在患有多发性硬化症的老年人中,B细胞治疗的安全性和有效性
Turlough Montague1, Yuuki Kang1, Karen Thomas1
1Royal North Shore Hospital, Sydney, NSW, Australia.
Frontiers in immunology
|February 13, 2026
概括
像ocrelizumab和ofatumumab这样的B细胞疗法对于患有多发性硬化症 (MS) 的老年人来说是安全有效的. 由于潜在的免疫球蛋白下降和不良事件,需要仔细监测.
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:
- 衰老的多发性硬化症 (MS) 患者在临床试验中代表性不足.
- 患有多发性硬化症 (opwMS) 的老年人可能面临高效疗法 (HET) 的不同风险-益处概况,因为复发率较低,感染/恶性病的风险更高.
- 在opwMS中使用ocrelizumab和ofatumumab的疗效和安全性需要进一步研究.
研究的目的:
- 评估老年MS患者的ocrelizumab或ofatumumab治疗的临床结果,MRI活性和不良事件.
- 评估B细胞治疗在55岁及以上多发性硬化症患者的安全性和有效性.
主要方法:
- 在第三级护理中心接受ocrelizumab或ofatumumab治疗的opwMS (≥55岁) 的回顾性审查.
- 临床结果的评估,包括扩展残疾状态量表 (EDSS) 和没有疾病活性证据 (NEDA-3).
- 评估MRI活性,治疗出现的不良事件 (TEAE) 和免疫球蛋白水平的变化.
主要成果:
- 在140名患者 (平均年龄63岁) 中,77.9%的患者在44个月内实现了稳定的EDSS,达到NEDA-3.
- 在50.7%的患者中发生了不良事件,导致10.7%的患者停止治疗;免疫球蛋白水平 (IgM,IgA,IgG) 显著下降.
- 在65岁以上的患者中 (n=47),不良事件发生率相似,69.6%的患者达到NEDA-3,但EDSS显示显著增加 (p=0.034).
结论:
- 用ocrelizumab或ofatumumab治疗B细胞的安全性和疗效与opwMS中年轻的队列相比,在44个月的中位数中显示出相似的安全性和疗效.
- 显著的免疫球蛋白下降需要对接受B细胞治疗的opwMS进行仔细监测.
- 虽然在一般情况下是有效的,但EDSS在老年子组中的增加潜力需要持续警和个性化治疗方法.
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