色氨酸免疫吸附用于类固醇难治性多发性硬化复发的强化治疗——147例患者的多中心观察性研究

Escalation Therapy of Steroid Refractory Multiple Sclerosis Relapse with Tryptophan Immunoadsorption - Observational Multicenter Study with 147 Patients.

作者信息

Schimrigk Sebastian, Faiss Jürgen, Köhler Wolfgang, Günther Albrecht, Harms Lutz, Kraft Andrea, Ehrlich Sven, Eberl Axel, Fassbender Cordula, Klingel Reinhard, Galle Jan, Riedlinger Arne, Hoffmann Frank

机构信息

Department of Neurology, General Hospital Lx00FC;denscheid, Lx00FC;denscheid, Germany.

出版信息

Eur Neurol. 2016;75(5-6):300-6. doi: 10.1159/000447059. Epub 2016 Jun 16.

DOI:10.1159/000447059

PMID:27304890

Abstract

BACKGROUND

A marked proportion of multiple sclerosis (MS) relapses is followed by incomplete recovery. Our aim was to considerably increase the evidence of the clinical use of immunoadsorption (IA) as escalation therapy for patients with MS relapse.

METHODS

A retrospective multicenter study was performed in MS patients with steroid refractory relapse who were treated with tryptophan IA. The main outcome parameter was change of acute relapse-related disability assessed by Expanded Disability Status Scale (EDSS) and visual acuity (VA) measurements for patients with optic neuritis (ON). IA treatments were performed using single-use tryptophan adsorbers.

RESULTS

Data of 147 MS patients and 786 single IA treatments were analyzed. Treatment with IA was commenced in mean 32 ± 35 days after the onset of relapse. One hundred and five out of 147 patients (71.4%) improved functionally after mean 5.4 IA treatments within 7-10 days. EDSS improved from median 5 (interquartile range, IQR 3.5) to 4 (IQR 2.5) (p < 0.001). In patients with ON (n = 32), VA improved after the IA series in 84% of cases from median 0.2 (IQR 0.6) to 0.6 (IQR 0.66) (p < 0.001). In 98.9% of IA treatments, no clinically relevant side effect was reported.

CONCLUSION

Tryptophan IA was found to be effective and well tolerated as escalation therapy for MS relapse.

摘要

背景

相当一部分多发性硬化症（MS）复发后恢复不完全。我们的目的是大幅增加免疫吸附（IA）作为MS复发患者强化治疗的临床应用证据。

方法

对接受色氨酸IA治疗的类固醇难治性复发MS患者进行了一项回顾性多中心研究。主要结局参数是通过扩展残疾状态量表（EDSS）评估的急性复发相关残疾的变化，以及对视神经炎（ON）患者的视力（VA）测量。IA治疗使用一次性色氨酸吸附器进行。

结果

分析了147例MS患者的数据和786次单次IA治疗。IA治疗平均在复发开始后32±35天开始。147例患者中有105例（71.4%）在平均5.4次IA治疗后7至10天内功能得到改善。EDSS从中位数5（四分位间距，IQR 3.5）改善至4（IQR 2.5）（p<0.001）。在ON患者（n = 32）中，84%的患者在IA治疗系列后VA得到改善，从中位数0.2（IQR 0.6）提高至0.6（IQR 0.66）（p<0.001）。在98.9%的IA治疗中，未报告有临床意义的副作用。