在多发性硬化症中独立于复发活动的持续进展
Chao Zhu1, Zhen Zhou2, Tomas Kalincik3,4
1Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, VIC 3004, Australia.
Brain communications
|September 5, 2025
概括
在复发性缓解性多发性硬化症 (RRMS) 中,残疾的进展可以在三分之一的患者中逆转. 较年轻的年龄,较低的发病率和高效的治疗预测了这种回归,降低了长期残疾风险.
科学领域:
- 神经学
- 临床研究
- 流行病学
背景情况:
- 在复发性复发性多发性硬化症 (RRMS) 中,残疾进展独立于复发性活动 (PIRA) 可能是继发性渐进性多发性硬化症 (SPMS) 之前的.
- 了解PIRA持久性对于定义RRMS转变为SPMS以及为治疗策略提供信息至关重要.
- PIRA事件可能自发回归,因此需要对影响持续性和不持续性的因素进行调查.
研究的目的:
- 在RRMS患者中确定与PIRA事件的持续性和不持续性相关的风险因素.
- 将持久性和非持久性PIRA患者的长期残疾进展风险进行比较.
- 检查基线特征和治疗对PIRA回归的影响.
主要方法:
- 使用MSBase注册 (1995-2024) 的队列研究,包括4713名患有PIRA事件的RRMS患者.
- 6个月的时间分析证实了PIRA的不持续性,时间扩展残疾状况表 (EDSS) 6和时间到SPMS.
- 使用分层考克斯回归模型,将持久性和非持久性PIRA组之间的结果进行比较.
主要成果:
- 大约三分之一的RRMS患者在8. 7年的中位随访期内出现PIRA回归.
- 较年轻的年龄,较低的基线EDSS和在基线使用高效疾病修饰疗法 (DMT) 与非持久PIRA (回归) 相关.
- 与持久性PIRA患者相比,非持久性PIRA患者的EDSS 6 (HR 0. 19) 和SPMS (HR 0. 18) 的风险显著降低.
结论:
- PIRA事件可以回归,年龄较小,基线残疾较低,高效DMT使用预测回归.
- 持续的PIRA是加速残疾累积和进展到SPMS的重要风险因素.
- 这些发现精确了PIRA动态的理解,并对RRMS患者的监测和管理产生影响.
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