我们应该留下来还是我们应该去? 关于在多发性硬化症中停止药物治疗的最新见解
Anne Mrochen1, Sven G Meuth2, Steffen Pfeuffer3
1Department of Neurology, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Klinikstr. 33, 35392, Giessen, Germany.
Neurological research and practice
|April 20, 2025
概括
停止多发性硬化症 (MS) 治疗可能会导致疾病重新激活的风险. 对老年人来说,平衡这一点与管理诸如心血管疾病 (CVD) 等并发症至关重要.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 心脏病学 心脏病学
背景情况:
- 多发性硬化症 (MS) 治疗决策包括停止疾病修饰疗法 (DMT).
- 从历史上看,停药是由于副作用或疾病进展.
- 个性化药物和高效的DMT (HE-DMT) 促使人们就计划停止使用DMT进行讨论.
研究的目的:
- 审查关于在MS中停止使用DMT的证据.
- 专注于对人口老龄化的影响.
- 检查心血管疾病 (CVD) 和多发性硬化在治疗决策中的相互作用.
主要方法:
- 对稳定的MS患者中断DMT随机试验 (DISCOMS,DOT-MS) 的分析.
- 关于复发风险的观察数据 (例如,OFSEP) 的审查.
- 综合关于HE-DMT结果和并发症影响的证据.
主要成果:
- 随机试验表明,在停止使用DMT后,疾病复发的风险存在.
- 有限的数据存在HE-DMT停止结果.
- 心血管疾病 (CVD) 在老年多发性硬化症患者中复杂化了DMT决策,较高的心血管疾病负担与更糟糕的MS结局有关.
结论:
- 停止使用DMT需要平衡避免多药店与疾病重新激活风险.
- 伴随性疾病,特别是心血管疾病对多发性硬化症进展的影响是关键考虑因素.
- 在考虑在MS患者中中止DMT时,全面的风险评估至关重要.
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