雄激素调节疗法对老年多发性硬化症男性患者疾病活动的影响。
Effects of androgen modifying therapies on disease activity in older men with multiple sclerosis.
作者信息
Zeydan Burcu, Neyal Nur, Nathoo Nabeela, Rangachari Manu, Atkinson Elizabeth J, Son Jiye, Conway Brittani L, Tobin W Oliver, Keegan B Mark, Weinshenker Brian G, Kantarci Kejal, Oh Jiwon, Kantarci Orhun H
机构信息
Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Radiology, Mayo Clinic, Rochester, MN, USA; Women's Health Research Center, Mayo Clinic, Rochester, MN, USA; Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA.
Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Radiology, Mayo Clinic, Rochester, MN, USA.
出版信息
J Neuroimmunol. 2025 Jun 15;403:578589. doi: 10.1016/j.jneuroim.2025.578589. Epub 2025 Mar 18.
BACKGROUND
Anti-inflammatory properties of androgens were assessed in animal models, but only several clinical studies investigated the effects of androgen on multiple sclerosis (MS). Inflammatory activity in MS often attenuates with aging, and androgen modifying therapies (AMT), which mimic decreased androgen levels, are frequently used in older men. We aimed to investigate if the number of disease activity events would increase in older (≥55 years) male persons with MS (MPwMS) who are on AMT.
METHODS
MPwMS with AMT initiation ≥55 years (AMT; n = 60) and without AMT history (no-AMT; n = 80) were included from a clinical-based observational study cohort. Clinical (relapses), Radiological (new lesions), and Disease (relapses and/or new lesions) activity events were evaluated before and after the age at AMT initiation in AMT and no-AMT groups.
RESULTS
Age at MS onset, progressive MS rate and treatment frequencies were similar between the groups. When events before and after the age at AMT initiation (mean = 65.0 ± 7.0 years) were compared, there was a drop in the percentage of individuals with Clinical (38.5 % vs. 10 %), Radiological (46.2 % vs. 40 %) and Disease (62.8 % vs. 40 %) activity events in the no-AMT group. In the AMT group, the percentage of individuals with Clinical activity events was not as dramatically decreased (33.3 % vs. 22.2 %), Radiological activity events was increased (35.2 % vs. 46.7 %), and Disease activity events was sustained (51.9 % vs. 51.1 %). The probability of Disease activity was higher in the AMT group at 3 years of AMT initiation (40 % vs. 29 %) compared to the no-AMT group matched for disease duration, but the difference was not significant (p = 0.582).
CONCLUSIONS
Rather than the expected decrease in disease activity with age, MPwMS receiving AMT experienced sustained or increased disease activity, particularly at >65 years. Close clinical monitoring of MPwMS starting on these medications is necessary.
背景
雄激素的抗炎特性已在动物模型中得到评估，但仅有几项临床研究探讨了雄激素对多发性硬化症（MS）的影响。MS中的炎症活动通常会随着年龄增长而减弱，而模拟雄激素水平降低的雄激素调节疗法（AMT）常用于老年男性。我们旨在研究接受AMT的年龄较大（≥55岁）的男性MS患者（MPwMS）的疾病活动事件数量是否会增加。
方法
从一项基于临床的观察性研究队列中纳入开始接受AMT时年龄≥55岁的MPwMS患者（AMT组；n = 60）和无AMT病史的患者（非AMT组；n = 80）。在AMT组和非AMT组中，评估了开始接受AMT时年龄前后的临床（复发）、影像学（新病灶）和疾病（复发和/或新病灶）活动事件。
结果
两组之间的MS发病年龄、进展性MS发生率和治疗频率相似。比较开始接受AMT时年龄前后（平均 = 65.0 ± 7.0岁）的事件时，非AMT组中出现临床（38.5%对10%）、影像学（46.2%对40%）和疾病（62.8%对40%）活动事件的个体百分比有所下降。在AMT组中，出现临床活动事件的个体百分比没有显著下降（33.3%对22.2%），影像学活动事件有所增加（35.2%对46.7%），疾病活动事件保持稳定（51.9%对51.1%）。与疾病持续时间匹配的非AMT组相比，在开始接受AMT 3年后，AMT组中出现疾病活动的概率更高（40%对29%），但差异不显著（p = 0.582）。
结论
接受AMT的MPwMS患者的疾病活动并未如预期那样随着年龄增长而减少，反而持续存在或增加，尤其是在>65岁时。对开始使用这些药物的MPwMS患者进行密切的临床监测是必要的。
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