痉挛是常见的,多发性硬化症(MS)的衰弱症状,包括基于大麻素的治疗,纳比肟。这篇综述的目的是研究指导多发性硬化症相关痉挛(MSS)管理的现有临床实践指南,为了识别相似和分歧的区域,并建议在哪里可以获得标准化和改进。
出版文献(PubMed),相关欧洲医学协会和健康技术评估机构的网站进行了系统搜索,以确定描述MSS的药理学管理的指南,重点关注纳比肟(Sativex®口腔黏膜喷雾剂)获得批准的欧洲国家。确定了16个公开可用的指南。分析的重点是,但不限于,纳比肟在MSS药物治疗的更广泛背景下的用途。
我们认为,目前对MSS的处理不够充分,如果在日常实践中可以获得一套清晰详细的指南并加以实施,这一点将会得到改善。我们欢迎国际小组更新和合并现有准则,使用基于证据的方法,变成一个单一的指导方针,在启动方法上更加详细和标准化,抗痉挛药物的监测和优化。
多发性硬化症患者通常会经历肌肉紧张或僵硬,无法控制这些肌肉。这被称为痉挛,这会对一个人进行日常活动的能力产生破坏性影响。除了物理治疗,医生可以开各种药物来改善痉挛;这些被称为抗痉挛治疗。通常,处方选择由指南文件指导,由医学专家撰写。这些文件包含重要信息,例如何时开处方,开什么药,开多少处方以及如何衡量治疗效果如何。这项研究的目的是检查是否指导欧洲多发性硬化症患者抗痉挛治疗处方的指南,适合日常医疗实践。特别是,这篇文章探讨了指南如何代表新的基于大麻的治疗被称为纳比肟,以Sativex口腔粘膜喷雾剂的名义出售,在过去的10年里,它在许多欧洲国家变得越来越普遍。
Spasticity is a common, debilitating symptom of multiple sclerosis (MS) with several treatment options including the cannabinoid-based treatment, nabiximols. The purpose of this review was to examine the existing clinical practice guidelines that direct the management of multiple-sclerosis-associated spasticity (MSS), to identify areas of similarity and divergence, and suggest where standardization and improvement may be obtained.
Published literature (PubMed), websites of relevant European Medical Associations and Health Technology Assessment bodies were systematically searched to identify guidelines describing the
pharmacological management of MSS, focussing on European countries where nabiximols (Sativex® oromucosal spray) is approved. Sixteen publicly available
guidelines were identified. Analysis was focused on, but not restricted to, the use of nabiximols in the wider context of the
pharmacological treatment of MSS.
We believe that currently MSS is insufficiently treated and this would be improved if a clear and detailed set of guidelines were available and implemented in daily practice. We would welcome the update and amalgamation of the existing guidelines by an international panel, using an evidence-based approach, into a single
guideline that is more detailed and standardized in its approach to the initiation, monitoring and optimization of anti-spasticity drugs.
People with multiple sclerosis often experience tight or stiff muscles and an inability to control those muscles. This is known as spasticity, which can have a devastating impact on a person’s ability to carry out their daily activities. In addition to physiotherapy, doctors can prescribe various medicines to improve spasticity; these are known as anti-spasticity treatments. Often, prescription choices are steered by
guideline documents, written by medical experts. These documents contain important information such as when to prescribe, what to prescribe, how much to prescribe and how to measure how well the treatment is working. The purpose of this study was to examine whether the guidelines that guide the prescription of anti-spasticity treatments in people with multiple sclerosis in Europe, are fit for purpose for day-to-day medical practice. In particular, this article examines how the guidelines represent the newer cannabis-based treatment known as nabiximols, sold under the name Sativex oromucosal spray, which has become more widely available in many European countries over the last 10 years.