Rommer Paulus S, Buckow Karoline, Ellenberger David, Friede Tim, Pitschnau-Michel Dorothea, Fuge Jan, Stüve Olaf, Zettl Uwe K
Department of Neurology, University of Rostock, Rostock, Germany.
Department of Neurology, Medical University of Vienna, Vienna, Austria.
Eur J Clin Invest. 2015 Jun;45(6):587-93. doi: 10.1111/eci.12450. Epub 2015 May 9.
Multiple Sclerosis is the most common disease in young adults affecting the central nervous system. Disease may progress with acute attacks (relapsing MS) or continuously (progressive MS). Glucocorticosteroids are used in the treatment of acute attacks. The aim of this study was to analyse characteristics of patients with MS, and their influence on current treatment patterns of relapses with glucocorticosteroids.
In 2001, the German National MS Society initiated the German MS-Registry. Patients with relapsing MS were included (n = 5106) from this registry. Logistic regression models were used to detect trends over time. The likelihood of administration of steroids is modelled in dependence of calendar year and in dependence to confounders in treatment conditions. The sample size allows that odds ratios can be detected with a power of 90% (alpha = 0.05).
Administration of glucocorticosteroids was influenced by EDSS (P < 0.0001), age (P < 0.0001) and disease duration (P < 0.0001). Therapy administration in an outpatient setting was more likely in patients with higher EDSS (P < 0.0001) and longer disease duration (P < 0.0001). The utilization of glucocorticosteroids increased with higher EDSS for all relapsing patients. Interestingly, all overutilization of glucocorticosteroids decreased over time and was accompanied by a steadily increased administration of emergent therapeutics. Although there are about 70% of registered patients with relapsing MS on immune-modulatory treatment, almost 60% of them received glucocorticosteroids for treatment of relapses.
Treatment patterns with glucocorticosteroids in patients with MS are influenced mainly by EDSS and disease duration. The decline in the utilization of glucocorticosteroids is accompanied by an increase in natalizumab treatment.
多发性硬化症是影响中枢神经系统的最常见的青年成人疾病。疾病可能会急性发作（复发型多发性硬化症）或持续进展（进展型多发性硬化症）。糖皮质激素用于治疗急性发作。本研究的目的是分析多发性硬化症患者的特征及其对目前糖皮质激素治疗复发模式的影响。
2001年，德国国家多发性硬化症协会启动了德国多发性硬化症登记处。从该登记处纳入复发型多发性硬化症患者（n = 5106）。使用逻辑回归模型来检测随时间的趋势。根据日历年以及治疗条件中的混杂因素对使用类固醇的可能性进行建模。样本量使得能够以90%的检验效能（α = 0.05）检测比值比。
糖皮质激素的使用受扩展残疾状态量表（EDSS）（P < 0.0001）、年龄（P < 0.）和病程（P < 0.0001）的影响。EDSS较高（P < 0.0001）和病程较长（P < 0.0001）的患者更有可能在门诊接受治疗。对于所有复发患者，糖皮质激素的使用随着EDSS的升高而增加。有趣的是，糖皮质激素的所有过度使用情况随时间减少，同时急救治疗的使用稳步增加。尽管约70%登记的复发型多发性硬化症患者接受免疫调节治疗，但其中近60%接受糖皮质激素治疗复发。
多发性硬化症患者使用糖皮质激素的治疗模式主要受EDSS和病程影响。糖皮质激素使用的下降伴随着那他珠单抗治疗的增加。
