中等至高效的疾病修饰疗法可降低晚发性多发性硬化症复发风险
Yi Chao Foong1,2, Daniel Merlo3, Melissa Gresle4,5
1University of Tasmania Menzies Institute for Medical Research, Hobart, Tasmania, Australia.
Journal of neurology, neurosurgery, and psychiatry
|October 29, 2025
概括
中度至高效的疾病修饰疗法 (DMT) 显著降低了晚发性多发性硬化症 (LOMS) 的复发风险. 虽然残疾进展很常见,但这些疗法对初始LOMS治疗有希望.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 临床试验 临床试验
背景情况:
- 晚期发病的多发性硬化症 (LOMS),在50岁后被诊断出来,代表了新增多发性硬化症 (MS) 病例的比例越来越高.
- 在LOMS中不同疾病修饰疗法 (DMT) 的比较有效性仍然不完全理解.
- 这项研究解决了对LOMS患者的基于证据的治疗指南的需求.
研究的目的:
- 在LOMS患者中,比较中度至高效的DMT与低效的DMT在LOMS患者中的有效性.
- 评估DMT对LOMS复发率,残疾进展和其他关键临床结果的影响.
- 为了为临床决策提供有关LOMS初始DMT选择的信息.
主要方法:
- 一项利用MSBase注册表数据的多中心队列研究.
- 纳入标准:被诊断患有多发性硬化症的个体,症状在50岁以后出现.
- 逆概率-治疗权重 (IPTW) 用于共同变量平衡;主要结果包括时间到第一次复发和年度复发率 (ARR).
主要成果:
- 中等到高效的DMT与显著较低的ARR (0.06对0.09,ARR比率0.68,p=0.01) 和减少第一次复发的时间 (HR 0.66,p=0.01) 相联系.
- 37%的参与者经历了6个月的确认残疾进展 (CDP) 超过4.43年的中位数,主要是由进展独立于复发活动 (PIRA) 驱动的.
- 虽然趋势有利于中度至高效的DMT在CDP的时间 (HR 0.78,p=0.08) 和复发相关恶化 (RAW) (HR 0.69,p=0.31) 中,但这些并没有达到统计学意义.
结论:
- 中等到高效的DMT有效地降低了LOMS患者复发风险.
- 尽管整体复发活动较低,但在LOMS中确诊的残疾进展很常见,主要是由于PIRA.
- 这些发现支持使用中度至高效的DMT作为LOMS的初始治疗策略.
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