Department of Neurology and Institute of Experimental Neurology, San Raffaele Hospital, Milan, Italy.
Department of Neurology and Institute of Experimental Neurology, San Raffaele Hospital, Milan, Italy.
Lancet. 2017 Apr 1;389(10076):1347-1356. doi: 10.1016/S0140-6736(16)32388-1. Epub 2016 Nov 24.
In the past 20 years the treatment scenario of multiple sclerosis has radically changed. The increasing availability of effective disease-modifying therapies has shifted the aim of therapeutic interventions from a reduction in relapses and disability accrual, to the absence of any sign of clinical or MRI activity. The choice for therapy is increasingly complex and should be driven by an appropriate knowledge of the mechanisms of action of the different drugs and of their risk-benefit profile. Because the relapsing phase of the disease is characterised by inflammation, treatment should be started as early as possible and aim to re-establish the normal complex interactions in the immune system. Before starting a treatment, neurologists should carefully consider the state of the disease, its prognostic factors and comorbidities, the patient's response to previous treatments, and whether the patient is likely to accept treatment-related risks in order to maximise benefits and minimise risks. Early detection of suboptimum responders, thanks to accurate clinical monitoring, will allow clinicians to redesign treatment strategies where necessary.
在过去的 20 年中，多发性硬化症的治疗方案发生了根本性的变化。越来越多有效的疾病修正治疗方法的出现，将治疗干预的目标从减少复发和残疾累积，转变为没有任何临床或 MRI 活动的迹象。治疗方法的选择越来越复杂，应该根据对不同药物的作用机制及其风险效益特征的适当了解来驱动。由于疾病的复发期以炎症为特征，因此应尽早开始治疗，并旨在重新建立免疫系统的正常复杂相互作用。在开始治疗之前，神经科医生应仔细考虑疾病的状态、其预后因素和合并症、患者对以前治疗的反应，以及患者是否可能接受与治疗相关的风险，以最大限度地提高益处并最小化风险。由于准确的临床监测，早期发现治疗反应不理想的患者，将使临床医生能够在必要时重新设计治疗策略。
