复发性复发性硬化症治疗缓解:一项观察性研究
Jannis Müller1,2,3, Sifat Sharmin1,2, Johannes Lorscheider3
1CORe, Department of Medicine, University of Melbourne, Melbourne, VIC, 3000, Australia.
CNS drugs
|February 14, 2025
概括
切换到效率较低的多发性硬化症 (MS) 疗法可能会增加复发风险. 复发性复发性多发性硬化症 (RRMS) 的治疗降级应该是个性化的,而不是普遍的.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 临床治疗学 临床治疗学
背景情况:
- 复发性复发性多发性硬化症 (RRMS) 的高效疗法会带来副作用的风险,降低附着性和增加成本.
- 考虑治疗降级,切换到效率较低的疗法,但缺乏可靠的证据.
- 这项研究旨在比较RRMS患者的缓解与持续治疗的临床结果.
研究的目的:
- 为了评估治疗减缓的临床结果,与在RRMS患者中继续高疗效的疾病修饰疗法相比.
- 确定降级策略是否会影响复发率和残疾恶化.
主要方法:
- 对87239名多发性硬化患者的大型国际观察队列的回顾性分析.
- 倾向性得分匹配用于比较876名减缓治疗的患者与继续治疗的匹配对照.
- 评估的结果包括复发和6个月后确认的残疾恶化,使用比例和累积危险模型.
主要成果:
- 缓解升级治疗的患者显示,未来复发的风险显著增加 (HR 2.36, p < 0.001) 和复发的复发 (HR 2.43, p < 0.001).
- 这种复发风险的增加在各种患者亚组中是一致的,包括年龄,性别,残疾和疾病持续时间.
- 没有特定的患者或疾病特征被确定为明确指导降级的安全性.
结论:
- 在RRMS中治疗降级与复发的风险更高有关.
- 不建议降级作为RRMS管理的通用策略.
- 在考虑由于安全性和有效性不确定而降低治疗升级时,个性化患者评估至关重要.
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