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Hur effektivt är fingolimod vid behandling av multipel skleros?
Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
2012 (Swedish)Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
Abstract [sv]

Multipel skleros (MS) är en kronisk, neurologisk sjukdom som drabbar centrala nervsystemet (CNS). Sjukdomen är autoimmun där kroppens eget immunförsvar angriper nervvävnaden, framför allt myelin, och därefter uppstår en inflammatorisk reaktion. Nerverna i det centrala nervsystemet påverkar många olika funktioner och eftersom myelinet som omsluter nervfibrerna blir inflammerat på olika ställen, både i hjärnan och i ryggmärgen, uppkommer olika typer av symptom. Symptomen för MS kan skilja sig mycket från en individ till en annan, och från skov till skov. Om McDonald-kriterierna uppfylls, som bygger på att minst två separata CNS-lesioner skilda i rum och med minst en månads intervall påvisas utan en tydlig anledning, ställs diagnosen MS. Individer med MS producerar autoreaktiva T-celler som deltar i bildningen av inflammatoriska lesioner längs myelinskidan, men det finns även CNS-celler som gliaceller och astrocyter, som deltar i inflammationsprocessen. Vävnadstypen HLA-DR2 är förknippad med ökad risk att få MS. Den vanligaste och den milda formen av MS, skovvis förlöpande MS, bromsas med immunmodulerande läkemedel som interferon beta, fingolimod, m.fl. Syftet med det här litteraturarbetet var att utreda den kliniska effekten av fingolimod, den första orala behandlingen mot MS, på möjliga skador som förekommer på grund av MS. Studierna som granskades i detta arbete hämtades från Pubmed. Resultatet visar att fingolimod har klinisk effekt vid MS, men det behövs fler studier för att undersöka säkerhetsprofilen mer ingående. I en studie under två år reducerades den årliga skovfrekvensen från 0.4 till mindre än hälften av detta. I en annan två-årig studie, där fingolimod jämfördes med interferon-beta 1a, fanns det en signifikant större reduktion i den årliga skovfrekvensen i fingolimodgruppen (årlig skovfrekvens < 0,20) än i interferongruppen (årlig skovfrekvens 0,33). Majoriteten av patienterna (>70 %) förblev skovfria med fingolimodbehandlingen i båda studierna. Det fanns inga studier där fingolimod kombinerades med annan MS-behandling, vilket skulle vara intressant att se i framtiden.

Abstract [en]

Multiple sclerosis (MS) is a chronic neurological disease that affects the nerves within the central nervous system (CNS). The disease is autoimmune where the body's own immune system attacks nerve tissue, especially myelin, causing an inflammatory reaction. The nerves of the central nervous system serve many different functions and since the myelin surrounding the nerve fibers becomes inflamed at different places, both in the brain and the spinal cord, a variety of symptoms result. Symptoms of MS can differ greatly from one individual to another, as well as from relapse to relapse. If the McDonald criteria, which are based on at least two separate CNS lesions separated in space and at least one month apart demonstrated without a clear reason, are fulfilled a diagnosis of MS is set.

Individuals with MS produce autoreactive T cells involved in the formation of inflammatory lesions along the myelin sheath, but CNS cells, glial cells and astrocytes, also participate in the inflammatory process. Tissue type HLA-DR2 is associated with increased risk of developing MS. The most common and mild form of MS, relapsing-remitting MS, can be slowed down with immunomodulatory drugs such as interferon beta, fingolimod, etc.

The aim of this literature study was to investigate the clinical efficacy of fingolimod, the first oral therapy for MS, on the possible damage that occurs due to MS. The studies examined in this work were taken from Pubmed. The results demonstrate that fingolimod has clinical efficacy in MS, but more studies are needed to investigate the safety profile in more detail. In a study over two years the annualized relapse rate was reduced from 0.4 to less than half of this. In another two-year study in which fingolimod was compared with interferon-beta 1a, there was a significantly greater reduction in the annualized relapse rate in the fingolimod group (annualized relapse rate <0.20) than in interferon group (annualized relapse rate 0.33). The majority of patients (>70 %) remained relapse-free with fingolimod treatment in both studies. There were no studies that combined fingolimod with other MS treatments, which would be interesting to see in the future.

Place, publisher, year, edition, pages
2012. , 51 p.
Keyword [en]
fingolimod. gilenya, multiple sclerosis, MS, efficacy
Keyword [sv]
fingolimod, gilenya, multipel skleros, MS, effekt
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:lnu:diva-18559OAI: oai:DiVA.org:lnu-18559DiVA: diva2:524990
Subject / course
Pharmacy
Educational program
Bachelor of Science Programme in Pharmacy, 180 credits
Presentation
(Swedish)
Uppsok
Medicine
Supervisors
Examiners
Available from: 2012-05-09 Created: 2012-05-04 Last updated: 2012-05-09Bibliographically approved

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