Practice guideline recommendations summary: Disease-modifying therapies for adults with multiple sclerosis
Practice guideline recommendations summary: Disease-modifying therapies for adults with multiple sclerosis
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DOI：
10.1212/wnl.0000000000005347
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发表时间：
2018-04-24
期刊：
影响因子：
9.9
通讯作者：
Pringsheim, Tamara
中科院分区：
文献类型：
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作者：
Rae-Grant, Alexander;Day, Gregory S.;Pringsheim, Tamara
目的制定多发性硬化症（MS）的疾病修饰治疗（DMT）的建议。方法多学科小组制定DMT建议，整合系统评价的结果;遵循符合医学研究所的流程，以确保透明度和患者参与;并开发了改良的德尔菲共识建议，涉及复发缓解型MS患者开始、转换和停止DMT，继发性进行性MS、原发性进行性MS和临床孤立的脱髓鞘综合征。支持结构化的理由，整合证据从一个或多个来源：系统评价，相关的证据（证据不从系统评价），原则的护理，和推理evidence.ResultsThirty建议开发：17开始DMT，包括建议谁应该开始他们; 10切换DMT，如果突破性疾病的发展;和3停止DMT。建议包括患者参与策略和个体化治疗，包括依从性监测和疾病合并症评估。该小组还讨论了DMT风险，包括对MS患者使用那他珠单抗、芬戈莫德、利妥昔单抗、ocrelizumab和富马酸二甲酯进行性多灶性白质脑病风险的咨询;并对未来的研究提出了建议，以评估早期治疗的相对优势，更高的效力DMT与标准的阶梯式护理方案，DMT的比较有效性，最佳转换策略，长期影响DMT的使用，高活动性MS的定义，以及治疗对患者特定优先结局的影响。本指南反映了启动、切换或停止MS DMT决策的复杂性。MS治疗领域正在迅速变化;神经病学学院的发展过程包括规划未来的更新。
ObjectiveTo develop recommendations for disease-modifying therapy (DMT) for multiple sclerosis (MS).MethodsA multidisciplinary panel developed DMT recommendations, integrating findings from a systematic review; followed an Institute of Medicine-compliant process to ensure transparency and patient engagement; and developed modified Delphi consensus-based recommendations concerning starting, switching, and stopping DMTs pertinent to people with relapsing-remitting MS, secondary progressive MS, primary progressive MS, and clinically isolated syndromes of demyelination. Recommendations were supported by structured rationales, integrating evidence from one or more sources: systematic review, related evidence (evidence not from the systematic review), principles of care, and inference from evidence.ResultsThirty recommendations were developed: 17 on starting DMTs, including recommendations on who should start them; 10 on switching DMTs if breakthrough disease develops; and 3 on stopping DMTs. Recommendations encompassed patient engagement strategies and individualization of treatment, including adherence monitoring and disease comorbidity assessment. The panel also discussed DMT risks, including counseling about progressive multifocal leukoencephalopathy risk in people with MS using natalizumab, fingolimod, rituximab, ocrelizumab, and dimethyl fumarate; and made suggestions for future research to evaluate relative merits of early treatment with higher potency DMTs vs standard stepped-care protocols, DMT comparative effectiveness, optimal switching strategies, long-term effects of DMT use, definitions of highly active MS, and effects of treatment on patient-specified priority outcomes. This guideline reflects the complexity of decision-making for starting, switching, or stopping MS DMTs. The field of MS treatment is rapidly changing; the Academy of Neurology development process includes planning for future updates.