Hospital Universitari Vall d'Hebron, Barcelona, Spain.
J Neurol Sci. 2009 Dec;287 Suppl 1:S2-6. doi: 10.1016/S0022-510X(09)71293-6.
Multiple sclerosis usually begins in young adulthood, and presents in 80-90% of patients with an initial disease course typified by relapses and remissions. The ability to recognise an individual's first neurological episode, commonly called a clinically isolated syndrome (CIS), represents a significant advance in the differential diagnosis of multiple sclerosis and offers the possibility of intervening at an earlier stage. Of note, over eighty percent of patients with a clinically isolated syndrome and magnetic resonance imaging lesions go on to develop multiple sclerosis within three years. The effect of first line therapies has been shown to be more pronounced when they are used at disease onset compared to a more advanced disease stage. First-line therapeutics have reached a milestone where a significant portion of disease activity is either preventable or at least modifiable. The results of the PreCISe Phase III multicentre, double-blind, randomised trial of glatiramer acetate versus placebo in patients with clinically isolated syndrome with abnormal MRI have recently been published. The study demonstrated a significant delay in progression to clinically definite multiple sclerosis in patients receiving glatiramer acetate, as well as a reduction in the burden of disease, as measured by both the number of new T2 lesions and T2 lesion volume. Considering these and previous results, this treatment should be regarded as an essential addition to the armamentarium of drugs available for the earliest treatment of this devastating disease.
多发性硬化症通常在成年早期开始发病，80-90%的患者初始疾病过程表现为复发和缓解。识别个体的首次神经发作（通常称为临床孤立综合征 [CIS]）的能力是多发性硬化症鉴别诊断的重大进展，并提供了在更早阶段进行干预的可能性。值得注意的是，超过 80%的临床孤立综合征和磁共振成像病变患者在三年内会发展为多发性硬化症。与更晚期疾病阶段相比，一线治疗在疾病发作时使用的效果更为明显。一线治疗已经取得了里程碑式的进展，其中很大一部分疾病活动是可预防的，或者至少是可以改变的。最近发表了一项关于醋酸格拉替雷与安慰剂治疗临床孤立综合征伴异常磁共振成像患者的 PreCISe III 期多中心、双盲、随机试验的结果。该研究表明，接受醋酸格拉替雷治疗的患者向临床确诊多发性硬化症的进展明显延迟，同时疾病负担也减轻，表现在新 T2 病变数量和 T2 病变体积均减少。考虑到这些结果和之前的结果，这种治疗方法应该被视为治疗这种毁灭性疾病的早期治疗的重要药物。
