Konen Franz Felix, Witte Torsten, Ernst Diana, Hagin David, Jendretzky Konstantin Fritz, Möhn Nora, Nay Sandra, Grote-Levi Lea, Sühs Kurt-Wolfram, Klotz Luisa, Pfeuffer Steffen, Pul Refik, Kleinschnitz Christoph, Pawlitzki Marc, Meuth Sven G, Skripuletz Thomas
Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
Department of Rheumatology and Clinical Immunology, Hannover Medical School, 30625, Hannover, Germany.
Neurol Res Pract. 2025 Jul 17;7(1):48. doi: 10.1186/s42466-025-00414-y.
Comorbid autoimmune disorders, including rheumatoid arthritis (RA), are common in people with multiple sclerosis (MS). Both conditions share pathogenic similarities, enabling potential overlap in treatments. While numerous disease-modifying therapies (DMT) are approved for MS and new options are under clinical trial, their effectiveness in RA varies.
A PubMed literature review was conducted to evaluate the effects of approved and currently investigated MS-DMT on MS and RA and vice versa. Certain MS-DMT showed beneficial effects for RA, such as teriflunomide, anti-CD20 therapies, and cladribine, while others demonstrated no significant impact (type-I interferons, Bruton´s tyrosine kinase (BTK) inhibitors) or lacked trials (sphingosine-1-phosphate receptor modulators, glatiramer acetate). In contrast, BTK inhibitors were shown to be effective for inactive secondary progressive forms of MS, whereas secukinumab showed limited effects in relapsing MS. Concerning DMT for RA in MS, no significant benefit was observed for abatacept, and there are no trials for Janus kinase inhibitors, or interleukin-(IL)-6 receptor inhibitors (tocilizumab, sarilumab). Adverse events, including RA exacerbation, were reported for some MS-DMT like dimethyl fumarate, alemtuzumab, and natalizumab. Tumor necrosis factor alpha (TNFα) inhibitors increased disease activity in MS patients.
Among approved DMT for MS and RA, teriflunomide and anti-CD20 therapies are the most suitable options for moderately or highly active MS with comorbid RA. Cladribine may also be considered, while TNFα inhibitors are contraindicated.
包括类风湿关节炎（RA）在内的合并自身免疫性疾病在多发性硬化症（MS）患者中很常见。这两种疾病在发病机制上有相似之处，使得治疗上可能存在重叠。虽然有多种疾病修正疗法（DMT）被批准用于治疗MS，并且有新的疗法正在临床试验中，但它们在RA中的有效性各不相同。
进行了一项PubMed文献综述，以评估已批准和目前正在研究的MS-DMT对MS和RA的影响，反之亦然。某些MS-DMT对RA显示出有益效果，如特立氟胺、抗CD20疗法和克拉屈滨，而其他一些则没有显著影响（I型干扰素、布鲁顿酪氨酸激酶（BTK）抑制剂）或缺乏相关试验（鞘氨醇-1-磷酸受体调节剂、醋酸格拉替雷）。相比之下，BTK抑制剂对非活动性继发进展型MS有效，而司库奇尤单抗在复发型MS中的效果有限。关于用于MS中RA的DMT，阿巴西普未观察到显著益处，并且没有关于Janus激酶抑制剂或白细胞介素-（IL）-6受体抑制剂（托珠单抗、萨瑞鲁单抗）的试验。一些MS-DMT，如富马酸二甲酯、阿仑单抗和那他珠单抗，报告了包括RA病情加重在内的不良事件。肿瘤坏死因子α（TNFα）抑制剂增加了MS患者的疾病活动度。
在已批准用于MS和RA的DMT中，特立氟胺和抗CD20疗法是合并RA的中度或高度活动性MS的最合适选择。也可以考虑克拉屈滨，而TNFα抑制剂则禁忌使用。
