,2, Hans-Peter Hartung^3,4,5,6, Marcin P Mycko⁷

¹Department of Neurology, University of Warmia & Mazury, Olsztyn, Poland. kselmaj@gmail.com.

Journal of neurology

|August 2, 2024

概括

针对老年人多发性硬化症 (MS) 的减缓疾病修饰疗法 (DMT) 可能是安全有效的,可能降低与长期免疫抑制相关的风险. 需要进一步的研究来确认对这个不断增长的人口的最佳策略.

科学领域:

神经学神经学
免疫学免疫学免疫学
老年病的医生老年病的医生

背景情况:

目前的多发性硬化症 (MS) 治疗通常需要终身使用,造成感染和癌症等风险,特别是与年龄相关的免疫系统变化 (免疫发生).
在MS中,炎症活性通常随着年龄的增长而下降,这表明老年人可能会改变治疗强度.
现有的关于减缓多发性硬化症疾病修饰疗法 (DMT) 的研究集中在特定情况下,对老年人群的数据有限.

研究的目的:

审查证据支持DMT降级作为老年MS患者的可行策略.
探索各种降级方法,包括剂量调整,切换到不那么强效的疗法,或停止治疗.
在与年龄相关的免疫衰变和MS活动下降的背景下,评估DMT降级的安全性和有效性.

主要方法:

对多发性硬化症中DMT降级策略的现有文献的审查,包括延长剂量,切换疗法和停止治疗.
对回顾性和观察性研究的分析,研究年龄对DMT疗效和结果的影响.
考虑最近在55岁以上的稳定多发性硬化患者中进行的一项随机对照断药研究.

主要成果:

纳塔利祖马布的延长间隔剂量维持了有效性,同时降低了PML风险;奥克雷祖马布剂量减轻了Ig下降.
年龄是DMT疗效的一个重要因素;停止治疗的老年患者表现出稳定的疾病,与年轻的同行不同.
最近的一项研究发现,在停止使用DMT后,老年患者 (>55岁) 的MS稳定,MRI活性仅略有增加.

结论:

在55岁以上的多发性硬化症患者中,DMT降级或停止治疗可能与持续高风险免疫抑制无差,健康风险可能较低.
虽然目前的证据是有希望的,但更大,更长期的前性研究是必不可少的,最终确定降级的好处和风险.
未来的研究应该包括随机对照试验,比较降级,延续和停止,并根据年龄和性别对子组进行分析,并纳入免疫衰变标志物.

关键词:

缓和局势的升级.改变疾病的疗法.免疫衰变的起源多发性硬化症是多发性硬化症.

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