Marian Lindsey M, Harris Kathleen A, Conway Devon S
Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic Foundation, Cleveland, OH, USA.
Mult Scler J Exp Transl Clin. 2024 May 6;10(2):20552173241251707. doi: 10.1177/20552173241251707. eCollection 2024 Apr-Jun.
Many patients report a wearing-off phenomenon with monoclonal antibody treatment for multiple sclerosis in which perceived benefits wear off before the next dose is due.
To determine prevalence of the wearing-off effect, symptoms experienced, impact on treatment satisfaction, and associated patient characteristics.
Patients receiving natalizumab, ocrelizumab, ofatumumab, or rituximab at a tertiary multiple sclerosis center were invited to take an online survey interrogating their monoclonal antibody experience. Additional history and patient characteristic data were collected. Logistic regression was used to determine if patient characteristics predicted the wearing-off effect and linear regression to evaluate the impact of the wearing-off effect on treatment satisfaction. The models were adjusted for age, disease duration, race, sex, body mass index, education, and depression as measured by the Patient Health Questionnaire-9.
We received 258 qualifying responses and 141 (54.7%) patients reported the wearing-off phenomenon. The most common symptom was fatigue (47.7%). Higher Patient Health Questionnaire-9 scores were significantly associated with the wearing-off phenomenon (OR = 1.02, = 0.005). The wearing-off effect (β = -0.52, = 0.04) and higher Patient Health Questionnaire-9 (β = -0.09, < 0.01) scores were associated with significantly reduced treatment satisfaction.
The wearing-off phenomenon is common, associated with depression, and reduces treatment satisfaction. Research addressing mitigation strategies is needed.
许多患者报告称，在接受治疗多发性硬化症的单克隆抗体治疗时会出现疗效减退现象，即在下一剂药物到期前，所感受到的疗效就已消失。
确定疗效减退效应的发生率、所经历的症状、对治疗满意度的影响以及相关的患者特征。
邀请在一家三级多发性硬化症中心接受那他珠单抗、奥瑞珠单抗、奥法木单抗或利妥昔单抗治疗的患者参加一项在线调查，询问他们使用单克隆抗体的经历。收集了更多的病史和患者特征数据。使用逻辑回归来确定患者特征是否可预测疗效减退效应，并使用线性回归来评估疗效减退效应对治疗满意度的影响。根据患者健康问卷-9所测量的年龄、病程、种族、性别、体重指数、教育程度和抑郁情况对模型进行了调整。
我们收到了258份合格回复，141名（54.7%）患者报告了疗效减退现象。最常见的症状是疲劳（47.7%）。患者健康问卷-9得分较高与疗效减退现象显著相关（OR = 1.02，P = 0.005）。疗效减退效应（β = -0.52，P = 0.04）和较高的患者健康问卷-9得分（β = -0.09，P < 0.01）与治疗满意度显著降低相关。
疗效减退现象很常见，与抑郁相关，并会降低治疗满意度。需要开展针对缓解策略的研究。
