Neuro-Oncology Program, Norris Cotton Cancer Center Dartmouth-Hitchcock Medical Center and Departments of Neurology and Medicine, Dartmouth Medical School, One Medical Center Drive Lebanon NH 03756, USA.
Curr Neuropharmacol. 2011 Sep;9(3):468-77. doi: 10.2174/157015911796557939.
In parallel to our better understanding of the role of the immune system in neurologic diseases, there has been an increased availability in therapeutic options for autoimmune neurologic diseases such as multiple sclerosis, myasthenia gravis, polyneuropathies, central nervous system vasculitides and neurosarcoidosis. In many cases, the purported benefits of this class of therapy are anecdotal and not the result of good controlled clinical trials. Nonetheless, their potential efficacy is better known than their adverse event profile. A rationale therapeutic decision by the clinician will depend on a comprehensive understanding of the ratio between efficacy and toxicity. In this review, we outline the most commonly used immune suppressive medications in neurologic disease: cytotoxic chemotherapy, nucleoside analogues, calcineurin inhibitors, monoclonal antibodies and miscellaneous immune suppressants. A discussion of their mechanisms of action and related toxicity is highlighted, with the goal that the reader will be able to recognize the most commonly associated toxicities and identify strategies to prevent and manage problems that are expected to arise with their use.
随着我们对免疫系统在神经疾病中的作用的认识不断提高，针对自身免疫性神经疾病（如多发性硬化症、重症肌无力、多发性神经病、中枢神经系统血管炎和神经结节病）的治疗选择也越来越多。在许多情况下，这类治疗的所谓益处只是传闻，而不是经过良好对照临床试验证实的结果。尽管如此，它们的潜在疗效比不良反应更广为人知。临床医生的合理治疗决策将取决于对疗效与毒性之间关系的全面了解。在这篇综述中，我们概述了神经疾病中最常用的免疫抑制药物：细胞毒性化疗药物、核苷类似物、钙调神经磷酸酶抑制剂、单克隆抗体和其他免疫抑制剂。强调了它们的作用机制和相关毒性，以期读者能够识别最常见的相关毒性，并确定预防和管理预期与使用相关的问题的策略。
