Evolving concepts in the treatment of relapsing multiple sclerosis
Evolving concepts in the treatment of relapsing multiple sclerosis
复制标题
DOI：
10.1016/s0140-6736(16)32388-1
复制
发表时间：
2017-04-01
期刊：
影响因子：
168.9
通讯作者：
Sorensen, Per Soelberg
中科院分区：
文献类型：
--
作者：
Comi, Giancarlo;Radaelli, Marta;Sorensen, Per Soelberg
在过去的20年里，多发性硬化症的治疗方案发生了根本性的变化。有效的疾病修饰疗法的日益可用性已经将治疗干预的目标从减少复发和残疾累积转移到没有任何临床或MRI活动迹象。治疗的选择越来越复杂，应该由对不同药物的作用机制及其风险-获益特征的适当了解来驱动。由于该疾病的复发阶段以炎症为特征，因此应尽早开始治疗，并旨在重建免疫系统中的正常复杂相互作用。在开始治疗之前，神经科医生应仔细考虑疾病的状态，其预后因素和合并症，患者对既往治疗的反应，以及患者是否可能接受治疗相关风险，以最大限度地提高收益并最大限度地降低风险。由于准确的临床监测，早期发现次优反应者将允许临床医生在必要时重新设计治疗策略。
In the past 20 years the treatment scenario of multiple sclerosis has radically changed. The increasing availability of effective disease-modifying therapies has shifted the aim of therapeutic interventions from a reduction in relapses and disability accrual, to the absence of any sign of clinical or MRI activity. The choice for therapy is increasingly complex and should be driven by an appropriate knowledge of the mechanisms of action of the different drugs and of their risk-benefit profile. Because the relapsing phase of the disease is characterised by inflammation, treatment should be started as early as possible and aim to re-establish the normal complex interactions in the immune system. Before starting a treatment, neurologists should carefully consider the state of the disease, its prognostic factors and comorbidities, the patient's response to previous treatments, and whether the patient is likely to accept treatment-related risks in order to maximise benefits and minimise risks. Early detection of suboptimum responders, thanks to accurate clinical monitoring, will allow clinicians to redesign treatment strategies where necessary.