Broadley Simon A, Barnett Michael H, Boggild Mike, Brew Bruce J, Butzkueven Helmut, Heard Robert, Hodgkinson Suzanne, Kermode Allan G, Lechner-Scott Jeannette, Macdonell Richard A L, Marriott Mark, Mason Deborah F, Parratt John, Reddel Stephen W, Shaw Cameron P, Slee Mark, Spies Judith, Taylor Bruce V, Carroll William M, Kilpatrick Trevor J, King John, McCombe Pamela A, Pollard John D, Willoughby Ernest
School of Medicine, Griffith University, Gold Coast Campus, QLD 4222, Australia; Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia.
Brain and Mind Research Institute, University of Sydney, Camperdown, NSW, Australia.
J Clin Neurosci. 2014 Nov;21(11):1857-65. doi: 10.1016/j.jocn.2014.01.017. Epub 2014 Jun 30.
In this third and final part of our review of multiple sclerosis (MS) treatment we look at the practical day-to-day management issues that are likely to influence individual treatment decisions. Whilst efficacy is clearly of considerable importance, tolerability and the potential for adverse effects often play a significant role in informing individual patient decisions. Here we review the issues surrounding switching between therapies, and the evidence to assist guiding the choice of therapy to change to and when to change. We review the current level of evidence with regards to the management of women in their child-bearing years with regards to recommendations about treatment during pregnancy and whilst breast feeding. We provide a summary of recommended pre- and post-treatment monitoring for the available therapies and review the evidence with regards to the value of testing for antibodies which are known to be neutralising for some therapies. We review the occurrence of adverse events, both the more common and troublesome effects and those that are less common but have potentially much more serious outcomes. Ways of mitigating these risks and managing the more troublesome adverse effects are also reviewed. Finally, we make specific recommendations with regards to the treatment of MS. It is an exciting time in the world of MS neurology and the prospects for further advances in coming years are high.
在我们对多发性硬化症（MS）治疗的系列综述的第三部分也是最后一部分中，我们将探讨可能影响个体治疗决策的日常实际管理问题。虽然疗效显然至关重要，但耐受性和不良反应的可能性在指导个体患者决策方面往往也起着重要作用。在此，我们回顾围绕治疗方案转换的问题，以及有助于指导选择转换为何种治疗方案以及何时转换的证据。我们审视关于育龄期女性管理的现有证据水平，涉及妊娠期间及母乳喂养期间的治疗建议。我们总结针对现有治疗方法推荐的治疗前和治疗后监测内容，并审视检测已知对某些治疗方法具有中和作用的抗体的价值的证据。我们回顾不良事件的发生情况，包括较常见且麻烦的影响以及那些不太常见但可能具有更严重后果的影响。还将探讨减轻这些风险以及处理较麻烦的不良反应的方法。最后，我们针对MS的治疗提出具体建议。在MS神经学领域，这是一个令人兴奋的时期，未来几年进一步取得进展的前景很高。
