Decompensated disease treatment
[Related drugs]
1. Glucocorticoids
Glucocorticoids are still considered to be the drugs of choice commonly used in the treatment of MS. It is an effective immunosuppressant, and glucocorticoids affect the immune response, especially the cellular immune response, and also the humoral immune response, but to a lesser extent. Commonly used clinically are methylprednisolone (methy1prednisolone, MPS), dexamethasone (dexamethasone, DXM), prednisone (predisone).
2. High-dose immunoglobulin
Most MS patients have increased cerebrospinal fluid IgG index and detectable antibodies such as oligoclonal bands and anti-myelin basic protein, suggesting the involvement of humoral immunity in the pathogenesis. Accordingly, intravenous high-dose immunoglobulin has become one of the new methods of MS treatment in recent years. The mechanism of action is to regulate the immune system and promote the regeneration of myelin.
3, interferon (interferon, IFN)
IFN has a broad-spectrum antiviral, antitumor and immunomodulatory effects. IFN-α and IFN-β are produced by leukocytes and fibroblasts respectively, both of which become type I interferon and have strong antiviral effects. Since MS patients cannot produce enough type I IFN, thus the application of exogenous type I IFN can suppress cellular immunity and carry out immunomodulatory effects. IFNβ-la: Avonex and Rebif, IFNβ-lb: Betaseron are commonly used to prevent and control the relapse of MS.
4.Immunosuppressants
(1)Methotrexate: It affects the synthesis of cellular nucleic acid and protein by inhibiting folate reductase, inhibits cell proliferation and the release of inflammatory mediators such as histamine, and has a strong inhibitory effect on humoral immunity and a weak inhibitory effect on cellular immunity.
(2) Azathioprine: By antagonizing purine biosynthesis, it inhibits DNA and RNA synthesis and prevents the conversion of antigen-sensitive lymphocytes into immunoblasts, producing an immunosuppressive effect that is stronger on T lymphocytes and weaker on B lymphocytes.
(3) Cyclophosphamide: It acts directly on proliferating cells, non-specifically kills antigen-sensitive small lymphocytes, restricts their conversion into immunoblasts, and has an inhibitory effect on both humoral and cellular immunity.
(4) Cyclosporine A (CSA): Cyclosporine A is a novel potentiated immunosuppressant, which can reversibly and specifically inhibit T-cell proliferation, mainly acting on IL-1 and IL-2 and the humoral immune system. CSA can reversibly and specifically inhibit T-cell subpopulation proliferation, inhibit interleukin release and γ-interferon production, thus affecting early It can effectively treat various autoimmune diseases, including neurological diseases, and is indeed effective in the treatment of MS.
(5) mitoxantrone: inhibits DNA synthesis and reduces the secretion of inflammatory cytokines such as TNF-α, IL-2, IL-2R and IFN-γ. Can reduce relapse in 67% of MS patients. Delay the process of loss of work capacity and walking index. Mitoxantrone is recommended as a drug for MS severe disease.
5.Glatiramer (Glatiramer acetate GA ):
Also known as copolymer-1 (COP-1) is a synthetic MBP containing a mixture of four amino acids, L-alanine, L-glutamic acid, L-lysine and L-tyrosine in a certain ratio. the efficacy of COP-1 in MS is definitely due to its structural similarity to myelin basic protein (MBP), which acts as a competitive inhibitor of the interaction between MBP and MHC class II COP-1 is used clinically as an alternative to IFN-β.
6.Legendanoside Tablets
Leigongteng multi-glucoside tablets have both anti-inflammatory and immunosuppressive effects. Due to the good efficacy of Leigongteng in clinical use, but the toxic side effects are large, not convenient for clinical promotion. Therefore, reducing toxicity and improving efficacy and content control are the two major keys, and Leigongduan Polyglucoside Tablets have solved these two key problems and can be widely promoted. The root of Radix Rehmanniae Polygoni is used to remove the toxic root bark, and the active ingredient Radix Rehmanniae Polygoni is extracted through chemical purification to remove the toxic components, which greatly reduces the toxicity and greatly improves the efficacy.
[Selection principle]
1.Glucocorticoid
Suitable for relapsing-remitting MS, but less effective for progressive MS.
2.High-dose immunoglobulin
It is effective for relapsing-remitting MS, which significantly improves the clinical symptoms and reduces the relapse rate, and MRI examination also shows that the volume and number of intracerebral lesions are reduced, but it is not effective for relapsing-progressive MS and primary progressive MS.
3.β-interferon
The US Food and Drug Administration has approved three beta-interferons for the treatment of MS with proven efficacy in reducing relapses in 1/3 of MS patients, and they are recommended as first-line agents, or for patients with relapsing-remitting MS who cannot tolerate Grammer. In randomized double-blind placebo studies, the use of beta-interferon reduced inflammatory damage by 50% to 80%; evidence was also obtained that these drugs help improve patients’ quality of life and improve cognitive function.
4. Immunosuppressants
For patients with hormone insensitivity or chronic progressive MS, azathioprine and cyclophosphamide are available. The efficacy is inconsistent. Some reports suggest that monthly shock doses of cyclophosphamide given for relapsing MS in remission may reduce the rate of deterioration. Mitoxantrone has been approved by the US Food and Drug Administration for the treatment of MS.
(1) Methotrexate (MTX): Small doses of MTX have been shown to be useful in the secondary progressive form;
(2) Azathioprine: It plays a role in reducing the relapse rate and preventing progression, with mild to moderate side effects. It is used for hormone-insensitive patients or chronic progressive MS, and is contraindicated in patients with acute progressive MS.
(3) Cyclophosphamide (CTX), because of its limited therapeutic effect and side effects, is used for relapsing-remitting acute or chronic progressive MS, and can be used as a reserved drug after failure with other treatments.
(4) Cyclosporine A (CSA): mainly used in progressive MS.
(5) Mitoxantrone: Delay the process of loss of work capacity and walking index. Mitoxantrone is recommended as a drug for severe disease in all types of MS.
5. Glatiramer (Glatiramer acetate GA ):
Approved by the US Food and Drug Administration for active relapsing-remitting MS, clinically available as an alternative therapy to IFN-β.
6.Raglan polysaccharide tablets.
Complementary therapy for all types of MS.