Kutz Christen
Colorado Springs Neurological Associates, 2312 North Nevada Avenue, Colorado Springs, CO 80907, USA.
Ther Adv Chronic Dis. 2016 Jul;7(4):190-7. doi: 10.1177/2040622316644481. Epub 2016 Jun 10.
Treatment of multiple sclerosis (MS) relapses can be complex in patients with concomitant diabetes. Corticosteroids and adrenocorticotropic hormones are known to cause alterations in glucose tolerance. Many patients have poor tolerability to therapy, necessitating alternative treatment options. Adrenocorticotropic hormone (H.P. Acthar Gel, repository corticotropin injection, Mallinckrodt ARD Inc., Hazelwood, MO, USA) is currently indicated for the treatment of MS relapses.
The objective of this study was to review patients' experiences of Acthar Gel for the treatment of MS exacerbations in patients with MS and diabetes.
A retrospective review of 13 patients' experiences with treatment. Qualified healthcare providers completed a questionnaire following Acthar Gel treatment for MS relapse.
Previous corticosteroid treatment with either intravenous methylprednisolone or prednisone was reported by 84.6% of patients; eight patients had complications following administration of prior steroid treatment, seven of whom experienced elevated blood glucose levels. Acthar Gel was administered daily for a mean of 5.3 days, with 61.5% of patients reporting relapse resolution. Two patients experienced elevated blood glucose.
The majority of patients experienced a timely resolution of their MS relapse with few hyperglycemic adverse events. Although more studies are necessary, these data suggest that Acthar Gel may be a well-tolerated and effective treatment option for patients with diabetes experiencing an MS relapse.
对于合并糖尿病的多发性硬化症(MS)患者,其复发的治疗可能较为复杂。已知皮质类固醇和促肾上腺皮质激素会导致葡萄糖耐量改变。许多患者对治疗的耐受性较差,因此需要其他治疗选择。促肾上腺皮质激素(H.P. Acthar Gel,长效促肾上腺皮质激素注射液,美国密苏里州黑兹尔伍德市马林克罗特ARD公司)目前被用于治疗MS复发。
本研究的目的是回顾患者使用Acthar Gel治疗MS合并糖尿病患者病情加重的经历。
对13例患者的治疗经历进行回顾性分析。合格的医疗服务提供者在患者使用Acthar Gel治疗MS复发后完成一份调查问卷。
84.6%的患者曾接受过静脉注射甲泼尼龙或泼尼松的皮质类固醇治疗;8例患者在先前的类固醇治疗后出现并发症,其中7例血糖水平升高。Acthar Gel平均每日给药5.3天,61.5%的患者报告病情复发得到缓解。2例患者血糖升高。
大多数患者的MS复发得到及时缓解,且高血糖不良事件较少。尽管需要更多研究,但这些数据表明,Acthar Gel可能是糖尿病合并MS复发患者耐受性良好且有效的治疗选择。