Tintoré Mar
Multiple Sclerosis Center of Catalonia, Clinical Neuroimmunology-Multiple Sclerosis Unit, Vall d'Hebron University Hospital, Barcelona, Spain.
J Neurol Sci. 2009 Feb 1;277 Suppl 1:S9-S11. doi: 10.1016/S0022-510X(09)70004-8.
It is now possible to diagnose patients with multiple sclerosis earlier than previously due to the integration of MRI parameters into the diagnostic criteria. This provides a window of opportunity to treat patients with disease-modifying treatments before clinically-manifest tissue destruction and disability has emerged. There are a number of reasons to believe that such early treatment will be particularly beneficial. For example, immunopathological studies have shown that the irreversible axonal damage that underlies accumulation of disability occurs very early in the course of the disease. In addition, natural history studies demonstrate that frequent relapses and accumulation of a high T2 lesion load in the first years following diagnosis are predictive of long-term disability outcome. Treating patients early, after a clinically isolated neurological syndrome suggestive of multiple sclerosis, appears to have a greater impact on relapse frequency than when treatment is initiated later in the disease course. The latest data comes from the PreCISe study, a placebo-controlled randomised study of glatiramer acetate in patients with a clinically isolated syndrome. The study showed that this treatment significantly reduced the risk of conversion to clinically definite multiple sclerosis, with the quartile time for conversion being prolonged by more than one year in the glatiramer acetate cohort compared to placebo-treated patients. The safety and tolerability of glatiramer acetate in this relatively healthy and independent patient population was acceptable and consistent with its known safety profile in patients with relapsing remitting multiple sclerosis. An application for an extension of the approved indication of glatiramer acetate to the treatment of patients with a first clinical event suggestive of multiple sclerosis has been filed with the regulatory authorities.
由于将MRI参数纳入诊断标准，现在能够比以前更早地诊断多发性硬化症患者。这提供了一个机会窗口，可在临床明显的组织破坏和残疾出现之前，用疾病修正治疗方法治疗患者。有许多理由相信这种早期治疗将特别有益。例如，免疫病理学研究表明，导致残疾累积的不可逆轴索损伤在疾病过程中很早就会发生。此外，自然史研究表明，诊断后的头几年频繁复发和高T2病变负荷的累积可预测长期残疾结果。在出现提示多发性硬化症的临床孤立神经综合征后尽早治疗患者，似乎比在疾病病程后期开始治疗对复发频率的影响更大。最新数据来自PreCISe研究，这是一项在临床孤立综合征患者中使用醋酸格拉替雷的安慰剂对照随机研究。该研究表明，这种治疗显著降低了转化为临床确诊多发性硬化症的风险，与安慰剂治疗的患者相比，醋酸格拉替雷组的转化四分位数时间延长了一年多。醋酸格拉替雷在这个相对健康和独立的患者群体中的安全性和耐受性是可以接受的，并且与其在复发缓解型多发性硬化症患者中的已知安全性概况一致。已向监管机构提交了将醋酸格拉替雷的批准适应症扩展至治疗首次临床事件提示多发性硬化症患者的申请。
