1.Glucocorticoids
(1) Methylprednisolone.
Mainly in the acute stage or in those with moderate to severe disease. Most often, high-dose shock therapy is used, 1g/d, added to 5% glucose 500mL intravenously, and then changed to oral prednisone 60mg for 3-5 days, and gradually reduce the dose within 28 days, depending on the condition.
(2) Prednisone.
Low price. It is recommended to take prednisone orally in the acute stage, 80-120mg/d, and reduce the dosage after 10d to 2 weeks, and slowly decrease according to the condition, 6 weeks to 2 months as a course of treatment, which can be reduced to about 10mg for a long time.
(3) Dexamethasone.
Add 30-40mg to 50mL of saline and push intravenously within 5 minutes. It can make the blood concentration reach the peak in a short time and effectively play the role of immunosuppression. Dexamethasone can also be administered as 20-30mg of dexamethasone plus 5% glucose 500mL intravenously for 2 weeks and then gradually reduce the dosage.
Side effects and points to note
Performance: euphoria and insomnia, headache, increased blood pressure, blurred vision, sweating, non-infectious diarrhea; epiglottitis, pneumonia, herpes zoster; hyperglycemia, hypokalemia; elevated blood sodium; peptic ulcer and bleeding; arrhythmia and rapid increase in blood pressure; osteoporosis, etc.
2.Intravenous application of high-dose immunoglobulin
IVIg is used in the treatment of acute MS patients, clinical symptoms are rapidly controlled and the efficacy is confirmed.
The dose of IVIg is 0.4g/kg/d for 5 days. Some choose 1g/kg/d for 2 days. The half-life of IVIg is 21-28 d. Stable disease can be maintained with a small dose (0.4g /kg) therapy once a month.
Side effects and precautions
The side effects of IVIg are mild, with an incidence of less than 10%. The common ones include headache, chills, palpitations and chest discomfort, which mostly occur 1h after treatment, and the symptoms can disappear by slowing down the titration rate. Fatigue, fever and nausea often appear after infusion and can last for 24 h. Skin reactions often occur in 2-5 d. IVIg can induce migraine and aseptic meningitis. It can induce stroke and deep venous thrombosis leading to pulmonary embolism due to increased blood viscosity. For patients with cardiovascular disease and congestive heart failure, the elderly, diabetes mellitus and kidney disease, the infusion rate should be slow. Severe allergic reactions can occur in patients with severe IgA deficiency, so IgA concentration should be checked before implementing immunoglobulin therapy, especially in those patients suspected of having immune insufficiency.
3.Interferon
Clinical studies have confirmed the effectiveness of IFN-β in the treatment of MS, and its efficacy is positively correlated with dosage and frequency within a certain dose range.
Conventional use
IFN-β1a (avonex): Glycosylated recombinant protein with the same amino acid sequence as natural INF-β. Dosage: 30 μg/w intramuscular injection once/week for 104 weeks revealed a reduction in the number of relapses, a slower progression of the disease course and a reduction in the number of intracerebral lesions.
IFN-β1b (betaseron): Non-glycosylated recombinant protein with one less amino acid than β-1a and substitution of serine by cysteine at position 17. Dosage: 0.05-0.25 mg subcutaneously every other day for 2 years. It can reduce the recurrence rate by 30% and the efficacy can be up to 5 years.
IFN-β1a (Rebif, Libby): Glycosylated recombinant protein. Rebif has been officially registered in China in 11 mcg, 22 mcg, and 44 mcg sizes. Dosage: 22-44 mcg, subcutaneous injection, 3 times/week, while 44 mcg, 3 times/week, has the best therapeutic effect. It can stop the disease progression of MS and reduce the number of relapses and the degree of disability of MS.
Side effects and precautions
Most IFN-β side effects are mild, and serious or intolerable adverse effects are rare. The most common side effects are flu-like symptoms, mainly fever, chills, myalgia, drowsiness, anorexia, weight loss and fatigue, etc. The incidence of flu-like symptoms in the high-dose group is 52% at the beginning of treatment and decreases to 8% by the end of the first year. Another possible but serious side effect of IFN-β is the appearance of depressive symptoms or aggravation of existing depression and increase in suicide rate, which should be treated with antidepressant and psychological therapy, and discontinued if necessary.
4.Immunosuppression
For hormone-insensitive patients or chronic progressive MS, azathioprine and cyclophosphamide may be used with inconsistent efficacy. Some reports suggest that monthly shock doses of cyclophosphamide in relapsing MS may reduce the relapse rate.
Methotrexate: 7.5 mg/week orally in adults. Myelosuppression, gastrointestinal reactions, alopecia, hepatic and renal impairment, and pulmonary toxicity may occur. Contraindicated in patients with hepatic or renal dysfunction.
Cyclophosphamide: 50mg once a day, 2-3 times a day, orally, 10-14 days for adults, mainly for progressive MS. 1000mg of cyclophosphamide was given as an IV once a week for 10 times, then once every 2 weeks for 10 times, and finally once a month for 10 times for a total of 30g. The results showed that the relapse and progression of MS could be reduced, and the side effects were tolerable. Bone marrow suppression, gastrointestinal reactions, hair loss, liver and kidney impairment, and pulmonary toxicity may occur.
Azathioprine: 2-3 mg/kg/d orally. Gastrointestinal reactions and bone marrow suppression may occur. If serious side effects occur during hormone shock therapy, the dosage should be reduced and azathioprine, 50-100 mg/d, can be added. mainly used for relieving relapsing MS. oral effect is slow, usually taking 2-3 months, or even 6 months after starting treatment.
Cyclosporin A (CSA): After one week of shock treatment with adrenocorticotropic hormone, add CSA, 2.5mg/kg/d, divided into 2 times/d, orally, and review liver and kidney function regularly (once a week during the first month of treatment). If the above-mentioned adverse reactions occur, the dosage can be reduced, and in serious cases, the drug can be discontinued, and the side effects can all be reduced or disappeared after discontinuation of the drug. It is contraindicated in patients with renal insufficiency, hypertension, infection, and malignancy. This drug is mainly used in progressive MS.
Mitoxantrone (Mitoxantrone): 12 mg/m2/dose , IV over 5-15 minutes, once every 3 months, cumulative dose of 120-140 mg/m2 is not recommended for continued use. Side effects may include leukopenia, depression, gastrointestinal reactions, bone pain, hair loss, and cardiotoxicity. Contraindicated in cardiovascular disease, hepatic impairment, and neutrophils below 1500/mm3.
5.Gramer
Grammer 20mg, subcutaneously, 1 time/d, can reduce relapse in nearly 1/3 of MS patients.
Side effects and precautions
Patients usually tolerate Gramoxone treatment without influenza-like symptoms. Immediate post-injection reactions include localized fever, flushing, tightness in the chest with palpitations, anxiety, or dyspnea,
These reactions resolve spontaneously and without sequelae. No blood monitoring is required. Use with caution in patients with cardiovascular disease.
6.Legendanoside tablets
Each tablet contains 10mg of Radix Polygoni, 1-1.5mg/kg/d, divided into three doses after meals.
The dose of Leigongdoside is an important factor affecting the toxicity and efficacy. Since the therapeutic dose is very close to the toxic dose, it is important to strictly control the dosage. When the dosage of Radix Polygoni Multi-glucoside tablet is increased to 5mg/kg/d, slight toxic side effects appear, and when the dosage is 15mg/kg/d, the toxic side effects increase significantly.
Side effects and precautions
The sensitivity of Radix et Rhizoma to different individuals, genders and ages varies somewhat. Children should be used with caution or reduced dosage, women of childbearing age and the elderly and frail should be used with caution, or the minimum effective amount should be explored to avoid poisoning.