Являются ли терапии B-клеток ключом к лечению рассеянного склероза?

Каковы долгосрочные эффекты терапии Б-клеток, относительно нового метода лечения рассеянного склероза, и нужно ли продолжать его принимать бесконечно?

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B-Cell Therapy for MS Long-Term Effects

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Did you know that your immune system can turn against you if you have multiple sclerosis (MS)? It’s like having a spy who has gone rogue and is now attacking you instead of protecting you. Scientists used to believe that your immune T cells were the main culprits in MS, but recent studies have shown that immune B cells, which make antibodies, play a significant role too. This discovery has paved the way for a new treatment approach that directly targets B cells.

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One antibody-based treatment that has shown promise in treating MS is rituximab (Rituxan), which is typically used to fight B-cell lymphoma, a type of cancer. A study conducted in 2008 found that rituximab reduced brain lesions and prevented relapses in people with MS after 48 weeks. Building on this success, the FDA has approved three B-cell therapy treatments specifically for MS: ocrelizumab (Ocrevus), ofatumumab (Kesimpta), and ublituximab-xiiy (Briumvi).

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These treatments differ in administration methods. Ocrevus and Briumvi are given intravenously once every six months, while Kesimpta is a monthly shot that can be self-administered at home. Some doctors still use rituximab for MS as well.

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The goal of these therapies is to reduce the number of B cells in the body. However, the benefits may not be immediately noticeable. According to Dr. Ari Green, a neurologist at UCSF Health, the real benefits of B-cell therapies for MS occur over years, even decades. The primary objective is to prevent long-term disability by stopping future injury and attacks on the nervous system.

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So, when should you consider B-cell therapy for MS? The sooner, the better. Within the first few months to a year of starting treatment, you should notice a decrease in relapses and an even better job of preventing new brain lesions. However, there is an ongoing debate among medical professionals about whether to start newly diagnosed patients with high-efficacy medications like B-cell therapies or with older drugs.

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Some doctors may prefer to start with older drugs that have a long safety track record and escalate to B-cell therapy if the patient doesn’t respond well. On the other hand, there is a growing trend to start with the most potent medications right away to prevent disease progression and worsening symptoms. Dr. Eric Seachrist, a neurologist at West Virginia University Hospitals who has MS himself, recommends starting with B-cell therapy as the first line of treatment for his patients. However, it is essential to weigh the risks and benefits of each option before making a decision.

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While B-cell therapy has shown positive results, there are certain factors to consider. Due to the treatment’s impact on the immune system, the risk of infection is increased, and the effectiveness of vaccines may be reduced. Moreover, since these drugs are relatively new, their long-term effects on depleting B cells over decades are not yet known. It’s crucial to have a personalized discussion with your doctor to determine the most suitable MS treatment approach for you.

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The duration of B-cell therapy for MS is still uncertain. Insights from its application in treating rheumatoid arthritis suggest that if B cells are temporarily depleted and treatment is stopped, the disease may come back. However, this may only apply to short-term B-cell therapy. As you age, your immune system naturally changes, and MS can become less active over time. It is yet to be determined whether highly aggressive therapies would be needed indefinitely or if a shift to milder treatments is possible over the long term.

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Current B-cell therapies may be more broad-spectrum than necessary in controlling MS, leading to potential risks and side effects. Dr. Green predicts that future treatments may become more specific and less risky. Ongoing research is exploring alternative ways to target B cells more effectively. As of now, anticipate using B-cell therapy for at least a decade or longer, but keep in mind that advancements in medical knowledge and new treatments could change this outlook.

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References: 1. Past, Present, and Future of Rituximab – The World’s First Oncology Monoclonal Antibody Therapy 2. B cell depletion therapies in autoimmune disease: advances and mechanistic insights 3. Targeting B cell leads to breakthrough therapy

📷 Фото Авторство: Digital Vision / Getty Images

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Вы или кто-то из ваших знакомых проходили лечение клетками В-лимфоцитов от рассеянного склероза? Как это повлияло на вашу жизнь? Поделитесь своими опытом в комментариях ниже и помогите другим узнать больше об этом методе лечения!

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