Current approaches to the identification and management of breakthrough disease in patients with multiple sclerosis

被引：112

作者：

Rudick, Richard A. ^{[1
]}

Polman, Chris H. ^{[2
]}

机构：

[1] Cleveland Clin, Neurol Inst, Mellen Ctr Multiple Sclerosis Treatment & Res, Dept Neurol, Cleveland, OH 44195 USA

[2] Vrije Univ Amsterdam Med Ctr, Dept Neurol, Amsterdam, Netherlands

来源：

LANCET NEUROLOGY | 2009年 / 8卷 / 06期

基金：

美国国家卫生研究院;

关键词：

INTERFERON-BETA TREATMENT; PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY; AVONEX COMBINATION TRIAL; PLACEBO-CONTROLLED TRIAL; NEUTRALIZING ANTIBODIES; IFN-BETA; MAGNETIC-RESONANCE; DOUBLE-BLIND; TREATMENT RESPONSE; CLINICAL-RESPONSE;

D O I：

10.1016/S1474-4422(09)70082-1

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Disease-modifying drugs (DMDs) for relapsing-remitting multiple sclerosis (RRMS) are only partly effective breakthrough disease commonly occurs despite treatment. Breakthrough disease is predictive of continued disease activity and a poor prognosis. Availability of several DMDs offers the possibility of tailoring treatment to individual patients with RRMS and altering treatment in patients with breakthrough disease. However, no biological or imaging markers have been validated to guide initial treatment, markers of individual responsiveness to DMDs are scarce, and there is no class I evidence to guide alternative therapy in patients with breakthrough disease. In this Review, we discuss proposed strategies to monitor patients with RRMS being treated with DMDs, outline approaches to identifying therapeutic response in individual patients, review MRI and biological markers of treatment response, and summarise the role of antibodies in biological therapies. We also outline possible strategies for the management of patients with breakthrough disease and highlight areas in which research is needed.

引用

页码：545 / 559

页数：15

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