在复发性多发性硬化症中,对初始高效治疗的年龄取决于反应
Emilio Portaccio1, Matteo Betti1, Ermelinda De Meo1,2
1Department of NEUROFARBA, Section of Neurology, University of Florence, Florence, Italy.
概括
高效的疾病修饰治疗 (DMT) 在年轻的复发性多发性硬化症患者中显示出更大的益处. 然而,任何DMT暴露都有助于减少残疾积累,即使在老年人中也是如此.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 临床研究 临床研究
背景情况:
- 多发性硬化症 (MS) 的复发形式需要有效的疾病修饰治疗 (DMT).
- 高效 (HE) 的DMT比平台的DMT提供了潜在的优势.
- 患者年龄对HE-DMT在现实环境中的疗效的影响尚未完全理解.
研究的目的:
- 评估高效 (HE) 疾病修饰治疗 (DMT) 与平台DMT相比的年龄相关有效性.
- 根据年龄和DMT类型,评估复发性复发性MS患者残疾累积的风险.
主要方法:
- 从意大利多发性硬化病登记处追溯分析了20984名复发性复发性多发性硬化病患者.
- 倾向性得分匹配创造了可比的HE-DMT或平台DMT开始的患者组.
- 考克斯回归模型分析了24周确认残疾累积 (CDA) 在2年和更长的随访期间的风险.
主要成果:
- 与平台DMT相比,HE-DMT在2年后显著降低了CDA风险 (HR=0.22,p<0.001).
- 在45岁以下的患者 (HR=0.49,p<0.001) 中,HE-DMT表现出更大的疗效,但在45岁以上的患者中 (HR=0.77,p=0.125) 没有.
- 在45岁以上的患者中,长期暴露于任何DMT可以减少残疾累积 (HR=0.13,p=0.050).
结论:
- 在复发性多发性硬化症患者中,初始HE-DMT的优越益处随着年龄的增长而减少.
- 无论有效性如何,持续的DMT暴露对于减少残疾累积至关重要,即使在老年MS患者中也是如此.
- 考虑到年龄和DMT暴露时间的个性化治疗决定对于优化多发性硬化症的结果至关重要.
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