Marfia Girolama Alessandra, Centonze Diego, Salvetti Marco, Ferraro Elisabetta, Panetta Valentina, Gasperini Claudio, Mirabella Massimiliano, Conte Antonella
Multiple Sclerosis Clinical and Research Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy.
Department of Systems Medicine, Tor Vergata University, Rome, Italy.
Front Neurol. 2022 Jul 15;13:898741. doi: 10.3389/fneur.2022.898741. eCollection 2022.
In multiple sclerosis (MS), bridging therapies are usually administered when switching from one therapy to another. Such treatments generally consist of injectable immunomodulatory drugs (interferon or glatiramer acetate), whose efficacy, safety, and tolerability data are consolidated for use even in fragile patients. We performed a nationwide survey to gather expert opinions regarding the most appropriate use of bridging therapies in MS.
An independent steering committee of Italian neurologists with expertise in MS treatment identified critical issues in the use of bridging therapies and formulated a questionnaire. This questionnaire was used to conduct a Delphi web survey, involving a panel of Italian neurologists with experience in MS treatment. Their anonymous opinions were collected in three sequential rounds. Consensus was defined as an interquartile range (IQR) ≤2.
Responses were obtained from 38 experts (100%) in all three rounds. Injectable immunomodulatory drugs were considered first-line therapy in patients with mild-to-moderate disease activity and in women planning to become pregnant. In addition, the experts were confident about prescribing these drugs in patients at risk of cancer recurrence, while the panel agreed to discontinue any treatments in patients with uncontrolled cardiovascular or metabolic disorders. Moreover, bridging therapy with injectable immunomodulatory drugs was considered appropriate in order to protect the patient from disease reactivation when a prolonged washout was needed and also while waiting for the completion of the immunization schedule.
The results of this nationwide survey confirm that, among Italian neurologists, there was wide agreement on the use of bridging therapies with injectable immunomodulatory drugs in several conditions in order to minimize the risk of disease reactivation when a prolonged washout was required or when the immunization schedule still needed to be completed in patients planning to become pregnant and in patients at risk of cancer recurrence.
在多发性硬化症（MS）中，当从一种治疗方法转换到另一种治疗方法时，通常会采用过渡疗法。此类治疗一般包括可注射的免疫调节药物（干扰素或醋酸格拉替雷），其疗效、安全性和耐受性数据已得到充分证实，甚至可用于身体虚弱的患者。我们开展了一项全国性调查，以收集有关MS过渡疗法最恰当使用的专家意见。
一个由在MS治疗方面具有专业知识的意大利神经科医生组成的独立指导委员会确定了过渡疗法使用中的关键问题，并制定了一份问卷。该问卷用于开展德尔菲网络调查，参与调查的是一组有MS治疗经验的意大利神经科医生。他们的匿名意见分三轮依次收集。共识被定义为四分位间距（IQR）≤2。
在所有三轮调查中均获得了38位专家（100%）的回复。可注射的免疫调节药物被视为疾病活动程度为轻度至中度的患者以及计划怀孕的女性的一线治疗药物。此外，专家们对为有癌症复发风险的患者开具这些药物有信心，而专家小组一致同意在患有未得到控制的心血管或代谢紊乱的患者中停用任何治疗。此外，当需要延长洗脱期以及等待免疫接种计划完成时，使用可注射的免疫调节药物进行过渡疗法被认为是合适的，以保护患者避免疾病重新激活。
这项全国性调查的结果证实，在意大利神经科医生中，对于在多种情况下使用可注射的免疫调节药物进行过渡疗法以在需要延长洗脱期时或在计划怀孕的患者以及有癌症复发风险的患者中免疫接种计划仍需完成时将疾病重新激活的风险降至最低，存在广泛共识。
