在多发性硬化症中,进展独立于复发和MRI活动和治疗策略
Fabien Rollot1,2,3,4, Romain Casey1,2,3,4, Anne Kerbrat5,6
1Université de Lyon, Université Claude Bernard Lyon 1, F-69000 Lyon, France.
Brain : a journal of neurology
|February 14, 2026
概括
高效疗法 (HET) 和中等效疗法 (MET) 在复发性多发性硬化症 (MS) 中显示出与复发和MRI活动 (PIRMA) 独立的进展相似的效果. 现实世界的数据表明,与MET相比,HET可能不会对PIRMA机制产生不同影响.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 临床研究 临床研究
背景情况:
- 高效疗法 (HET) 对复发和MRI活动 (PIRMA) 在复发性多发性硬化症 (RMS) 中的进展的影响尚不清楚.
- 需要现实数据来比较RMS患者在PIRMA上的HET与中度疗效疗法 (MET) 的有效性.
研究的目的:
- 在RMS患者中评估HET与PIRMA的MET相比,HET在现实生活中的有效性.
- 评估HET和MET对第一个PIRMA,确认残疾进展 (CDP),复发相关恶化 (RAW) 和MRI相关恶化 (MAW) 的影响.
主要方法:
- 从2010年1月到2023年6月的法国多发性硬化症 (MS) 登记处分析数据.
- 包括首先接受HET (n=2666) 或MET (n=7833) 治疗的RMS患者,至少两年EDSS和MRI随访.
- 用于分析结果的倾向性得分框架,包括时间到第一个PIRMA,CDP,RAW和MAW.
主要成果:
- 第一次PIRMA的受限平均存活时间在HET组 (8.7年) 与MET组 (8.9年) 相比略短 (p=0.017).
- 在HET组 (7.6年) 与MET组 (7.3年) (p=0.071) 中,时间到首次确认残疾进展 (CDP) 往往更长.
- 与HET相比,MET的复发相关恶化 (RAW) 和MRI相关恶化 (MAW) 时间显著缩短 (两者p<0.001).
- 增加PIRMA发病率的基线风险因素包括高EDSS,年龄较大和脊髓损伤.
结论:
- 虽然与MET相比,HET可以更好地控制与疾病活动相关的残疾积累,但这项现实研究表明,与PIRMA相关的机制不受HET和MET的影响.
- 需要进一步的研究,以充分阐明不同疗法疗效对多发性硬化症进展的各个方面长期影响.
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