Boster Aaron, Edan Gilles, Frohman Elliott, Javed Adil, Stuve Olaf, Tselis Alexandros, Weiner Howard, Weinstock-Guttman Bianca, Khan Omar
The Multiple Sclerosis Clinical Research Center, Department of Neurology, Wayne State University School of Medicine, and The Detroit Medical Center, Detroit, MI 48201, USA.
Lancet Neurol. 2008 Feb;7(2):173-83. doi: 10.1016/S1474-4422(08)70020-6.
Several lines of evidence link immunosuppression to inflammation in patients with multiple sclerosis (MS) and provide a rationale for the increasing use of immunosuppressive drugs in the treatment of MS. Treatment-refractory, clinically active MS can quickly lead to devastating and irreversible neurological disability and treating these patients can be a formidable challenge to the clinician. Patients with refractory MS have been treated with intense immunosuppression, such as cyclophosphamide or mitoxantrone, or with autologous haematopoeitic stem cell transplants. Evidence shows that intense immunosuppression might be effective in patients who are unresponsive to immunomodulating therapy, such as interferon beta and glatiramer acetate. Natalizumab, a new addition to the armamentarium for treating MS, might also have a role in the treatment of this MS phenotype. This Review describes the use of intense immunosuppressant drugs and natalizumab in patients with rapidly worsening MS and provides clinicians with guidelines for the use of these drugs in this patient group.
多条证据表明，免疫抑制与多发性硬化症（MS）患者的炎症相关，这为在MS治疗中越来越多地使用免疫抑制药物提供了理论依据。治疗难治性、临床活动期的MS可迅速导致严重且不可逆的神经功能残疾，对这些患者进行治疗对临床医生而言可能是一项艰巨的挑战。难治性MS患者已接受过如环磷酰胺或米托蒽醌等强化免疫抑制治疗，或接受过自体造血干细胞移植。有证据表明，强化免疫抑制对那些对免疫调节治疗（如β干扰素和醋酸格拉替雷）无反应的患者可能有效。那他珠单抗是治疗MS药物库中的新成员，在这种MS表型的治疗中可能也发挥作用。本综述描述了强化免疫抑制药物和那他珠单抗在快速进展型MS患者中的应用，并为临床医生提供了在该患者群体中使用这些药物的指南。
