Portaccio E, Zipoli V, Siracusa G, Sorbi S, Amato M P
Department of Neurology, University of Florence, Viale G. Morgagni 5, Florence, Italy.
Eur Neurol. 2009;61(3):177-82. doi: 10.1159/000189271. Epub 2009 Jan 8.
Interferon-beta (IFNB) therapies are the most widely used as first-line intervention in the treatment of relapsing-remitting (RR) multiple sclerosis (MS). Despite long-term experience, however, the definition and prediction of response remain controversial.
The objective of this study was to assess the long-term validity of the main clinical definitions of response applied after 1 and 2 years of IFNB therapy in a cohort of RRMS patients followed up for at least 5 years.
We tested these different definitions against a 'hard' parameter of treatment failure, represented by the need to suspend IFNB and switch to an intravenous immunosuppressive (IVIS) treatment, using Kaplan-Meier and Cox survival analyses.
Out of 147 RRMS patients treated with IFNB therapy and followed up for 7.8 +/- 2.1 years, 26 (18%) were switched to an IVIS therapy. On the whole, disability progression as indicated using the Expanded Disability Status Scale (EDSS) and a higher number of relapses in the first 2 years of therapy were related to long-term treatment failure.
Our study highlights the role of disability and high relapse rate in the first 2 years of treatment in predicting long-term response and the switching to second-line therapies.
β-干扰素（IFNB）疗法是复发缓解型（RR）多发性硬化症（MS）治疗中最广泛使用的一线干预措施。然而，尽管有长期经验，但反应的定义和预测仍存在争议。
本研究的目的是评估在一组随访至少5年的RRMS患者中，IFNB治疗1年和2年后应用的主要临床反应定义的长期有效性。
我们使用Kaplan-Meier和Cox生存分析，针对以需要停用IFNB并改用静脉免疫抑制（IVIS）治疗为代表的治疗失败“硬”参数，测试了这些不同的定义。
在147例接受IFNB治疗并随访7.8±2.1年的RRMS患者中，26例（18%）改用了IVIS治疗。总体而言，使用扩展残疾状态量表（EDSS）表明的残疾进展以及治疗前2年中较高的复发次数与长期治疗失败有关。
我们的研究强调了治疗前2年中的残疾和高复发率在预测长期反应以及改用二线治疗方面的作用。
