BRAIN and NERVE－神経研究の進歩75巻5号

2023年05月発行

増大特集 神経・精神領域の薬剤ハンドブック

〈各論〉

多発性硬化症治療薬—治療戦略と疾患修飾薬

著者： 茂木晴彦¹² 北川賢¹ 中原仁¹

所属機関： ¹慶應義塾大学医学部神経内科 ²東京慈恵会医科大学内科学講座脳神経内科

ページ範囲：P.485 - P.490

文献概要

多発性硬化症は中枢神経を侵す原因不明の炎症性脱髄疾患である。かつて「不治の病」であったが，20世紀より多くの疾患修飾薬が登場し，本邦では8種類が処方可能である。昨今の治療戦略のアップデートは目覚ましく，“escalation strategy”から予後不良因子に基づいた“personalized approach”，さらには“early top-down strategy”へと大きく変化しつつある。

参考文献

1）Walton C, King R, Rechtman L, Kaye W, Leray E, et al: Rising prevalence of multiple sclerosis worldwide: insights from the Atlas of MS, third edition. Mult Scler 26: 1816-1821, 2020

2）Schumacher GA, Beebe G, Kibler RF, Kurland LT, Kurtzke JF, et al: Problems of experimental trials of therapy in multiple sclerosis: report by the panel on the evaluation of experimental trials of therapy in multiple sclerosis. Ann N Y Acad Sci 122: 552-568, 1965

3）Skoog B, Runmarker B, Winblad S, Ekholm S, Andersen O: A representative cohort of patients with non-progressive multiple sclerosis at the age of normal life expectancy. Brain 135: 900-911, 2012

4）Thompson AJ, Banwell BL, Barkhof F, Carroll WM, Coetzee T, et al: Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol 17: 162-173, 2018

5）Dobson R, Giovannoni G: Multiple sclerosis: a review. Eur J Neurol 26: 27-40, 2019

6）Rotstein D, Montalban X: Reaching an evidence-based prognosis for personalized treatment of multiple sclerosis. Nat Rev Neurol 15: 287-300, 2019

7）Brown JWL, Coles A, Horakova D, Havrdova E, Izquierdo G, et al: Association of initial disease-modifying therapy with later conversion to secondary progressive multiple sclerosis. JAMA 321: 175-187, 2019

8）He A, Merkel B, Brown JWL, Zhovits Ryerson L, Kister I, et al: Timing of high-efficacy therapy for multiple sclerosis: a retrospective observational cohort study. Lancet Neurol 19: 307-316, 2020

9）Spelman T, Magyari M, Piehl F, Svenningsson A, Rasmussen PV, et al: Treatment escalation vs immediate initiation of highly effective treatment for patients with relapsing-remitting multiple sclerosis: data from 2 different national strategies. JAMA Neurol 78: 1197-1204, 2021

10）Filippi M, Amato MP, Centonze D, Gallo P, Gasperini C, et al: Early use of high-efficacy disease-modifying therapies makes the difference in people with multiple sclerosis: an expert opinion. J Neurol 269: 5382-5394, 2022

11）Ho PR, Koendgen H, Campbell N, Haddock B, Richman S, et al: Risk of natalizumab-associated progressive multifocal leukoencephalopathy in patients with multiple sclerosis: a retrospective analysis of data from four clinical studies. Lancet Neurol 16: 925-933, 2017

12）Ryerson LZ, Foley J, Chang I, Kister I, Cutter G, et al: Risk of natalizumab-associated PML in patients with MS is reduced with extended interval dosing. Neurology 93: e1452-e1462, 2019［doi: 10.1212/WNL.0000000000008243］

13）Hauser SL, Bar-Or A, Cohen JA, Comi G, Correale J, et al: Ofatumumab versus teriflunomide in multiple sclerosis. N Engl J Med 383: 546-557, 2020

14）Forryan J, Yong J: Rapid cognitive decline in a patient with chronic lymphocytic leukaemia: a case report. J Med Case Rep 14: 39, 2020［doi: 10.1186/s13256-020-2360-9］

15）Kappos L, Bar-Or A, Cree BAC, Fox RJ, Giovannoni G, et al: Siponimod versus placebo in secondary progressive multiple sclerosis (EXPAND): a double-blind, randomised, phase 3 study. Lancet 391: 1263-1273, 2018

16）Kira JI, Nakahara J, Sazonov DV, Kurosawa T, Tsumiyama I, et al: Effect of ofatumumab versus placebo in relapsing multiple sclerosis patients from Japan and Russia: Phase 2 APOLITOS study. Mult Scler 28: 1229-1238, 2022

17）Hakkarainen KM, Juuti R, Burkill S, Geissbuhler Y, Sabido M, et al: Pregnancy outcomes after exposure to interferon beta: a register-based cohort study among women with MS in Finland and Sweden. Ther Adv Neurol Disord 13: 1756286420951072, 2020［doi: 10.1177/1756286420951072］

18）Dobson R, Dassan P, Roberts M, Giovannoni G, Nelson-Piercy C, et al: UK consensus on pregnancy in multiple sclerosis: ‘Association of British Neurologists’ guidelines. Pract Neurol 19: 106-114, 2019

19）Vukusic S, Carra-Dalliere C, Ciron J, Maillart E, Michel L, et al: Pregnancy and multiple sclerosis: 2022 recommendations from the French multiple sclerosis society. Mult Scler 29: 11-36, 2023

20）中原　仁: 多発性硬化症の診断と治療. 日本内科学会雑誌110: 2021-2027, 2021