Genç Gençer, Demirkaya Şeref, Bek Semai, Odabaşi Zeki
Department of Neurology, Gümüşsuyu Military Hospital, İstanbul, Turkey.
Department of Neurology, Gülhane Training and Research Hospital, Ankara, Turkey.
Noro Psikiyatr Ars. 2017 Jun;54(2):116-124. doi: 10.5152/npa.2016.12621. Epub 2016 Mar 1.
Although it has been shown that immunomodulatory therapies (IMTs) in multiple sclerosis (MS) can modify the course of the disease by reducing the relapse rate and delaying the progression of disability, no study comparing IMTs head-to-head in terms of clinical, radiological, and electrophysiological changes is available. We aimed to investigate the effects of interferon-beta (IFN-B) 1b, IFN-B-1a subcutaneous (sc), IFN-B-1a intramuscular (im), and glatiramer acetate (GA) therapies on clinical, electrophysiological, and radiological findings.
We studied a cohort of 85 MS patients who were followed up for at least 2 years and had complete charting, including pre-treatment and post-treatment clinical, radiological, and electrophysiological findings. We compared the IMTs' effects on these findings retrospectively.
Annual relapse rates were 0.1 for IFN-B-1a sc, 0.2 for IFN-B-1b, 0.3 for GA, and 0.5 for IFN-B-1 a im (p=0.01). The percentages of relapse-free patients after one year were 54.5% for IFN-B-1a im and GA, 82.9% for IFN-B-1a sc, and 86.4% for IFN-B-1b, and after two years the percentages were 27.3% for IFN-B-1a im, 54.5% for GA, 72.7% for IFN-B-1b, and 78% for IFN-B-1a sc (p<0.05). Disability scores after 2 years increased for IFN-B-1a im, decreased for IFN-B-1a sc (with a 0.1-point increase compared to the first year), and did not change for IFN-B-1b or GA compared to before treatment. Within the 2-year treatment period, no significant increase in the number of magnetic resonance T2 lesions was observed. No significant differences were found for any of the therapies in terms of evoked potentials.
Our results revealed that high dose and more frequent regimens were more effective in terms of reducing the relapse rate, whereas there were no differences in terms of efficacy on radiological and electrophysiological findings between groups. Additional prospective studies comparing the efficacy of IMTs on MS are needed.
尽管已表明多发性硬化症（MS）的免疫调节疗法（IMTs）可通过降低复发率和延缓残疾进展来改变疾病进程，但尚无关于IMTs在临床、放射学和电生理变化方面进行直接对比的研究。我们旨在研究β-干扰素（IFN-B）1b、皮下注射（sc）的IFN-B-1a、肌肉注射（im）的IFN-B-1a以及醋酸格拉替雷（GA）疗法对临床、电生理和放射学结果的影响。
我们研究了一组85例MS患者，这些患者至少随访了2年，并有完整的记录，包括治疗前和治疗后的临床、放射学和电生理结果。我们回顾性比较了IMTs对这些结果的影响。
皮下注射IFN-B-1a的年复发率为0.1，IFN-B-1b为0.2，GA为0.3，肌肉注射IFN-B-1a为0.5（p=0.01）。一年后无复发患者的百分比，肌肉注射IFN-B-1a和GA为54.5%，皮下注射IFN-B-1a为82.9%，IFN-B-1b为86.4%；两年后，肌肉注射IFN-B-1a为27.3%，GA为54.5%，IFN-B-1b为72.7%，皮下注射IFN-B-1a为78%（p<0.05）。两年后，肌肉注射IFN-B-1a的残疾评分增加，皮下注射IFN-B-1a的残疾评分降低（与第一年相比增加了0.1分），与治疗前相比，IFN-B-1b或GA的残疾评分没有变化。在2年治疗期内，磁共振T2病变数量未观察到显著增加。在诱发电位方面，任何一种疗法均未发现显著差异。
我们的结果显示，高剂量和更频繁的治疗方案在降低复发率方面更有效，而各治疗组在放射学和电生理结果的疗效方面没有差异。需要进行更多比较IMTs对MS疗效的前瞻性研究。
