Departments of Pediatrics, Neurology and Neurological Sciences, Stanford University, Stanford, California 94305; email:
Annu Rev Immunol. 2014;32:257-81. doi: 10.1146/annurev-immunol-032713-120227. Epub 2014 Jan 15.
Eighty percent of individuals with multiple sclerosis (MS) initially develop a clinical pattern with periodic relapses followed by remissions, called relapsing-remitting MS (RRMS). This period of fluctuating disease may last for a decade or more. Clinical relapses reflect acute inflammation in the central nervous system (CNS), composed of the brain and spinal cord. Often, different anatomic areas in the CNS are involved each time a relapse occurs, resulting in varied clinical manifestations in each instance. Relapses are nearly always followed by some degree of remission, though recovery to baseline status before the flare is often incomplete. There are nine approved drugs for treatment of RRMS. The most potent drug for inhibiting relapses, the humanized anti-α4 integrin antibody known as Natalizumab, blocks homing of mononuclear cells to the CNS. The mechanisms of action of the approved drugs for RRMS provide a strong foundation for understanding the pathobiology of the relapse. Despite substantial progress in controlling relapses with the current armamentarium of medications, there is much to learn and ever more effective and safe therapies to develop.
80%的多发性硬化症（MS）患者最初会出现一种临床模式，即周期性复发伴缓解，称为复发缓解型多发性硬化症（RRMS）。这种疾病的波动期可能会持续十年或更长时间。临床复发反映了中枢神经系统（CNS）的急性炎症，包括大脑和脊髓。通常，每次复发都会涉及 CNS 的不同解剖区域，导致每次发作的临床表现各不相同。复发后几乎总会有一定程度的缓解，但在发作前恢复到基线状态通常并不完全。目前有九种药物被批准用于治疗 RRMS。最有效的抑制复发药物是一种称为那他珠单抗的人源化抗α4 整合素抗体，它可以阻止单核细胞向中枢神经系统归巢。批准用于 RRMS 的药物的作用机制为理解复发的病理生物学提供了坚实的基础。尽管目前的药物治疗在控制复发方面取得了重大进展，但仍有许多需要学习，并且需要开发更有效和更安全的治疗方法。
