Relapsing- Remitting Multipl Sklerozda 1. Basamak Enjektabl İmmünmodülatör İlaçlar İle Tedavi
Özet
Multipl skleroz (MS), merkezi sinir sisteminin (CNS) kronik inflamatuar, demiyelinizan, nörodejeneratif ve otoimmün bir hastalığıdır. Genç yetişkinleri daha fazla etkileyen bir hastalık olan MS, dört farklı klinik formda ortaya çıkabilir: Relapsing-Remitting MS (RRMS), Sekonder-Progresif MS (SPMS), Primer-Progresif MS (PPMS) ve Progresif-Relapsing MS (PRMS). Relapsing-remitting MS (RRMS) yönetimi, otoimmün yanıtı baskılayarak hastalığın seyrini etkileyen hastalık modifiye edici tedavilere (DMT’ler) dayanır. RRMS tedavisi için onaylanmış çeşitli enjeksiyonlu ve oral DMT’ler mevcuttur. Önerilen ilk basamak tedavileri arasında interferonlar (IFN beta-1a ve IFN beta-1b) ve glatiramer asetat (GA) bulunmaktadır. Bu tedaviler, günlük ya da haftalık uygulama aralığında değişen enjeksiyonlar şeklinde sunulmaktadır. Şu anda relapsing formlar için onaylanmış beş IFN beta ilacı bulunmaktadır: Subkütanöz (SC) IFN beta-1b (Betaferon; Bayer HealthCare Pharmaceuticals Inc, ve Extavia; Novartis Pharmaceuticals Corp), SC IFN beta-1a (Rebif; EMD Serono Inc), intramüsküler (IM) IFN beta-1a (Avonex; Biogen Inc) ve SC peginterferon beta-1a (Plegridy; Biogen Inc). GA, RRMS hastalarında relaps oranını azaltarak ve MRI hastalık aktivitesini düşürerek önemli bir etki göstermiştir. MS kadınlarda erkeklere göre daha sık görüldüğünden bu ilaçların gebelikteki kullanımı önem arz etmektedir. Gebelik süresince kullanılması gerekirse hasta ile görüşülerek ortak karar alınması uygundur. Kimyasal özellikler ve düşük oral absorpsiyon nedeniyle yenidoğanların/bebeklerin anne sütü yoluyla GA’ya maruz kalması ihmal edilebileceği gösterildiğinden GA, emzirme döneminde kullanılabilir.
Referanslar
Bermel RA, Rudick RA. Interferon-Treatment for Multiple Sclerosis. Neurology. 2007;68(4):633–646.
Williams AE, Vietri JT, Isherwood G, Flor A. Symptoms and association with health outcomes in relapsing-remitting multiple sclerosis: results of a US patient survey. Mult Scler Int. 2014;2014:203183.
National Multiple Sclerosis Society. Just the Facts: 2007-2008. 2008. Erişim adresi: http://www.nationalmssociety.org/about-multiple-sclerosis/what-is-ms/download.aspx?id=22. Erişim tarihi: 17 Ağustos 2009.
Lublin FD, Baier M, Cutter G. Effect of relapses on development of residual deficit in multiple sclerosis. Neurology. 2003;61(11):1528-1532.
Charcot JM. Histologie de la sclérose en plaques. Gazette des hôpitaux, Paris. 1868;41:554-555.
Madsen C. The innovative development in interferon beta treatments of relapsing-remitting multiple sclerosis. Brain Behav. 2017;7:e00696.
Dargahi N, Katsara M, Tselios T, et al. Multiple sclerosis: immunopathology and treatment update. Brain Sci. 2017;7:E78.
Bolaños-Jiménez R, Arizmendi-Vargas J, Carrillo-Ruiz J, et al. Multiple sclerosis: An overview of the disease and current concepts of its pathophysiology. J Neurosci Behav Health. 2010;3:44–50.
Tolley K, Hutchinson M, You X, Wang P, Sperling B, Taneja A, et al. A network meta-analysis of efficacy and evaluation of safety of subcutaneous pegylated interferon beta-1a versus other injectable therapies for the treatment of relapsing-remitting multiple sclerosis. PLoS One. 2015;10(6):e0127960.
Borden EC, Sen GC, Uze G, Silverman RH, Ransohoff RM, Foster GR, et al. Interferons at age 50: past, current and future impact on biomedicine. Nat Rev Drug Discov. 2007;6(12):975–90.
Weinstock-Guttman B, Ransohoff RM, Kinkel RP, Rudick RA. The interferons: biological effects, mechanisms of action, and use in multiple sclerosis. Ann Neurol. 1995;37:7–15.
Jacobs L, O’Malley J, Freeman A, Ekes R, Reese PA. Intrathecal interferon in multiple sclerosis. Arch Neurol. 1982;39:609–615.
Noronha A, Toscas A, Jensen MA. Interferon beta decreases T cell activation and interferon gamma production in multiple sclerosis. J Neuroimmunol. 1993;46:145–153.
Mary Filipi, PhD, APRN-C; Samantha Jack, MS. Interferons in the Treatment of Multiple Sclerosis A Clinical Efficacy, Safety, and Tolerability Update. DOI: 10.7224/1537-2073.2018-063.
La Mantia L, Di Pietrantonj C, Rovaris M, Rigon G, Frau S, Berardo F, Gandini A, Longobardi A, Weinstock-Guttman B, Vaona A. Interferons-beta versus glatiramer acetate for relapsing-remitting multiple sclerosis. Cochrane Database of Systematic Reviews. 2014;Issue 7. Art. No.: CD009333. DOI: 10.1002/14651858.CD009333.pub2.
Hu X, Miller L, Richman S, et al. A novel PEGylated interferon beta-1a for multiple sclerosis: safety, pharmacology, and biology. J Clin Pharmacol. 2012;52:798-808.
Hu X, Shang S, Nestorov I, et al. COMPARE: pharmacokinetic profiles of subcutaneous peginterferon beta-1a and subcutaneous interferon beta-1a over 2 weeks in healthy subjects. Br J Clin Pharmacol. 2016;82:380-388.
Barry GW, Arnason BG. Long-term experience with interferon beta-1b (Betaferon®) in multiple sclerosis. Published: Eylül 2005, Volume 252, pages iii28–iii33.
Ireland SJ, Guzman AA, O'Brien DE, et al. The effect of glatiramer acetate therapy on functional properties of B cells from patients with relapsing-remitting multiple sclerosis. JAMA Neurol. 2014;71:1421–1428.
Racke MK, Lovett-Racke AE, Karandikar NJ. The mechanism of action of glatiramer acetate treatment in multiple sclerosis. Neurology. 2010;74 Suppl 1:25-30.
Comi G, Filippi M, Wolinsky JS, European/Canadian Glatiramer Acetate Study Group. European/Canadian multicenter, double-blind, randomized, placebo-controlled study of the effects of glatiramer acetate on magnetic resonance imaging—measured disease activity and burden in patients with relapsing multiple sclerosis. Annals of Neurology. 2001;49:290–7.
Hellwig K, Verdun di Cantogno E, Sabidó M. A systematic review of relapse rates during pregnancy and postpartum in patients with relapsing multiple sclerosis. Ther Adv Neurol Disord. 2021;14:17562864211051012.
Gonçalves-Andrade F, et al. Adverse effects of interferon beta and glatiramer acetate in the treatment of multiple sclerosis. Neuropharmacology. 2010;57(4):617-626.
