Dalakas M C
Neuromuscular Diseases Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892.
Semin Neurol. 1994 Jun;14(2):97-105. doi: 10.1055/s-2008-1041065.
Immunosuppressive drugs and immunomodulating procedures can improve the quality of life in patients with immune-related neurologic diseases, or even be life saving, if properly used to avoid deleterious or irreversible adverse effects. For the successful use of these drugs or procedures, the treating physician must be familiar and comfortable with the drugs' mode of action and consider some important principles: 1. The diagnosis must be secure before starting therapy. 2. It is essential to have a basic understanding of the immunologic dysfunction that is amenable to immunotherapy. 3. The goals and the expectations of therapy must be defined, and the risk/benefit ratio of the drugs or procedures must be well understood. 4. Improvement must be based on objective measurements of muscle strength and a beneficial change in activities of daily living, and not solely on a change in the laboratory test values. 5. The limitations of therapy and the time suitable for starting or stopping a drug should be clear to both the therapist and the patient. 6. The selection of a drug or procedure should be guided on the basis of current knowledge, preferably established in controlled trials. 7. Every effort must be made to prevent the development of adverse effects and to determine the lowest dose of a medication that controls the disease. 8. Drug interactions that can cause adverse effects and conditions that can worsen a disease must be avoided.
免疫抑制药物和免疫调节程序可以改善免疫相关神经疾病患者的生活质量，若使用得当以避免有害或不可逆的不良反应，甚至可以挽救生命。为成功使用这些药物或程序，治疗医生必须熟悉并掌握药物的作用方式，并考虑一些重要原则：1. 在开始治疗前诊断必须明确。2. 对适合免疫治疗的免疫功能障碍有基本了解至关重要。3. 必须明确治疗的目标和期望，并且要充分了解药物或程序的风险/获益比。4. 改善必须基于肌肉力量的客观测量以及日常生活活动中的有益变化，而不能仅仅基于实验室检查值的变化。5. 治疗的局限性以及开始或停止用药的合适时间，治疗师和患者都应清楚。6. 药物或程序的选择应基于当前知识，最好是在对照试验中确立的知识。7. 必须尽一切努力预防不良反应的发生，并确定控制疾病的最低药物剂量。8. 必须避免可能导致不良反应的药物相互作用以及可能使疾病恶化的情况。
