Nicholas Richard, Chataway Jeremy
Imperial Healthcare Trust, London, UK.
BMJ Clin Evid. 2009 May 14;2009:1202.
Multiple sclerosis is the most common cause of neurological disability in young adults. Irreversible disability can occur, but life expectancy is generally not affected.
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions aimed at reducing relapse rates and disability in people with multiple sclerosis? What are the effects of interventions to improve symptoms during acute relapse? What are the effects of treatments for fatigue, spasticity, and multidisciplinary care on disability in people with multiple sclerosis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2008 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 68 systematic reviews, RCTs, and observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review, we present information relating to the effectiveness and safety of the following key interventions: amantadine, azathioprine, behaviour modification, botulinum toxin, corticosteroids, exercise, gabapentin, inpatient or outpatient rehabilitation, interferon beta, intrathecal baclofen, intravenous immunoglobulin, methotrexate, mitoxantrone, modafinil, natalizumab, oral drug treatments, parenteral glatiramer acetate, physiotherapy, and plasma exchange.
多发性硬化症是年轻成年人神经功能障碍最常见的病因。虽可能出现不可逆的残疾，但一般不影响预期寿命。
我们进行了一项系统综述，旨在回答以下临床问题：旨在降低多发性硬化症患者复发率和残疾程度的干预措施有哪些效果？在急性复发期间改善症状的干预措施有哪些效果？针对疲劳、痉挛以及多学科护理对多发性硬化症患者残疾状况的治疗效果如何？我们检索了：截至2008年6月的Medline、Embase、Cochrane图书馆及其他重要数据库（Clinical Evidence综述会定期更新，请查看我们的网站获取本综述的最新版本）。我们纳入了来自美国食品药品监督管理局（FDA）和英国药品及医疗保健产品监管局（MHRA）等相关机构的危害警示。
我们找到了68项符合我们纳入标准的系统综述、随机对照试验和观察性研究。我们对干预措施的证据质量进行了GRADE评估。
在本系统综述中，我们呈现了以下关键干预措施的有效性和安全性相关信息：金刚烷胺、硫唑嘌呤、行为矫正、肉毒杆菌毒素、皮质类固醇、运动、加巴喷丁、住院或门诊康复、干扰素β、鞘内注射巴氯芬、静脉注射免疫球蛋白、甲氨蝶呤、米托蒽醌、莫达非尼、那他珠单抗、口服药物治疗、皮下注射醋酸格拉替雷、物理治疗和血浆置换。
