標準的治療で再発が抑制できない多発性硬化症—再発抑制困難なRRMS

Therapeutic Strategy for Multiple Sclerosis Resistant to Standard Treatment: MS Cases When Relapses Cannot be Controlled with Standard Treatment

本邦において承認されている疾患修飾薬は，現在8種類ある。再発抑制効果に違いはあるが，ナタリズマブやオファツムマブは，非常に高い抑制効果を示す。実際，これらの薬剤で再発をコントロールできないケースは多くないため，両剤で再発が抑制できなければ，抗ナタリズマブ抗体のチェックや診断の再考を慎重に行い，多発性硬化症らしくない所見があれば，ステロイドや免疫抑制薬などの検討を行う。

Abstract

Eight disease-modifying drugs have been approved for treating multiple sclerosis in Japan., The drugs show some differences in for the degree to which they prevent relapses; among them, natalizumab and ofatumumab are significantly effective in preventing relapses. If relapses are not suppressed when treated with natalizumab, the presence of anti-natalizumab antibodies should be investigated. When relapses cannot be suppressed with natalizumab, the patient should be treated with ofatumumab and vice versa. If relapses cannot be suppressed with both natalizumab and ofatumumab, then the diagnosis of multiple sclerosis should be thoroughly reassessed. In cases with atypical symptoms and/or exhibiting factors such as multiple sclerosis, oral steroids, and/or immunosuppressive agents can be administered to prevent relapses.