The MS Guide to DMTs
关于多发性硬化症治疗的好消息？你有选择！潜在的压力新闻？你有很多选择。我们打破了基础知识。
Trevis Gleason hasa clear memory of the day he was first diagnosed with multiple sclerosis (MS) in 2001. His doctor sent him home with a huge binder of information on disease-modifying therapies (also called DMTs, disease-modifying treatments, or disease-modifying medications).
DMTs are a key component of comprehensive MS care, and they're currently the best options available to slow the natural course of the disease, according to the National Multiple Sclerosis Society.
格里森的时候,现在53岁,被诊断,我们re only three DMTs available to treat MS. He was told to read through all the information provided and pick the one he wanted to be on. Going through the material was time-consuming and confusing, as many of the drugs came with potentially serious side effects ranging from flu-like symptoms to a risk of developing heart or liver problems. In the end, Gleason, who splits his time between Ireland and Seattle, decided his best option was an interferon beta-1b treatment (more on that in a few).
虽然自格森的经验已经近二十年，但许多MS患者仍然可以与决定哪个DMT最适合他们的困境。现在，而不是三种选择，由美国食品和药物管理局（FDA）批准有17项。这很棒......但也有点眩晕。
The MS community has seen many advancements in the last 10 years, says Eoin Flanagan, M.B., B.Ch., a neurologist with the Mayo Clinic who specializes in MS. “We’re doing better in terms of having a lot more choices available, but that can make it difficult to navigate the lineup of so many different medications,” he says.
这就是本指南可以提供帮助的地方。
The Goal of DMTs
It’s important to know that DMTs aren’t meant to treat current MS symptoms (such as fatigue or numbness). Instead, the goal is to decrease the overall number of relapses you experience and to slow the accumulation of lesions in the central nervous system, Dr. Flanagan explains.
While using DMTs can’t “fix” the damage MS has already done, these medications are meant to help prevent or limit damage in the future, adds Kathy Costello, M.S., C.R.N.P., associate vice president of healthcare access with the National MS Society.
“这就像取出保险单一样，”Costello说。“你想给自己最好的生活机会。”
但在你选择“政策”之前有很多需要考虑的事情，包括潜在的副作用。Costello说，这就是为什么在决定哪个DMT对你是对的，这是如此重要的原因。
“如果你是新诊断患有MS, not only is this disease brand new to you, but now you’re faced with a decision about being on a very powerful drug, potentially for the rest of your life,” she says. “The person living with the disease needs to think about their goals and their risk tolerance. They need to do their homework in understanding these therapies so they can have a real conversation with their doctor.”
There are two main questions Costello encourages people to consider and discuss with their healthcare provider:
What should I expect from the disease-modifying therapy?
What are the side effects, and how should I manage them?
在你做出决定之前，它可能会与你的医生进行多次对话 - 这很好。在一起，您将决定最适合您的治疗方法。每个人的身体或疾病都可以不同地响应这些药物，加上今天充分控制您的疾病的药物可能不会在未来这样做。
The good news: You have options. Here’s what you should know about the primary types of DMTs.
MS的第一代可注射治疗
一些第一个DMTS超过20年前批准了FDA。例子包括：
Avonex or Rebif (interferon beta-1a)
Betaseron or Extavia (interferon beta-1b)
Copaxone（Glatiramer醋酸酯）
弗拉纳曼博士说，这些较旧的一些较旧的药物并不像最近批准的DMTS那么强大。即便如此，一些患者更喜欢他们，因为他们已经围绕着最长，所以他们的益处，副作用和危险因素是众所周知的。此外，这些药物往往对某些人造成更温和的副作用。
The downside: First-generation DMTs may not have the potency to help patients who are dealing with multiple MS attacks per year. If you have active MS with lots of inflammation showing up on your MRI, you may require newer-generation meds, Dr. Flanagan says.
Another issue is that these older DMTs require self-injection, either under the skin or in a muscle, which can cause bruising and discomfort at the injection site.
Holly Hill, who was diagnosed with MS in 1988, began using Betaseron not long after it became available, but the injections left her with horrible bruising. She then switched to Avonex, which despite also being a self-injection DMT came with few side effects, she says. Hill stayed on it for about 15 years, injecting herself with the medication once per week with few problems.
MS的口腔和灌注的药物
口服药物是可用的较新的DMT。弗拉纳曼博士说，它们可能会被视为更方便和吸引患者患者副作用的患者。
口腔可以拍摄的药物的实例包括：
Tecfidera（富马酸二甲基）
Aubagio (teriflunomide)
吉伦亚（Fingolimod）
There are also infusion-based medications, which are given intravenously at a medical facility. An infusion-based DMT is delivered through IV directly into a vein and doesn’t need to be administered as often as self-injection medications.
Examples of infusion-based DMTs include:
Ocrevus（ocrelizumab）
Tysabri (natalizumab)
Lemtrada (alemtuzumab)
Newer DMTs: The Risks You Need to Know
While most patients tolerate newer medications well, they do come with a greater risk for side effects and infection, Dr. Flanagan says. As a result, doctors will monitor patients who are on those medications more closely.
一种这样的副作用称为渐进式多灶性白血病（PML），是由称为John Cunningham病毒（JC病毒）的病毒引发的严重和潜在的致命脑感染，其中超过60％的成年人已经暴露于，弗拉纳曼博士解释道。病毒通常在健康的人群中仍然是休眠，但由于一些DMTS改变了一个人的免疫系统如何功能，在极少数情况下，可以在使用DMT的人中重新激活病毒。
服用含输注的药物Tysabri的人似乎处于开发PML的最高风险。弗拉纳曼博士说，因为这患者在患者处于患者之前，他们经过测试，看看他们是否已经暴露于病毒。
“For those who have been exposed to the virus, we try not to use that medication,” Dr. Flanagan says. “But if you’ve not been exposed, it’s generally safe, and we monitor the blood counts to see if you’ve become exposed to the virus over time.”
何时切换您的DMT
弗拉纳曼博士说，有许多原因可能会关闭一点或尝试新药。例如，如果您的MRI上出现新的复发和新的活性病变，则可能不会为您工作。
“Alternatively, if patients develop side effects and just don’t tolerate the medication—they get abdominal pain, for example—then we might switch to a medication of a similar strength, hoping that they won’t get those side effects with the new medication,” Dr. Flanagan says.
Like Holly Hill, some patients may decide it’s time to switch medications as their MS progresses over the years. After being on Avonex for so long, Hill decided to try one of the newer oral medications. She’s since been on Tecfidera), which is a tablet taken twice daily.
“我很好地忍受了，”希尔说。“我根本没有副作用。”
DMTS和MS：您需要了解怀孕的内容
根据国家多发性硬化症协会，没有任何这些药物批准用于怀孕的女性的FDA，或者是母乳喂养的妇女。如果是，请与您的医疗保健提供者交谈以确定最佳和最安全的处理计划。
There are certain drugs, such as Aubagio, which should be avoided if you plan on becoming pregnant in the future, Dr. Flanagan says. These medications may cause malformations in a fetus and may stay in a woman’s system for a year or two, even after she stops taking it, he says.
The Bottom Line
已经显示出上述所有疾病修饰的治疗在治疗MS方面是有效的。该关键正在与您的医疗保健提供者合作，找到此时为您提供最大利益的人 - 并监控您的结果，以防它不适用于您。
“I think there’s a medication out there for each patient, but it’s important to look at the whole situation and take all the factors into account,” Dr. Flanigan says. Once you do, you’ll be able to make a decision that is right for you.
