在多发性硬化症和并发性类风湿性关节炎的疾病修饰疗法的管理
Franz Felix Konen1, Torsten Witte2, Diana Ernst2
1Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
Neurological research and practice
|July 17, 2025
概括
对于患有多发性硬化症 (MS) 和类风湿性关节炎 (RA) 的患者来说,特里弗卢诺米德和抗CD20疗法是有效的疾病修饰治疗方法. 克拉迪宾也是一种选择,但应避免使用TNFα抑制剂.
科学领域:
- 免疫学 免疫学 免疫学
- 神经学 神经学
- 类风湿病学 类风湿病学
背景情况:
- 副发病性自身免疫性疾病,如类风湿性关节炎 (RA),在多发性硬化症 (MS) 患者中很常见.
- 在MS和RA之间共享的致病途径表明潜在的治疗重叠.
- 对于MS治疗RA的疾病修饰疗法 (DMT) 的疗效有所不同.
研究的目的:
- 审查MS-DMTs对MS和RA的影响,反之亦然.
- 确定合适的DMT,用于患有并发性MS和RA的患者.
- 评估现有和正在研究的治疗方法的安全性和有效性.
主要方法:
- 使用PubMed.com进行了全面的文献审查.
- 审查的重点是针对MS和RA的已批准和正在研究的DMT.
- 评估了对这两种情况的影响,以及不良事件.
主要成果:
- 特里弗卢诺米德,抗CD20疗法和克拉德里宾在MS患者的RA中表现出益处.
- 一型干扰素和布鲁顿的氨酸激酶 (BTK) 抑制剂对RA的疗效有限.
- 对于某些MS形式,BTK抑制剂是有效的,而secukinumab对复发性MS具有有限的效果.
- 在患有RA的多发性硬化症患者中没有观察到阿巴切的显著益处;Janus激酶抑制剂和IL-6受体抑制剂缺乏试验.
- 随着二甲基烟酸,阿莱姆图祖马布和纳塔利祖马布的使用,观察到包括RA恶化在内的不良事件.
- 瘤坏死因子α (TNFα) 抑制剂增加了MS疾病的活性.
结论:
- 推Teriflunomide和抗CD20治疗中度至高度活跃的MS与并发性RA.
- 克拉德里宾可以被视为一种治疗选择.
- 由于增加疾病活性的风险,TNFα抑制剂在MS患者中禁用.
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