高剂量脉冲葡萄皮质治疗可以预防新诊断的多发性硬化症患者的白质脊髓伪
Simone Sacco1, Nico Papinutto1, Vinicius A Schoeps1
1Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, CA, USA.
在疾病修饰疗法 (DMT) 开始前给予高剂量葡萄糖皮质类药物 (HDG) 会抑制多发性硬化症 (MS) 中的脊髓 (SC) 伪缩. 这提高了临床试验中SC和脑MRI结果的准确性.
科学领域:
- 神经学 神经学
- 神经成像是一种神经成像.
- 临床试验 临床试验
背景情况:
- 脊髓缩是多发性硬化症 (MS) 进展的生物标志物.
- 疾病修饰疗法 (DMT) 在开始后可能会导致中枢神经系统 (CNS) 的容量暂时减少 (伪缩),使缩评估复杂化.
- 高剂量的葡萄皮质激素 (HDGs) 减少炎症,并可能减轻伪缩.
研究的目的:
- 为了调查HDG预治疗是否影响新诊断的DMT先前MS患者的DMT启动后的SC和大脑的伪缩.
- 评估HDG对MS临床试验的MRI生物标志物的可靠性的影响.
主要方法:
- 123名从未接受过治疗的多发性硬化症患者被跟踪了3年.
- 参与者被分为三个组:具有先前HDG的DMT (DMT-HDG),没有先前HDG的DMT (DMT/没有HDG) 和没有DMT (没有DMT).
- 使用混合效应模型分析了SC总横截面积,灰质面积,白质面积和区域大脑体积.
主要成果:
- 在DMT/无HDG组的第一年显示出显著的SC伪缩 (-2.06%),而在DMT-HDG组中没有观察到这种情况 (-0.51%).
- 1年SC体积损失在DMT/无HDG组明显大于DMT-HDG组 (P=0.02).
- 人口,临床和基线放射性特征在各组都相似.
结论:
- 用HDG进行预处理有效地抑制中枢神经系统白质伪缩,特别是在SC,在MS开始使用DMT后.
- 通过HDG抑制伪缩,可以提高SC和脑MRI结果的准确性.
- 在活跃的MS中,HDG预治疗可能会促进使用SC和脑MRI的短期临床试验.
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