人类嗜T淋巴细胞病毒1型相关脊髓病/热带痉挛性截瘫的管理：2019年系统评价与基于共识的建议
Management of HAM/TSP: Systematic Review and Consensus-based Recommendations 2019.
作者信息
Araujo Abelardo, Bangham Charles R M, Casseb Jorge, Gotuzzo Eduardo, Jacobson Steve, Martin Fabiola, Penalva de Oliveira Augusto, Puccioni-Sohler Marzia, Taylor Graham P, Yamano Yoshihisa
机构信息
Laboratory for Clinical Research in Neuroinfections (AA), Evandro Chagas National Institute of Infectious Diseases, FIOCRUZ, Rio de Janeiro, Brazil; Section of Immunology of Infection (CRMB), Department of Infectious Disease, Imperial College London, United Kingdom; Faculdade de Medicina da Universidade de São Paulo/Institute of Tropical Medicine of Sao Paulo (JC), Brazil; Instituto de Medicina Tropical "Alexander von Humboldt" (EG), Universidad Peruana Cayetano Heredia, Lima, Peru; Viral Immunology Section (SJ), National Institutes of Health, Bethesda, MD; Stonewall Medical Centre (FM), Windsor, Australia; Instituto de Infectologia Hospital Emilio Ribas (APO), Sao Paulo University, Sao Paulo, Brazil; Federal University of the State of Rio de Janeiro (UNIRIO)/Federal University of Rio de Janeiro (UFRJ) (MP-S), Brazil; Section of Virology (GPT), Department of Infectious Disease, Imperial College London, United Kingdom; and Department of Rare Diseases Research (YY), Institute of Medical Science, St Marianna University School of Medicine, Kanagawa, Japan.
出版信息
Neurol Clin Pract. 2021 Feb;11(1):49-56. doi: 10.1212/CPJ.0000000000000832.
PURPOSE OF REVIEW
To provide an evidence-based approach to the use of therapies that are prescribed to improve the natural history of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP)-a rare disease.
RECENT FINDINGS
All 41 articles on the clinical outcome of disease-modifying therapy for HAM/TSP were included in a systematic review by members of the International Retrovirology Association; we report here the consensus assessment and recommendations. The quality of available evidence is low, based for the most part on observational studies, with only 1 double-masked placebo-controlled randomized trial.
SUMMARY
There is evidence to support the use of both high-dose pulsed methyl prednisolone for induction and low-dose (5 mg) oral prednisolone as maintenance therapy for progressive disease. There is no evidence to support the use of antiretroviral therapy. There is insufficient evidence to support the use of interferon-α as a first-line therapy.
综述目的
提供一种基于证据的方法，用于使用那些为改善人类嗜T淋巴细胞病毒1型相关脊髓病/热带痉挛性截瘫（HAM/TSP）（一种罕见疾病）的自然病程而开具的治疗方法。
最新发现
国际逆转录病毒学协会成员进行的一项系统评价纳入了所有41篇关于HAM/TSP疾病修饰治疗临床结局的文章；我们在此报告共识评估和建议。现有证据质量较低，大部分基于观察性研究，仅有1项双盲安慰剂对照随机试验。
总结
有证据支持使用大剂量脉冲式甲泼尼龙进行诱导治疗，以及使用低剂量（5毫克）口服泼尼松龙作为进展性疾病的维持治疗。没有证据支持使用抗逆转录病毒疗法。没有足够证据支持将α干扰素用作一线治疗。
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