Cavaletti Guido, Forsey Katherine, Alberti Paola
Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
J Peripher Nerv Syst. 2023 Sep;28(3):295-307. doi: 10.1111/jns.12566. Epub 2023 Jun 5.
Several widely used medications, with a relevant efficacy profile, are toxic to the peripheral nervous system and an even larger number of agents are suspected to be neurotoxic. There are concerns about the use of these drugs in patients with Charcot-Marie-Tooth disease (CMT), a hereditary motor and sensory neuropathy. This review provides evidence-based updated recommendations on this clinically relevant topic.
A systematic review of the available studies/reports written in English was performed from July to September 2022 including in the search string all reported putative neurotoxic drugs.
The results of our systematic review provide evidence-based support for the statement that use of vincristine, and possibly paclitaxel, can occasionally induce an atypical, and more severe, course of drug-related peripheral neurotoxicity in CMT patients. It is therefore reasonable to recommend caution in the use of these compounds in CMT patients. However, no convincing evidence for a similar recommendation could be found for all other drugs.
It is important that patients with CMT are not denied effective treatments that may prolong life expectancy for cancer or improve their health status if affected by non-oncological diseases. Accurate monitoring of peripheral nerve function in CMT patients treated with any neurotoxic agent remains mandatory to detect the earliest signs of neuropathy worsening and atypical clinical courses. Neurologists monitoring CMT patients as part of their normal care package or for natural history studies should keep detailed records of exposures to neurotoxic medications and support reporting of accelerated neuropathy progression if observed.
几种广泛使用且具有显著疗效的药物对周围神经系统有毒性，还有更多药物被怀疑具有神经毒性。人们担心在患有夏科-马里-图斯病（CMT，一种遗传性运动和感觉神经病变）的患者中使用这些药物。本综述就这一临床相关主题提供基于证据的最新建议。
于2022年7月至9月对以英文撰写的现有研究/报告进行了系统综述，在检索词中纳入了所有报告的假定神经毒性药物。
我们系统综述的结果为以下观点提供了基于证据的支持，即使用长春新碱以及可能的紫杉醇，偶尔会在CMT患者中诱发非典型且更严重的药物相关周围神经毒性病程。因此，建议在CMT患者中谨慎使用这些化合物是合理的。然而，对于所有其他药物，未找到类似建议的令人信服的证据。
重要的是，不应拒绝CMT患者接受可能延长癌症患者预期寿命或改善其非肿瘤疾病健康状况的有效治疗。在用任何神经毒性药物治疗的CMT患者中，对外周神经功能进行准确监测仍然是必要的，以检测神经病变恶化和非典型临床病程的最早迹象。作为日常护理或自然史研究的一部分对CMT患者进行监测的神经科医生，应详细记录神经毒性药物的暴露情况，并支持报告观察到的神经病变加速进展情况。
