Демиелинизирующие заболевания: Рассеянный склероз
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Презентация на тему Демиелинизирующие заболевания ЦНС
- Бұл бет үшін навигация:
- Glucocorticoids
- Interferon beta
Glucocorticoids: 1. On the basis of several and generally consistent Class I and Class II studies, glucocorticoid treatment has been demonstrated to have a short-term benefit on the speed of functional recovery in patients with acute attacks of MS. It is appropriate, therefore, to consider for treatment with glucocorticoids any patient with an acute attack of MS (Type A recommendation). 2. There does not appear, however, to be any long-term functional benefit after the brief use of glucocorticoids in this clinical setting (Type B recommendation). 3. Currently, there is not compelling evidence to indicate that these clinical benefits are influenced by the route of glucocorticoid administration, the particular glucocorticoid prescribed, or the dosage of glucocorticoid, at least at the doses that have been studied to date (Type C recommendation). 4. On the basis of a single Class II study, it is considered possible that regular pulse glucocorticoids may be useful in the long-term management of patients with RRMS (Type C recommendation) Interferon beta: 1. On the basis of several consistent Class I studies, IFN has been demonstrated to reduce the attack rate (whether measured clinically or by MRI) in patients with MS or with clinically isolated syndromes who are at high risk for developing MS (Type A recommendation). Treatment of MS with IFN produces a beneficial effect on MRI measures of disease severity such as T2 disease burden and probably also slows sustained disability progression (Type B recommendation). 2. As a result, it is appropriate to consider IFN for treatment in any patient who is at high risk for developing CDMS, or who already has either RRMS or SPMS and is still experiencing relapses (Type A recommendation). The effectiveness of IFN in patients with SPMS but without relapses is uncertain (Type U recommendation). 3. It is possible that certain populations of MS patients (e.g.,those with more attacks or at earlier disease stages) may be better candidates for therapy than others, although, at the moment, there is insufficient evidence regarding these issues (Type U Recommendation) 4. On the basis of Class I and II studies and several pieces of consistent Class III evidence, it is considered probable that there is a dose-response curve associated with the use of IFN for the treatment of MS (Type B recommendation). It is possible, however, that a portion of this apparent dose-effect instead may be due to differences in the frequency of IFN administration (rather than dose) between studies. 5. On the basis of several Class II studies, the route of administration of IFN is probably not of clinical importance, at least with regard to efficacy (Type B recommendation). The side-effect profile, however, does differ between routes of administration. There is no known clinical difference between the different types of IFN, although this has not been thoroughly studied (Type U recommendation). 6. On the basis of several Class I studies, treatment of patients with MS with IFN is associated with the production of Nab (Type A recommendation). The rate of NAb production, however, is probably less with IFN-1a treatment than with IFN-1b treatment (Type B recommendation). The biologic effect of NAb is uncertain, although their presence may be associated with a reduction in clinical effectiveness of IFN treatment (Type C recommendation). Whether there is a difference in immunogenicity between subcutaneous and intramuscular routes of administration is unknown (Type U recommendation). The clinical utility of measuring NAb in an individual on IFN therapy is uncertain жүктеу/скачать 2,26 Mb. Достарыңызбен бөлісу:
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