稳定期多发性硬化症患者停止或转换疾病修正治疗后的临床和 MRI 结果：病例系列报告。
Clinical and MRI outcomes after stopping or switching disease-modifying therapy in stable MS patients: a case series report.
机构信息
MS Comprehensive Care Center at the University of Southern California Keck School of Medicine of USC, USA.
出版信息
Mult Scler Relat Disord. 2017 Oct;17:123-127. doi: 10.1016/j.msard.2017.07.007. Epub 2017 Jul 6.
OBJECTIVE
To evaluate clinical and MRI outcomes after stopping or switching disease-modifying therapy in patients with stable MS.
METHODS
A retrospective chart review was conducted of stable MS patients who discontinued or switched their DMT from 2011 to 2015. Clinical and MRI outcomes were obtained at baseline and 1-year follow-up.
RESULTS
For the DMT discontinuation group, 15 patients were included, with 67% female, 53% Caucasian, mean age of 45.3 ± 12.2 years, disease duration of 9.1 ± 4.3 years, MS type (80% RRMS, 20% SPMS), and EDSS of 3.7 ± 1.6. The average duration of stable MS course was 5.5 ± 3.7 years. Within a mean of 6.4 ± 2.2 months after DMT discontinuation, all 15 patients experienced worsening of MS disease. After re-evaluation of MS treatment options, all 15 patients were restarted on DMT, of which, 6 (40%) restarted on their prior DMT, 4 (26.7%) switched to another DMT due to adverse events on prior DMT, and 5 (33.3%) switched to a more potent DMT due to worsening of MS activity. One year follow-up showed 2 patients (13.3%) who were restarted on their prior DMT experienced a relapse and the remaining 13 patients (86.7%) had no clinical or MRI activities. For the DMT switch group, 23 patients were included, with 65% female, 61% Caucasian, a mean age of 46.9 ± 11.6 years, disease duration of 11.7 ± 5.1 years, MS Type (83% RRMS, 17% SPMS), and EDSS of 3.5 ± 0.9. After switching DMT, 9 (39.1%) patients experienced worsening of clinical or MRI outcomes at the 1-year follow-up. Of the 9 switch failures, the majority (N = 6) were due to switching to dimethyl fumarate.
CONCLUSION
DMT discontinuation in stable MS patients resulted in worsening of MS disease course for all patients, which improved upon DMT restart or switch. In contrast, 39% of MS stable patients experienced worsening of MS disease course when switched to another DMT, with DMT selection potentially impacting switch outcomes.
目的
评估稳定期多发性硬化症（MS）患者停止或转换疾病修正治疗（DMT）后的临床和 MRI 结局。
方法
对 2011 年至 2015 年期间停止或转换 DMT 的稳定期 MS 患者进行回顾性图表审查。在基线和 1 年随访时获得临床和 MRI 结果。
结果
对于 DMT 停药组，纳入 15 例患者，其中 67%为女性，53%为白种人，平均年龄为 45.3 ± 12.2 岁，疾病病程为 9.1 ± 4.3 年，MS 类型（80%RRMS，20%SPMS），EDSS 为 3.7 ± 1.6。稳定期 MS 病程的平均持续时间为 5.5 ± 3.7 年。在停止 DMT 后平均 6.4 ± 2.2 个月内，所有 15 例患者的 MS 病情均恶化。在重新评估 MS 治疗选择后，所有 15 例患者均重新开始 DMT 治疗，其中 6 例（40%）继续使用之前的 DMT，4 例（26.7%）因之前的 DMT 出现不良反应而改用其他 DMT，5 例（33.3%）因 MS 活动恶化而改用更有效的 DMT。一年随访显示，重新开始使用之前 DMT 的 2 例（13.3%）患者出现复发，其余 13 例（86.7%）患者无临床或 MRI 活动。对于 DMT 转换组，纳入 23 例患者，其中 65%为女性，61%为白种人，平均年龄为 46.9 ± 11.6 岁，疾病病程为 11.7 ± 5.1 年，MS 类型（83%RRMS，17%SPMS），EDSS 为 3.5 ± 0.9。转换 DMT 后，9 例（39.1%）患者在 1 年随访时出现临床或 MRI 结局恶化。在 9 例转换失败中，大多数（N=6）是由于转换为富马酸二甲酯。
结论
稳定期 MS 患者停止 DMT 后，所有患者的 MS 病程均恶化，重新开始 DMT 或转换后病情改善。相比之下，39%的稳定期 MS 患者在转换为另一种 DMT 时出现 MS 病情恶化，DMT 的选择可能影响转换结果。
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