Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS 7000, Australia.
Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS 7000, Australia.
Mult Scler Relat Disord. 2019 Nov;36:101374. doi: 10.1016/j.msard.2019.08.016. Epub 2019 Aug 15.
Disease modifying therapies (DMT) are a common medication class for treating people living with MS. However, although treatment with DMT can extend over more than a decade, little is known about their long-term effects. Here, we systematically review long-term (≥4 years) studies on the effect of DMT on disability progression and relapse in people living with MS.
We searched the EMBASE and Medline databases in January 2018, using search terms that included DMT and relevant outcome measures. Two authors screened all resulting studies and evaluated the risk of bias of included studies using the ROBINS-I tool for non-randomized studies. Where there was sufficient data, we performed meta-analyses using RevMan 5. Studies that could not be included in a meta-analysis were included in data synthesis.
Our search returned 7,766 unique articles for review. After screening, 18 articles were included. Follow-up in these studies ranged from a mean of 3.9 years to a median of 17.8 years. Fifteen (83.3%) of the included studies had a moderate risk of bias and three (16.7%) had a serious risk of bias. Meta-analysis showed that DMT significantly reduced the risk of EDSS 6.0 and SPMS compared to no treatment.
There is some evidence that long-term treatment with interferon beta reduces the risk of EDSS 6.0 and SPMS compared to no treatment or placebo. More work is needed on the effect of second generation DMT and the relative effect of DMT on health outcomes.
疾病修正疗法（DMT）是治疗多发性硬化症患者的常用药物类别。然而，尽管 DMT 的治疗可能持续超过十年，但对其长期效果知之甚少。在这里，我们系统地回顾了关于 DMT 对多发性硬化症患者残疾进展和复发影响的长期（≥4 年）研究。
我们于 2018 年 1 月在 EMBASE 和 Medline 数据库中搜索了使用 DMT 和相关结局测量的搜索词。两名作者筛选了所有产生的研究，并使用非随机研究的 ROBINS-I 工具评估了纳入研究的偏倚风险。在有足够数据的情况下，我们使用 RevMan 5 进行荟萃分析。无法纳入荟萃分析的研究将纳入数据综合。
我们的搜索返回了 7766 篇用于审查的独特文章。经过筛选，有 18 篇文章被纳入。这些研究的随访时间从平均 3.9 年到中位数 17.8 年不等。纳入的 18 项研究中有 15 项（83.3%）存在中度偏倚风险，3 项（16.7%）存在严重偏倚风险。荟萃分析表明，与不治疗相比，DMT 显著降低 EDSS 6.0 和 SPMS 的风险。
有一些证据表明，与不治疗或安慰剂相比，长期使用干扰素β治疗可降低 EDSS 6.0 和 SPMS 的风险。需要更多的工作来研究第二代 DMT 的效果以及 DMT 对健康结果的相对效果。
