Immune Reconstitution Therapy or Continuous Immunosuppression for the Management of Active Relapsing–Remitting Multiple Sclerosis Patients? A Narrative Review

Neurology and Therapy

Per Soelberg Sørensen¹  Isa Ahmed AlSharoqi²  Murat Kurtuncu³  Cavit Boz⁴  Ilham Slassi⁵  Thomas Müller⁶  Saeed Bohlega⁷  Magd Zakaria⁸  Salam El-Koussa⁹  Vahid Shaygannejad^1,10  Mohamed Aljumah^1,11  Abdelkader Daif^1,12  Chris Retief^1,13  Mohammad Ali Sahraian^1,14  Karim Taha^1,15  Jihad Inshasi^1,16 

[1] Danish Multiple Sclerosis Center, University of Copenhagen–Rigshospitalet;Department of Clinical Neurosciences, Salmaniya Medical Complex;Department of Neurology, Istanbul Faculty of Medicine, Istanbul University;Department of Neurology, Karadeniz Technical University;Department of Neurology, Sheikh Khalifa Ibn Zaid Hospital, Mohammed VI University;Department of Neurology, St. Joseph Hospital Berlin-Weissensee;Department of Neurosciences, King Faisal Specialist Hospital and Research Centre;Faculty of Medicine, Ain Shams University;Hopital Libanais Geitaoui;Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences;King Fahad Medical City, Ministry of Health;King Khalid University Hospital, King Saud University;Life Wilgers Hospital;MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences;Merck;Neurology Department, Rashid Hospital and Dubai Medical College, Dubai Health Authority;

关键词: Disease-modifying drug;    Escalation therapy;    Immune reconstitution therapy;    Maintenance therapy;    Multiple sclerosis;   

DOI  :  10.1007/s40120-020-00187-3

来源: DOAJ

【 摘 要 】

Abstract The majority of disease-modifying drugs (DMDs) available for the management of active relapsing–remitting multiple sclerosis (RMS) depend on continuous drug intake for maintained efficacy, with escalation to a more active drug when an unacceptable level of disease activity returns. Among continuously applied regimens, interferons and glatiramer acetate act as immunomodulators, while dimethyl fumarate, fingolimod, ocrelizumab, natalizumab and teriflunomide are associated with continuous immunosuppression. By contrast, immune reconstitution therapy (IRT) provides efficacy that outlasts a short course of treatment. Autologous hemopoietic stem cell transplantation is perhaps the classic example of IRT, but this invasive and intensive therapy has challenging side-effects. A short treatment course of a pharmacologic agent hypothesized to act as an IRT, such as Cladribine Tablets 3.5 mg/kg or alemtuzumab, can provide long-term suppression of MS disease activity, without need for continuous treatment (the anti-CD20 mechanism of ocrelizumab has the potential to act as an IRT, but is administered continuously, at 6-monthly intervals). Cladribine Tablets 3.5 mg/kg shows some selectivity in targeting adaptive immunity with a lesser effect on innate immunity. The introduction of IRT-like disease-modifying drugs (DMDs) challenges the traditional maintenance/escalation mode of treatment and raises new questions about how disease activity is measured. In this review, we consider a modern classification of DMDs for MS and its implications for the care of patients in the IRT era.

【 授权许可】

Unknown