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特立氟胺可降低复发相关的神经后遗症、住院和类固醇的使用。

Teriflunomide reduces relapse-related neurological sequelae, hospitalizations and steroid use.

机构信息

St Michael's Hospital, University of Toronto, Toronto, ON, Canada,

出版信息

J Neurol. 2013 Oct;260(10):2472-80. doi: 10.1007/s00415-013-6979-y. Epub 2013 Jul 14.

Abstract

Multiple sclerosis (MS) relapses impose a substantial clinical and economic burden. Teriflunomide is a new oral disease-modifying therapy approved for the treatment of relapsing MS. We evaluated the effects of teriflunomide treatment on relapse-related neurological sequelae and healthcare resource use in a post hoc analysis of the Phase III TEMSO study. Confirmed relapses associated with neurological sequelae [defined by an increase in Expanded Disability Status Scale/Functional System (sequelae-EDSS/FS) ≥ 30 days post relapse or by the investigator (sequelae-investigator)] were analyzed in the modified intention-to-treat population (n = 1086). Relapses requiring hospitalization or intravenous (IV) corticosteroids, all hospitalizations, emergency medical facility visits (EMFV), and hospitalized nights for relapse were also assessed. Annualized rates were derived using a Poisson model with treatment, baseline EDSS strata, and region as covariates. Risks of sequelae and hospitalization per relapse were calculated as percentages and groups were compared with a χ(2) test. Compared with placebo, teriflunomide reduced annualized rates of relapses with sequelae-EDSS/FS [7 mg by 32 % (p = 0.0019); 14 mg by 36 % (p = 0.0011)] and sequelae-investigator [25 % (p = 0.071); 53 % (p < 0.0001)], relapses leading to hospitalization [36 % (p = 0.015); 59 % (p < 0.0001)], and relapses requiring IV corticosteroids [29 % (p = 0.001); 34 % (p = 0.0003)]. Teriflunomide-treated patients spent fewer nights in hospital for relapse (p < 0.01). Teriflunomide 14 mg also decreased annualized rates of all hospitalizations (p = 0.01) and EMFV (p = 0.004). The impact of teriflunomide on relapse-related neurological sequelae and relapses requiring healthcare resources may translate into reduced healthcare costs.

摘要

多发性硬化症(MS)复发会带来巨大的临床和经济负担。特立氟胺是一种新的口服疾病修正治疗药物,已获准用于治疗复发型 MS。我们在 III 期 TEMSO 研究的事后分析中评估了特立氟胺治疗对复发相关神经后遗症和医疗资源使用的影响。在改良意向治疗人群(n = 1086)中分析了与神经后遗症相关的确诊复发(定义为复发后 30 天内扩展残疾状况量表/功能系统(后遗症-EDSS/FS)增加≥30 天或研究者(后遗症-研究者))。还评估了需要住院或静脉(IV)皮质类固醇、所有住院、急诊医疗设施就诊(EMFV)和因复发住院的夜间次数。使用泊松模型,以治疗、基线 EDSS 分层和地区为协变量,得出年复发率。根据复发的后遗症发生率和住院率计算风险百分比,并使用 χ(2)检验比较组间差异。与安慰剂相比,特立氟胺降低了有后遗症-EDSS/FS 的年复发率[7 mg 组 32%(p = 0.0019);14 mg 组 36%(p = 0.0011)]和有后遗症-研究者的年复发率[25%(p = 0.071);53%(p < 0.0001)]、导致住院的复发率[36%(p = 0.015);59%(p < 0.0001)]和需要 IV 皮质类固醇的复发率[29%(p = 0.001);34%(p = 0.0003)]。特立氟胺治疗的患者因复发住院的夜间次数更少(p < 0.01)。特立氟胺 14 mg 还降低了所有住院治疗(p = 0.01)和 EMFV(p = 0.004)的年复发率。特立氟胺对复发相关神经后遗症和需要医疗资源的复发的影响可能会转化为降低医疗成本。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d0a2/3824843/dc0bb56beeb9/415_2013_6979_Fig1_HTML.jpg

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