Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Brain Repair and Rehabilitation, University College London, Institute of Neurology, Faculty of Brain Sciences, London, UK.
Lancet. 2017 Apr 1;389(10076):1357-1366. doi: 10.1016/S0140-6736(16)31320-4. Epub 2016 Nov 24.
Multiple sclerosis is a major cause of neurological disability, which accrues predominantly during progressive forms of the disease. Although development of multifocal inflammatory lesions is the underlying pathological process in relapsing-remitting multiple sclerosis, the gradual accumulation of disability that characterises progressive multiple sclerosis seems to result more from diffuse immune mechanisms and neurodegeneration. As a result, the 14 anti-inflammatory drugs that have regulatory approval for treatment of relapsing-remitting multiple sclerosis have little or no efficacy in progressive multiple sclerosis without inflammatory lesion activity. Effective therapies for progressive multiple sclerosis that prevent worsening, reverse damage, and restore function are a major unmet need. In this Series paper we summarise the current status of therapy for progressive multiple sclerosis and outline prospects for the future.
多发性硬化症是一种主要的神经功能障碍疾病，主要在疾病的进展形式中累积。尽管多灶性炎症病变的发展是复发缓解型多发性硬化症的基础病理过程，但逐渐累积的残疾似乎更多地是由弥漫性免疫机制和神经退行性变引起的。因此，在没有炎症性病变活动的情况下，14 种具有治疗复发缓解型多发性硬化症监管批准的抗炎药物对进展型多发性硬化症几乎没有疗效或没有疗效。预防病情恶化、逆转损伤和恢复功能的有效治疗方法是一个主要的未满足需求。在本系列论文中，我们总结了进展型多发性硬化症治疗的现状，并概述了未来的前景。
