在多发性硬化症中使用高效的疾病修饰疗法:专家德尔菲共识的建议
Massimo Filippi1,2,3,4,5, Maria Pia Amato6,7, Diego Centonze8,9
1Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy. filippi.massimo@hsr.it.
Journal of neurology
|August 10, 2025
概括
意大利专家建议在多发性硬化症 (MS) 管理中早期和个性化使用高效疾病修饰疗法 (HE-DMT). 这种共识旨在通过积极的,基于证据的治疗策略来预防残疾并改善患者的长期结果.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 临床治疗学 临床治疗学
背景情况:
- 多发性硬化症 (MS) 管理需要优化治疗策略.
- 高效疾病修饰疗法 (HE-DMT) 为MS患者提供了显著的潜力.
- 目前的临床证据和意大利现实实践需要更新HE-DMT使用的建议.
研究的目的:
- 建立专家的共识,在意大利MS患者早期和适当使用HE-DMTs.
- 将建议与当前的临床证据和现实实践保持一致.
- 引导治疗决策,以改善MS的长期结果.
主要方法:
- 一个两轮的德尔菲共识过程,涉及来自54个多发性硬化中心的65名意大利神经科医生.
- 专家们对43个关于治疗目标,HE-DMT定义,患者概况和HE-DMT时间的陈述进行了评分.
- 共识定义为强烈 (≥80%的同意) 或适度 (70-80%的同意).
主要成果:
- 在33个陈述中达成强烈共识 (76.7%),在6个陈述中达成中度共识 (14.0%).
- 专家们支持早期启动HE-DMT,以防止不可逆转的残疾.
- 建议在HE-DMT升级时使用临床,放射和生物标志物指标的个性化方法.
结论:
- 早期,个性化的HE-DMT使用对于优化长期MS结果至关重要.
- 强大的专家一致性表明,人们正在转向积极主动的多发性硬化症治疗.
- 对于HE-DMT决策的可操作指标可以为政策提供信息并改善获取.
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