Abstract
One of the promising areas in the pathogenetic treatment of multiple sclerosis (MS) is anti-B-cell therapy using ocrelizumab, an anti-CD20 monoclonal antibody. The drug is indicated for primary progressive MS (PPMS), secondary progressive MS (SPMS) and exacerbations, and highly active MS. Objective : to analyze the use of the drug in 32 patients with different types of MS in everyday neurological practice. Patients and methods . The investigation included 32 patients diagnosed with MS using the 2017 McDonald criteria: 12 patients with PPMS, 12 with highly active MS and 8 with SPMS and exacerbations. The median Expanded Disability Status Scale (EDSS) score was 4.0; the most severe course of the disease was observed in patients with SPMS. All the patients received a treatment cycle of 600-mg intravenous ocrelizumab injections (with an infusion pump) every 6 months; the initial dose was by 300 mg every 2 weeks. The follow-up period was 6 to 18 months. Results and discussion. During ocrelizumab therapy, the patients with PPMS showed stabilization of EDSS score; and 6 (50%) had even its slight decrease by 0.5–1.0 scores, which may be caused by compensation for the existing symptoms due to pathogenetic treatment. In highly active MS, only 1 of the 12 ocrelizumab-treated patients had an ongoing exacerbation of the disease. During a subsequent 6–18-month follow-up, magnetic resonance imaging revealed that none of the patients had manifestations of MS activity; the EDSS score decreased in all the patients, indicating their achievement of stable remission. Six (75%) of the 8 patients with SPMS and exacerbations also displayed a decrease in EDSS score in the absence of exacerbations. No adverse events, including infusion reactions, were recorded during drug administration. The drug has a good tolerance and safety profile and ease-to-use. Conclusion . Ocrelizumab therapy with will be able to improve the quality of treatment in patients with different types of MS, which is of great medical and social importance
Highlights
Одним из перспективных направлений патогенетического лечения рассеянного склероза (РС) является анти-В-клеточная терапия с использованием окрелизумаба – моноклонального антитела против CD20-рецептора
The drug is indicated for primary progressive multiple sclerosis (MS) (PPMS), secondary progressive MS (SPMS) and exacerbations, and highly active MS
The investigation included 32 patients diagnosed with MS using the 2017 McDonald criteria: 12 patients with PPMS, 12 with highly active MS and 8 with SPMS and exacerbations
Summary
Бойко О.В.1,2, Петров С.В.2, Лащ Н.Ю.1, Гусева М.Р.1, Бойко А.Н.1,2 1ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. У пациентов с ППРС на фоне терапии окрелизумабом произошла стабилизация показателя EDSS, а у 6 (50%) – даже его небольшое снижение на 0,5–1,0 балл, что может быть связано с компенсацией имевшихся симптомов под влиянием курса патогенетического лечения. Окрелизумаб может быть рекоактивационных цитокинов, а также представляя антигены мендован при лечении практически всех форм течения РС сенсибилизированным клеткам, в том числе при формиро- (за исключением ВПРС без обострений), но наиболее активвании эктопических лимфоидных фолликулов в оболочках но его назначают больным с ППРС, высокоактивным РСО мозга [3, 4]. В нашем исследовании у 8 (66,7%) из 12 больных ППРС за 6 мес до начала лечения отмечено существенное нарастание тяжести состояния, а у 5 из 12 (41,7%) при МРТ выявлены новые очаги в головном или спинном мозге на Т2-ВИ. Начало заболевания с шаткости при ходьбе, через 2 года из-за
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