D'Amico Emanuele, Leone Carmela, Zanghì Aurora, Fermo Salvatore Lo, Patti Francesco
Multiple Sclerosis Center, Policlinico G. Rodolico, Via Santa Sofia, 78, Catania, 95123, Italy.
J Neurol. 2016 Sep;263(9):1802-9. doi: 10.1007/s00415-016-8207-z. Epub 2016 Jun 17.
Performing a therapeutic switch in MS is still a matter of debate. Objective of our study is to compare switching to another first-line therapy with switching to a second-line therapy in persons with relapsing-remitting multiple sclerosis (pwRRMS). A retrospective analysis of data prospectively collected was performed. PwRRMS experiencing on-treatment disease activity were included. No clinical relapse, no sustained disability progression by the Expanded Disability Status Scale (EDSS), and no radiological activity (new T2 and/or gadolinium-enhanced brain lesions) were used as indicators of no disease activity (NEDA 3). Time to reach the first relapse after switch and time to reach an EDSS of 4.0 were also evaluated. Ninety-one pwRRMS were enrolled. Forty-eight (52.7 %) were on lateral switch, and 43 (47.3 %) on escalation switch. At baseline, the two groups differed for T2 and T1 brain lesions number (higher in the escalation group, p < 0.005). The proportion of pwRRMS who were NEDA 3 after 24 months from the switch was similar in the two groups (20.8 % in lateral group and 18.6 % in escalation group). No difference in timing to reach the first relapse after switch and an EDSS of 4.0 were found. Therefore, in selected pwRRMS, lateral and escalation strategies showed similar efficacy in delaying MS progression.
在多发性硬化症（MS）中进行治疗转换仍存在争议。我们研究的目的是比较复发缓解型多发性硬化症患者（pwRRMS）从一线治疗转换为另一种一线治疗与转换为二线治疗的情况。我们对前瞻性收集的数据进行了回顾性分析。纳入了在治疗期间出现疾病活动的pwRRMS患者。无临床复发、扩展残疾状态量表（EDSS）无持续残疾进展以及无影像学活动（新的T2和/或钆增强脑病变）被用作无疾病活动（NEDA 3）的指标。还评估了转换后首次复发的时间以及达到EDSS 4.0的时间。共纳入91例pwRRMS患者。48例（52.7%）进行横向转换，43例（47.3%）进行升级转换。基线时，两组在T2和T1脑病变数量上存在差异（升级组更高，p < 0.005）。转换后24个月达到NEDA 3的pwRRMS患者比例在两组中相似（横向组为20.8%，升级组为18.6%）。在转换后首次复发的时间以及达到EDSS 4.0的时间方面未发现差异。因此，在选定的pwRRMS患者中，横向和升级策略在延缓MS进展方面显示出相似的疗效。
