Treatment effects of immunomodulatory therapies at different stages of multiple sclerosis in short-term trials
Treatment effects of immunomodulatory therapies at different stages of multiple sclerosis in short-term trials
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DOI：
10.1212/wnl.0b013e3182050388
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发表时间：
2011-01-04
期刊：
影响因子：
9.9
通讯作者：
Bates, David
中科院分区：
文献类型：
--
作者：
Bates, David
干扰素-β（IFN β）治疗的干预对抗髓鞘的早期炎症损伤并保护轴突;与已经发生永久性损伤的后期相比，这种治疗可能在疾病过程的早期表现出更大的疗效。在临床孤立综合征（CIS）患者中进行的临床试验显示了早期治疗多发性硬化（MS）的临床益处，如3年后延迟转换为临床确诊的多发性硬化和残疾减少所证明的;然而，5年时失去了统计学意义。此外，在CIS试验中，在MS过程中较晚开始治疗的患者没有像较早开始治疗的患者那样受益。在复发缓解型多发性硬化（RRMS）的治疗中，通过MRI评估，免疫调节药物（IMD）治疗显著降低了复发率和疾病负担。IFN β治疗在RRMS中比在继发性进展型多发性硬化（SPMS）中表现出更大的益处。SPMS试验一致显示复发率降低和新MRI病变累积，但在至残疾进展时间方面存在相互矛盾的结果，这是SPMS试验的主要结局指标。目前的证据表明，IFN β治疗可能是更有效的SPMS的早期阶段，其特征是复发发作和MRI证据更大的脑病变疾病活动。因此，IFN β治疗的干预适用于除PPMS或非复发性SPMS以外的MS的所有阶段。醋酸格拉替雷干预治疗RRMS是合适的。证据的平衡表明，早期治疗是必不可少的，以延迟不可逆的神经损伤和随之而来的残疾的积累。神经病学2011; 76（增刊1）：S14-S25
Intervention with interferon-beta (IFN beta) therapy counters early inflammatory damage to myelin and protects axons; such therapy might demonstrate greater efficacy earlier in the disease course compared with later when permanent damage has already occurred. Clinical trials conducted in patients with clinically isolated syndrome (CIS) show clinical benefits of early treatment of multiple sclerosis (MS), as evidenced by delayed conversion to clinically definite multiple sclerosis and reduced disability 3 years later; however, statistical significance is lost at 5 years. Moreover, in the CIS trials, patients who began treatment later in the course of MS did not benefit as much as those who began treatment earlier. In the treatment of relapsing-remitting multiple sclerosis (RRMS), immunomodulatory drug (IMD) therapy markedly reduced relapse rates and the burden of disease, as assessed by MRI. IFN beta therapy has demonstrated greater benefits in RRMS than in secondary progressive multiple sclerosis (SPMS). The SPMS trials consistently show reduction in relapse rates and accumulation of new MRI lesions, but have conflicting results for time to disability progression, which is the primary outcome measure in SPMS trials. Current evidence suggests that IFN beta therapy may be more effective in the early stages of SPMS, characterized by relapsing episodes and MRI evidence of greater brain lesion disease activity. Thus, intervention with IFN beta therapy is appropriate for all stages of MS except PPMS or non-relapsing SPMS. Intervention with glatiramer acetate is appropriate for RRMS. The balance of evidence indicates that early therapy is essential to delay the accumulation of irreversible neurologic damage and consequent disability. NEUROLOGY 2011; 76(Suppl 1):S14-S25