维生素 D 对疾病修正治疗类药物对多发性硬化症活动的影响。
Effect of vitamin D on MS activity by disease-modifying therapy class.
机构信息
Partners Multiple Sclerosis Center (D.L.R., B.C.H., M.T.M., R.L.C., A.J.M., H.L.W., B.G., T.C.) and Ann Romney Center for Neurologic Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital; and Biostatistics Center (B.C.H.), Massachusetts General Hospital, Boston.
出版信息
Neurol Neuroimmunol Neuroinflamm. 2015 Oct 29;2(6):e167. doi: 10.1212/NXI.0000000000000167. eCollection 2015 Dec.
OBJECTIVE
To determine whether vitamin D status predicts disease activity in patients with multiple sclerosis (MS) taking interferon-β (IFN), glatiramer acetate (GA), and fingolimod (FTY).
METHODS
Participants (n = 324) with relapsing-remitting MS on IFN (96), GA (151), or FTY (77) were identified from the Comprehensive Longitudinal Investigation of MS at Brigham and Women's Hospital (CLIMB) Study at the Partners MS Center. FTY-treated participants were analyzed separately because of differences in selection. Serum vitamin 25(OH)D concentration was adjusted for season. We evaluated the relationship between 25(OH)D tertile and time to relapse or gadolinium-enhancing lesion using a Cox model adjusted for age, sex, and disease duration.
RESULTS
Higher 25(OH)D was associated with longer time to the combined endpoint in the overall IFN/GA cohort (p for trend = 0.042; hazard ratio [HR] = 0.77) and in the IFN subgroup (HRIFN = 0.58; p IFN = 0.012), but not in GA-treated participants (p = 0.50; HR = 0.89). For gadolinium-enhancing lesions alone, there was a significant association observed in GA and IFN subgroups, although the effect was more pronounced on IFN (HRGA = 0.57; p GA = 0.039 vs HRIFN = 0.41; p IFN = 0.022). No significant associations were found for relapses. For FTY, higher 25(OH)D was associated with longer survival for the combined endpoint (HRFTY = 0.48; p FTY = 0.016) and for relapses (HRFTY = 0.50; p FTY = 0.046), but not for gadolinium-enhancing lesions.
CONCLUSIONS
Disease activity generally improved with higher 25(OH)D, but this study raises the question of effect modification by treatment class.
目的
确定维生素 D 状态是否可预测接受干扰素-β（IFN）、那他珠单抗（GA）和芬戈莫德（FTY）治疗的多发性硬化症（MS）患者的疾病活动度。
方法
从布里格姆妇女医院（Brigham and Women's Hospital）的合作伙伴多发性硬化症中心的综合纵向多发性硬化症研究（CLIMB）中确定了接受 IFN（96 例）、GA（151 例）或 FTY（77 例）治疗的复发缓解型 MS 患者。由于选择的差异，对接受 FTY 治疗的患者进行了单独分析。血清维生素 25（OH）D 浓度根据季节进行了调整。我们使用 Cox 模型评估了 25（OH）D 三分位与复发或钆增强病变时间的关系，该模型调整了年龄、性别和疾病持续时间。
结果
较高的 25（OH）D 与总体 IFN/GA 队列（趋势检验 p = 0.042；风险比[HR] = 0.77）和 IFN 亚组（HRIFN = 0.58；p IFN = 0.012）的联合终点时间延长相关，但在 GA 治疗的患者中则没有相关性（p = 0.50；HR = 0.89）。对于单独的钆增强病变，GA 和 IFN 亚组观察到有显著的相关性，尽管 IFN 的影响更为明显（HRGA = 0.57；p GA = 0.039 与 HRIFN = 0.41；p IFN = 0.022）。对于复发，未发现显著相关性。对于 FTY，较高的 25（OH）D 与联合终点（HRFTY = 0.48；p FTY = 0.016）和复发（HRFTY = 0.50；p FTY = 0.046）的生存时间延长相关，但与钆增强病变无关。
结论
一般来说，疾病活动度随着 25（OH）D 的增加而改善，但这项研究提出了一个问题，即治疗类别是否存在作用修饰。
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