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首页> 外文期刊>Patient Preference and Adherence >An update on the use of natalizumab in the treatment of multiple sclerosis: appropriate patient selection and special considerations
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An update on the use of natalizumab in the treatment of multiple sclerosis: appropriate patient selection and special considerations

机译：那他珠单抗在多发性硬化症治疗中的应用更新：适当的患者选择和特殊考虑

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Abstract: In the context of an increasing repertoire of multiple sclerosis (MS) therapeutics, choosing the appropriate treatment for an individual patient is becoming increasingly challenging. Natalizumab, a humanized monoclonal antibody directed against alpha4beta1 integrin, has proven short-term and long-term efficacies in terms of relapse rate reduction, prevention of disability progression, and reduction of magnetic resonance imaging-detectable activity. It is well tolerated and has further been shown to improve patients’ quality of life. Its use is limited by the risk of progressive multifocal leukoencephalopathy (PML), which occurs at an overall incidence of 3.78 cases per 1,000 patients. Three major risk factors for the occurrence of natalizumab-associated PML have been identified: John Cunningham virus (JCV) seropositivity, prior use of immunosuppressants, and treatment duration ≥2?years. Therefore, in patients considered for natalizumab therapy, as well as in patients receiving natalizumab, effective control of MS activity has to be balanced against the risk of an opportunistic central nervous system infection associated with a high risk of significant morbidity or death. Discontinuation of natalizumab is an issue in daily clinical practice, since it is an option to reduce the PML risk. However, after cessation of natalizumab therapy, currently, there is no approved strategy for avoiding postnatalizumab disease reactivation available. In this paper, short-term and long-term safety and efficacy data are reviewed. Issues in daily clinical practice, such as selection of patients, monitoring of patients, and natalizumab discontinuation, are discussed.
机译：摘要：在多发性硬化症（MS）疗法的种类越来越多的背景下，为个体患者选择合适的疗法变得越来越具有挑战性。纳他珠单抗，一种针对α4β1整联蛋白的人源化单克隆抗体，已在降低复发率，预防残疾发展和降低磁共振成像可检测活性方面证明了短期和长期疗效。它具有良好的耐受性，并且进一步证明可以改善患者的生活质量。它的使用受到进行性多灶性白质脑病（PML）风险的限制，这种疾病的总发病率为每1000名患者3.78例。已确定发生那他珠单抗相关PML的三个主要危险因素：约翰·坎宁安病毒（JCV）血清反应阳性，先前使用免疫抑制剂和治疗时间≥2年。因此，在考虑使用那他珠单抗治疗的患者以及接受那他珠单抗的患者中，必须有效控制MS活性与机会性中枢神经系统感染的风险以及与重大发病或死亡的高风险相关的风险。那他珠单抗的中止在日常临床实践中是一个问题，因为它是降低PML风险的一种选择。但是，目前停止那他珠单抗治疗后，尚无可避免的避免那他珠单抗疾病再激活的已批准策略。本文回顾了短期和长期的安全性和有效性数据。讨论了日常临床实践中的问题，例如患者选择，患者监测和那他珠单抗停药。

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