背景:这项回顾性研究,在2005年至2016年间进行的研究调查了停用可注射一线疾病改善治疗(DMT)的多发性硬化(MS)患者的结局.该研究旨在确定影响停药治疗的因素,并评估停药对疾病进展的影响。
方法:收集了2,270例患者的数据,这些患者接受了至少两年的注射DMT,随后由于临床和MRI缓解而停止治疗。副作用,或不遵守。患者分为两组:停药后稳定(SAD)和停药后复发(RAD)。采用生存分析和逻辑回归分析评估影响治疗中止的因素。
结果:在60名停止DMT的患者中,三分之一(n=20)保持稳定,而40例患者在随访期间经历了临床和/或MRI活动。与RAD患者相比,SAD组停止治疗的年龄明显更晚(35.9±11.1vs.30.7±6.1,p=0.025)。40岁以下的患者经历恶化的可能性更高(75%),而那些50岁以上的人表现出80%的稳定率。SAD患者使用DMT的时间比RAD患者更长(69.1±47.3vs.46.6±20.3个月,p=0.012)。显着比例(42.9%)的恶化患者在没有咨询医生的情况下中断了DMT,强调治疗依从性的潜在挑战。治疗停止后,RAD患者在中位数为21.0个月后出现复发。生存分析表明,在达到稳定期后停止治疗的患者的病程更有利(p=0.237)。有证据表明四年后组间有区别。回归分析表明,停药时年龄较大对复发概率有有利影响(HR:0.904;p=0.031;95%CI:0.825,0.991)。与疾病稳定性无关的停药原因对复发概率有积极但不精确的影响。
结论:这项研究提供了对MS患者停止注射DMT的结果的见解,强调停药年龄和停止治疗的原因在预测疾病进展中的重要性。研究结果表明,在达到稳定后停止治疗可能会导致更有利的结果,强调MS管理中个性化治疗决策的必要性。需要进一步的研究来验证这些发现并为临床实践提供信息。
BACKGROUND: This retrospective study, conducted between 2005 and 2016, investigated the outcomes of patients with multiple sclerosis (MS) who discontinued injectable first-line disease-modifying therapies (DMTs). The study aimed to identify factors influencing treatment discontinuation and assess the impact of discontinuation on disease progression.
METHODS: Data was collected from 2,270 patients who received injectable DMTs for at least two years and subsequently discontinued treatment due to clinical and MRI remission, side effects, or noncompliance. Patients were categorized into two groups: those stable after discontinuation (SAD) and those with relapse after discontinuation (RAD). Survival analysis and logistic regression were employed to assess factors influencing treatment discontinuation.
RESULTS: Of the 60 patients who discontinued DMTs, one-third (n = 20) remained stable, while 40 patients experienced clinical and/or MRI activity during follow-up. The SAD group had a significantly later age at treatment discontinuation compared to RAD patients (35.9 ± 11.1 vs. 30.7 ± 6.1, p = 0.025). Patients below 40 years old had a higher likelihood of experiencing worsening (75 %), while those over 50 years old demonstrated an 80 % stability rate. SAD patients used DMTs for a more extended period than RAD patients (69.1 ± 47.3 vs. 46.6 ± 20.3 months, p = 0.012). A notable proportion (42.9 %) of worsened patients discontinued DMTs without consulting a physician, emphasizing potential challenges in treatment adherence. After treatment discontinuation, RAD patients experienced relapses after a median of 21.0 months. Survival analysis suggested a more favorable disease course for patients who discontinued treatment after achieving a stable period (p = 0.237), with evidence of differentiation between groups after four years. Regression analysis indicated that older age at discontinuation had a favorable impact on relapse probability (HR: 0.904; p = 0.031; 95 % CI: 0.825, 0.991). Reasons for discontinuation unrelated to disease stability showed a positive but imprecise effect on relapse probability.
CONCLUSIONS: This study provides insights into the outcomes of MS patients discontinuing injectable DMTs, emphasizing the importance of age at discontinuation and reasons for treatment cessation in predicting disease progression. The findings suggest that discontinuation after achieving stability may lead to more favorable outcomes, highlighting the need for personalized treatment decisions in MS management. Further research is warranted to validate these findings and inform clinical practices.