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缓解疾病修饰疗法的升级:一个回顾性,观察性单中心研究

Carolyn Goldschmidt¹, Jordan Glassman², Brandon Ly²

¹Endeavor Health, Evanston, IL, USA.

Multiple sclerosis and related disorders

|June 6, 2025

概括

调查多发性硬化症 (MS) 中疾病修饰疗法 (DMT) 的降级表明,虽然不是绝对不劣,但从某些DMT (如ocrelizumab和 fumarates) 中降级似乎比其他更安全. 对个性化多发性硬化症治疗策略需要进一步的研究.

科学领域:

神经学神经学
免疫学免疫学免疫学
药理学药理学是指药理学的学科.

背景情况:

长时间接触多发性硬化症 (MS) 的高效疗法存在风险.
关于MS管理中治疗降级策略的安全性和有效性的数据有限.
缓解治疗可能是高效疗法和停止治疗之间的中间途径.

研究的目的:

评估多发性硬化症 (MS) 患者减缓疾病修饰疗法 (DMT) 的结果.
评估从高效疗法 (HET) 过渡到中效疗法 (MET) 以及从MET过渡到低效疗法 (LET) 的有效性.
为了比较不同DMT的降级策略的安全性和有效性.

主要方法:

追溯分析了163名从HET降级到MET的患者和127名从MET降级到LET的患者的医疗记录.
年化复发率 (ARR) 分析使用普朗森通用线性混合效应模型 (GLMM).
使用后勤GLMM评估的MRI活动和残疾;针对ARR和MRI活动进行的非劣势测试.

主要成果:

71%的患者降级到MET和77%的LET仍然没有复发.
与纳塔利祖马布或s1p调节剂相比,从ocrelizumab或烟酸盐中减轻升级显示出更高的复发和MRI活性.
在任何一个患者队列中都没有证明降级的非劣势性.

结论:

现实世界的证据表明,从ocrelizumab和 fumarates中缓解升级可能比从natalizumab和s1p调节器更安全.
在MS中降级策略需要进一步调查.
治疗决策应根据患者的疾病特征进行个性化.

关键词:

缓和局势的升级.改变疾病的疗法.多发性硬化症是多发性硬化症.没有劣势的不劣势.治疗策略治疗策略

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