Vohl Katja, Duscha Alexander, Gisevius Barbara, Kaisler Johannes, Gold Ralf, Haghikia Aiden
Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany.
Front Neurol. 2019 Feb 22;10:132. doi: 10.3389/fneur.2019.00132. eCollection 2019.
The autoimmune disease Multiple Sclerosis (MS) represents a heterogeneous disease pattern with an individual course that may lead to permanent disability. In addition to immuno-modulating therapies patients benefit from symptomatic approaches like intrathecal corticosteroid therapy (ICT), which is frequently applied in a growing number of centers in Germany. ICT reduces spasticity, which elongates patient's walking distance and speed, thus improves quality of life. In our study we set out to investigate cerebrospinal fluid (CSF) parameters and clinical predictors for response to ICT. Therefore, we analyzed 811 CSF samples collected from 354 patients over a time period of 12 years. Patients who received ICT were divided in two groups (improving or active group) depending on their EDSS-progress. As control groups we analyzed data of ICT naïve patients, who were divided in the two groups as well. Additionally we observed the clinical progress after receiving ICT by comparison of patients in both groups. The results showed clinical data had a significant influence on the probability to benefit from ICT. The probability (shown by Odds Ratio of 1.77-2.43) to belong to the improving group in contrast to the active group is significantly ( < 0.0001) higher at later stages of disease with early disease onset (< 35 years, OR = 2.43) and higher EDSS at timepoint of ICT-initiation (EDSS > 6, OR = 2.06). Additionally, we observed lower CSF cell counts (6.68 ± 1.37 μl) and lower total CSF protein (412 ± 18.25 mg/l) of patients who responded to ICT compared to patients who did not ( < 0.05). In the control group no significant differences were revealed. Furthermore analyses of our data revealed patients belonging to the improving group reach an EDSS of 6 after ICT-initiation less often than patients of the active group (after 13 years 39.8% in the improving group, 67.8% in the active group). Our study implies two relevant messages: (i) although the study was not designed to prospectively assess clinical data, in this cohort no severe side effects were observed under ICT; (ii) disease onset, EDSS, CSF cell count, and total protein may serve as predictive markers for therapy response.
自身免疫性疾病多发性硬化症（MS）呈现出异质性的疾病模式，其病程因人而异，可能导致永久性残疾。除了免疫调节疗法外，患者还能从鞘内注射皮质类固醇疗法（ICT）等对症治疗方法中获益，德国越来越多的医疗中心经常采用这种疗法。ICT可减轻痉挛，从而延长患者的行走距离和速度，进而提高生活质量。在我们的研究中，我们着手调查脑脊液（CSF）参数以及对ICT反应的临床预测指标。因此，我们分析了在12年时间里从354名患者身上采集的811份脑脊液样本。接受ICT治疗的患者根据其扩展残疾状态量表（EDSS）进展情况分为两组（改善组或活跃组）。作为对照组，我们分析了未接受ICT治疗患者的数据，这些患者也被分为两组。此外，我们通过比较两组患者接受ICT治疗后的情况来观察临床进展。结果显示，临床数据对从ICT治疗中获益的可能性有显著影响。与活跃组相比，属于改善组的概率（用优势比1.77 - 2.43表示）在疾病后期、发病较早（< 35岁，优势比 = 2.43）且ICT开始时EDSS较高（EDSS > 6，优势比 = 2.06）时显著更高（< 0.0001）。此外，我们观察到，与无反应患者相比，对ICT有反应的患者脑脊液细胞计数较低（6.68 ± 1.37 μl），脑脊液总蛋白也较低（412 ± 18.25 mg/l）（< 0.05）。在对照组中未发现显著差异。此外，对我们数据的分析显示，与活跃组患者相比，改善组患者在开始ICT治疗后达到EDSS为6的情况较少（13年后，改善组为39.8%，活跃组为67.8%）。我们的研究传达了两条相关信息：（i）尽管该研究并非旨在前瞻性评估临床数据，但在这个队列中，ICT治疗未观察到严重副作用；（ii）疾病发作、EDSS、脑脊液细胞计数和总蛋白可作为治疗反应的预测指标。
