Caon Christina
Multiple Sclerosis Center, Department of Neurology, Wayne State University, Detroit, MI, USA.
J Neurol Sci. 2009 Feb 1;277 Suppl 1:S33-6. doi: 10.1016/S0022-510X(09)70010-3.
The different immunomodulatory treatments available to patients with relapsing remitting multiple sclerosis are only partially effective. Since these treatments are most effective in the early relapsing stage of the disease, it is important to adjust therapy in a timely fashion in order to fall within the window of opportunity when maximal benefit can be gained from a second-line treatment. Consensus guidelines have been established to define a sub-optimal treatment response. Switching to another class of immunomodulatory therapy represents a logical treatment strategy in patients who fail to respond adequately to first line treatments. Several observational studied have now shown such a strategy to be beneficial. Disease control can be improved following switching in patients with persistent relapse activity on first-line treatment. In patients experiencing intolerable side-effects to first- line-treatment, tolerability can be improved by switching without loss of disease control. In particular, a switch between different classes of immunomodulatory treatments seems to be more beneficial than switching within the same class. Formal switching algorithms need to be developed in order to ensure that all patients who could benefit from such an approach are managed in a timely and optimal manner.
复发缓解型多发性硬化症患者可用的不同免疫调节治疗仅部分有效。由于这些治疗在疾病的早期复发阶段最为有效，因此及时调整治疗方案很重要，以便在能够从二线治疗中获得最大益处的机会窗口内进行治疗。已制定共识指南来定义次优治疗反应。对于对一线治疗反应不佳的患者，换用另一类免疫调节疗法是一种合理的治疗策略。现在有几项观察性研究表明这种策略是有益的。对于一线治疗后仍有持续复发活动的患者，换药后疾病控制情况可以得到改善。对于一线治疗出现无法耐受副作用的患者，换药可改善耐受性且不会丧失疾病控制。特别是，不同类别的免疫调节治疗之间的换药似乎比同一类别内的换药更有益。需要制定正式的换药算法，以确保所有能从这种方法中受益的患者都能得到及时、最佳的治疗。
