Zecca Chiara, Heldner Mirjam R, Kamm Christian P, Riccitelli Gianna C, Disanto Giulio, Caporro Matteo, Cianfoni Alessandro, Pravatà Emanuele, Gobbi Claudio
Department of Neurology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano , Via Tesserete 46, CH-6903 Lugano , Switzerland +41 91 811 6921 ; +41 91 811 6915 ;
Expert Opin Biol Ther. 2015 May;15(5):633-40. doi: 10.1517/14712598.2015.1025046. Epub 2015 Apr 3.
We aimed to investigate the influence of natalizumab (NTZ) treatment on multiple sclerosis course in patients with and without spinal involvement.
Annualized relapse rate (ARR), disability progression and occurrence of new brain and spinal T2 lesions (N2TL) in 68 spinal (S-P) versus 68 non-spinal matched patients (NS-P) were retrospectively collected and compared between before (2 years) and after NTZ treatment using multivariate regression models.
Mean duration of NTZ treatment was 31.3 ± 16.3 months in S-P and 32.1 ± 15.1 months in N-SP (p = 0.56). The mean ARR after NTZ treatment was similarly reduced in both S-P (0.07 ± 0.19) and N-SP (0.07 ± 0.16) (p < 0.001 for both). Disability progression after NTZ start was similarly low in S-P and NS-P. However, when compared to before NTZ start, disability progression was significantly reduced in S-P (p = 0.017), but not in NS-P (p = 0.68). This was largely mediated by a higher disability progression before NTZ start in S-P than N-SP. The risk of developing N2TL during NTZ was not different between S-P and NS-P (p = 0.10).
NTZ similarly reduced the occurrence of relapses and NT2L in S-P and NS-P, whereas the effect on disability progression was particularly evident in the presence of spinal involvement. NTZ appears to be a treatment of high efficacy in both S-P and NS-P.
我们旨在研究那他珠单抗（NTZ）治疗对有或无脊髓受累的多发性硬化症患者病程的影响。
回顾性收集68例脊髓受累患者（S-P组）和68例匹配的无脊髓受累患者（NS-P组）的年化复发率（ARR）、残疾进展情况以及新的脑和脊髓T2病变（N2TL）的发生情况，并使用多变量回归模型比较NTZ治疗前（2年）和治疗后的情况。
S-P组NTZ治疗的平均持续时间为31.3±16.3个月，NS-P组为32.1±15.1个月（p = 0.56）。NTZ治疗后，S-P组（0.07±0.19）和NS-P组（0.07±0.16）的平均ARR均同样降低（两组p均<0.001）。NTZ开始治疗后，S-P组和NS-P组的残疾进展同样较低。然而，与NTZ开始治疗前相比，S-P组的残疾进展显著降低（p = 0.017），而NS-P组则未降低（p = 0.68）。这在很大程度上是由于S-P组在NTZ开始治疗前的残疾进展高于NS-P组。NTZ治疗期间发生N2TL的风险在S-P组和NS-P组之间没有差异（p = 0.10）。
NTZ同样降低了S-P组和NS-P组的复发率和NT2L的发生率，而对残疾进展的影响在存在脊髓受累的情况下尤为明显。NTZ似乎对S-P组和NS-P组都是一种高效的治疗方法。
