Department of Neurology, Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH 44195, USA.
Mult Scler. 2010 May;16(5):588-96. doi: 10.1177/1352458509360549. Epub 2010 Feb 18.
Disease-modifying drugs are initiated early and continued for years in patients with multiple sclerosis. Long-term tolerability and impact are not known. The objective of this study was to evaluate long-term tolerability of intramuscular interferon beta-1a and effects on disability and quality of life. Patients were evaluated an average of 15 years after randomization into a placebo-controlled, double-blind trial of intramuscular interferon beta-1a for relapsing multiple sclerosis. Patient-reported Expanded Disability Status Scale, the Short Form-36, a visual analog scale of self-care independence, and a living situation questionnaire were administered. Status was ascertained in 79% (136/172) of eligible patients. Analysis focused on 122 living patients. Despite open-label, non-standardized treatment after the 2-year clinical trial, 46% (n= 56) of the patients remained on intramuscular interferon beta-1a. Expanded Disability Status Scale scores were correlated highly with Short Form-36 subcategories and visual analog scale scores. Patients currently using intramuscular interferon beta-1a had a significantly lower mean Expanded Disability Status Scale score (p= 0.011), less progression to Expanded Disability Status Scale milestones, significantly better scores on the physical component of the Short Form-36 (p< 0.0001), and reported better general health and greater independence. We conclude that patients continuing to use intramuscular interferon beta-1a had less disability and better quality of life compared with patients not currently using intramuscular interferon beta-1a 15 years after randomization into a clinical trial.
多发性硬化症患者需要长期使用疾病修正药物,甚至长达数年。目前尚不清楚这些药物的长期耐受性和影响。本研究的目的是评估肌内注射干扰素 β-1a 的长期耐受性及其对残疾和生活质量的影响。患者在随机进入肌内注射干扰素 β-1a 治疗复发性多发性硬化症的安慰剂对照、双盲临床试验后平均 15 年接受评估。评估内容包括扩展残疾状态量表、健康调查简表-36、自我护理独立性视觉模拟量表和生活状况问卷。符合条件的 172 名患者中,有 79%(136/172)的患者进行了随访。分析重点关注 122 名存活患者。尽管在 2 年临床试验结束后进行了开放标签、非标准化治疗,但仍有 46%(n=56)的患者继续使用肌内注射干扰素 β-1a。扩展残疾状态量表评分与健康调查简表-36 的子类别和视觉模拟量表评分高度相关。目前使用肌内注射干扰素 β-1a 的患者的平均扩展残疾状态量表评分显著较低(p=0.011),进展为扩展残疾状态量表里程碑的比例较低,健康调查简表-36 的身体成分评分显著较高(p<0.0001),且患者自述总体健康状况更好,独立性更强。我们的结论是,与未继续使用肌内注射干扰素 β-1a 的患者相比,继续使用肌内注射干扰素 β-1a 的患者在临床试验随机分组后 15 年时残疾程度更低,生活质量更高。