关于免疫调节剂和免疫抑制剂对渐进性多发性硬化症的证据是什么? - 一个柯克伦评论摘要与评论
1Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Caserta, Italy.
NeuroRehabilitation
|June 9, 2025
概括
这项研究发现,利图西马布和干扰素β-1b可以略微减少渐进性多发性硬化症 (PMS) 的复发. 然而,许多疾病修饰疗法 (DMT) 增加了因不良事件而停止治疗,对残疾进展的证据有限.
科学领域:
- 神经免疫学 神经免疫学
- 临床神经学 临床神经学
- 药理学 药理学是指药理学的学科.
背景情况:
- 多发性硬化症 (MS) 是中枢神经系统的慢性炎症性脱髓化疾病,导致显著的成年残疾,特别是在其渐进的形式 (PMS).
- 目前对MS的治疗选择在有效性上有所不同,并带有潜在的风险,需要基于证据的临床决策.
- 由于选择有限,并可能导致严重后果,对PMS有效的管理策略至关重要.
研究的目的:
- 进行网络元分析,比较免疫调节剂和免疫抑制剂在治疗渐进性多发性硬化症 (PMS) 的疗效和安全性.
- 评估各种疾病修饰疗法 (DMT) 对PMS患者复发率,残疾进展和严重不良事件 (SAE) 的影响.
- 评估由于PMS中不同DMT相关的不良事件 (AEs) 而导致治疗中止的风险.
主要方法:
- 在CENTRAL,MEDLINE,Embase进行了系统的文献搜索,并将试验注册到2022年8月8日.
- 包括随机对照试验 (RCT) 与免疫调节剂和免疫抑制剂与安慰剂或其他药物进行了比较.
- 一个网络元分析 (NMA) 综合了来自23个涉及10,167名参与者的RCT的数据.
主要成果:
- 利图西马布可能不会降低2年复发风险,而干扰素β-1b可能会在PMS中与安慰剂相比,在3年内减少18%的复发.
- 证据表明DMT可以减少残疾进展或SAE的确定性低至非常低,免疫球蛋白显示SAE风险增加了7倍.
- 由于AEs的治疗中止增加了干扰素β-1a,干扰素β-1b,glatiramer乙酸和fingolimod;利图西马布,纳塔利祖马布,西波尼莫德和ocrelizumab可能不会增加这种风险.
结论:
- 与安慰剂相比,Rituximab和干扰素β-1b可以在PMS患者的复发中略有减少,分别在2年和3年内.
- 几种DMT与因不良事件而导致治疗中止的风险增加有关.
- 与安慰剂相比,可用的DMT对残疾进展和PMS中SAE的影响的可靠证据仍然有限.
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