Comi Giancarlo
Department of Neurology, Scientic Institute San Raffaele, Via Olgettina 60, 20132, Milano, Italy.
Neurol Sci. 2008 Sep;29 Suppl 2:S253-5. doi: 10.1007/s10072-008-0954-x.
Most of the Consensus Groups in Europe and America support an early decision-making therapeutic approach in patients with a diagnosis of Multiple Sclerosis, either with IFNbeta or GA which have been demonstrated to be a reasonable therapeutic strategy because of their benefit. The treat-early approach within disease management is based on the assumption, particularly during the early phase of the disease, on the reduction of both relapse rate and of the ongoing inflammatory processes. As soon as the MS diagnosis is certain or even in patients with a first episode suggestive of MS, with negative prognostic factors and a typical presentation, the induction therapy, which is more aggressive on the immune system, seems to have more relevant short-and long-lasting beneficial effects. However, if the disease course is suboptimally controlled, an escalating strategy, using either Mitoxantrone, Cyclophosphamide, various other immuno-active agents, or the combination of different drugs, is suggested. The current challenge in therapeutic strategy is to identify the most effective drug, or combination of drugs, during a specific phase of the disease of each single patient. Nevertheless, the decision to adopt a combination therapy in patients with a low response to monotherapy should not be delayed until severe irreversible disability is evident.
欧美大多数共识小组支持对确诊为多发性硬化症的患者采用早期决策治疗方法，使用干扰素β或醋酸格拉替雷，由于其益处，已被证明是一种合理的治疗策略。疾病管理中的早期治疗方法基于这样的假设，特别是在疾病早期，可降低复发率和持续的炎症过程。一旦多发性硬化症的诊断确定，甚至在首次发作提示为多发性硬化症、具有不良预后因素且表现典型的患者中，对免疫系统更具攻击性的诱导疗法似乎具有更显著的短期和长期有益效果。然而，如果疾病进程控制不佳，建议采用逐步升级策略，使用米托蒽醌、环磷酰胺、各种其他免疫活性剂或不同药物的组合。治疗策略目前面临的挑战是在每位患者疾病的特定阶段确定最有效的药物或药物组合。尽管如此，对于单药治疗反应不佳的患者，不应等到出现严重不可逆残疾才决定采用联合治疗。
