髓鞘少突胶质细胞糖蛋白-免疫球蛋白 G 相关疾病(MOGAD)的药物治疗:文献更新。

IF 3.4 2区 医学 Q2 CLINICAL NEUROLOGY Expert Review of Neurotherapeutics Pub Date : 2024-10-01 Epub Date: 2024-08-07 DOI:10.1080/14737175.2024.2385941
Giuseppe Schirò, Salvatore Iacono, Giuseppe Salemi, Paolo Ragonese
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引用次数: 0

摘要

导言:髓鞘少突胶质细胞糖蛋白-免疫球蛋白G相关疾病(MOGAD)是一种临床实体,有别于多发性硬化症和水通道蛋白-4(AQP4+)-IgG阳性神经脊髓炎视网膜谱系障碍。目前治疗多发性神经胶质细胞增多症的疗效和安全性尚缺乏相关证据:在这篇文章中,作者回顾了有关 MOGAD 药物治疗的现有文献。本文基于对包括荟萃分析、临床试验、系统综述、观察性研究、系列病例和病例报告在内的文章的广泛检索:静脉注射大剂量甲基强的松龙是治疗急性发作最常用的方法,患者的治疗反应良好。对于恢复不佳的病例,静脉注射免疫球蛋白(IVIG)或血浆置换被证明是有效的。维持疗法包括霉酚酸酯、硫唑嘌呤、IVIG、口服皮质类固醇、利妥昔单抗和白细胞介素-6受体(IL6-R)拮抗剂。利妥昔单抗是最常用的药物,而IL6-R拮抗剂则成为对目前治疗无效者的有效选择。需要进行更大规模的前瞻性研究和更长时间的随访,以确认阻断 IL6-R 是否是一种有效而安全的选择。由于没有证据表明现有的新疗法存在重大安全问题,作者认为,等待疾病活动后再考虑改变治疗方法是不明智的。
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The pharmacological management of myelin oligodendrocyte glycoprotein-immunoglobulin G associated disease (MOGAD): an update of the literature.

Introduction: Myelin oligodendrocyte glycoprotein-immunoglobulin G associated disease (MOGAD) is a clinical entity distinct from multiple sclerosis and aquaporin-4 (AQP4+)-IgG-positive neuromyelitis optica spectrum disorder. There is a lack of evidence regarding the efficacy and safety of current treatments used for MOGAD.

Areas covered: In this article, the authors review the currently available literature on the pharmacological management of MOGAD. This article is based on an extensive search for articles including meta-analyses, clinical trials, systematic reviews, observational studies, case series and case reports.

Expert opinion: Intravenous high-dose methylprednisolone is the most common therapy for acute attack with patients having a good treatment response. In cases with poor recovery, intravenous immunoglobulins (IVIG) or plasma-exchange proved to be effective. Maintenance therapies include mycophenolate mofetil, azathioprine, IVIG, oral corticosteroids, rituximab, and interleukin-6 receptor (IL6-R) antagonists. Rituximab is the most used drug while IL6-R antagonists emerged as an effective option for people not responding to current treatments. Larger prospective studies with longer follow-ups are needed to confirm whether the blockage of the IL6-R is an effective and safe option. Since there is no evidence of major safety issues related to the new available therapies, the authors believe that waiting for disease activity to consider a possible treatment change, is an unwise approach.

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来源期刊
Expert Review of Neurotherapeutics
Expert Review of Neurotherapeutics Medicine-Neurology (clinical)
CiteScore
7.00
自引率
2.30%
发文量
61
审稿时长
4-8 weeks
期刊介绍: Expert Review of Neurotherapeutics (ISSN 1473-7175) provides expert reviews on the use of drugs and medicines in clinical neurology and neuropsychiatry. Coverage includes disease management, new medicines and drugs in neurology, therapeutic indications, diagnostics, medical treatment guidelines and neurological diseases such as stroke, epilepsy, Alzheimer''s and Parkinson''s. Comprehensive coverage in each review is complemented by the unique Expert Review format and includes the following sections: Expert Opinion - a personal view of the data presented in the article, a discussion on the developments that are likely to be important in the future, and the avenues of research likely to become exciting as further studies yield more detailed results Article Highlights – an executive summary of the author’s most critical points
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