为计划怀孕的临床稳定型复发缓解型多发性硬化症患者更换治疗方案。
Switching treatments in clinically stable relapsing remitting multiple sclerosis patients planning for pregnancy.
作者信息
Almouzain Lubna, Stevenson Fiona, Chard Declan, Rahman Nur Abdul, Hamilton Fiona
机构信息
Research Department at Primary Care and Population Health, Institution of Epidemiology, University College of London, London, UK.
Clinical Pharmacy Department, King Saud University, Riyadh, Saudi Arabia.
出版信息
Mult Scler J Exp Transl Clin. 2021 Mar 19;7(1):20552173211001571. doi: 10.1177/20552173211001571. eCollection 2021 Jan-Mar.
BACKGROUND
The decision to have children can be complex, particularly for people with multiple sclerosis (MS). A key concern is the use of disease modifying drugs (DMDs) during pregnancy, and how continuing, stopping or switching them may affect the mother and child. In people with active MS, stopping medications puts the mother at risk of relapse and disease rebound.
OBJECTIVES
Review evidence on the effect of different switching strategies in people with stable relapsing remitting MS (RRMS).
METHODS
We searched MEDLINE, EMBASE, EMCARE, CINAHL, SCOPUS, Cochrane Library up to March 2020. Only papers in English were included and no other limits were applied. Seven articles were included: four cohorts, two case reports and one randomized controlled trial (RCT).
RESULTS
Two strategies were found: de-escalating, which was associated with an increased risk of relapses, and switching between first line injectables, with no change in relapse rate observed.
CONCLUSION
Evidence on the effect of switching strategy on disease course in stable RRMS patients planning for pregnancy is scarce, but when switching, current evidence suggests the risk of relapses mirrors known medication efficacy.
背景
生育的决定可能很复杂，尤其是对于患有多发性硬化症（MS）的人来说。一个关键问题是孕期使用疾病修正药物（DMDs），以及继续、停用或更换这些药物可能如何影响母亲和孩子。对于患有活动性MS的人来说，停药会使母亲面临复发和疾病反弹的风险。
目的
综述不同换药策略对病情稳定的复发缓解型MS（RRMS）患者的影响的证据。
方法
我们检索了截至2020年3月的MEDLINE、EMBASE、EMCARE、CINAHL、SCOPUS、Cochrane图书馆。仅纳入英文论文，不设其他限制。纳入了7篇文章：4篇队列研究、2篇病例报告和1篇随机对照试验（RCT）。
结果
发现了两种策略：逐步减量，这与复发风险增加相关；在一线注射药物之间换药，未观察到复发率变化。
结论
关于换药策略对计划怀孕的病情稳定的RRMS患者疾病进程影响的证据很少，但换药时，现有证据表明复发风险反映了已知的药物疗效。
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