视神经脊髓炎谱系疾病预防发作的治疗进展及1例患儿的用药监护

Progress in preventive therapy of neuromyelitis optica spectrum disorder attack and pharmaceutical care for one pediatric patient

目的:总结预防视神经脊髓炎谱系疾病(neuromyelitis optica spectrum disorder,NMOSD)发作的药物选择及应用情况,提高对该病预防发作治疗的认识,为临床选择用药提供依据。方法:通过Pub Med检索近年来NMOSD治疗的相关文献,对其免疫抑制剂的选择进行总结分析,并对临床工作中发现的1例NMOSD患儿免疫抑制剂的选择进行分析。结果:预防NMOSD发作,首选利妥昔单抗,其次为霉酚酸酯,再次为硫唑嘌呤。如以上3种免疫抑制剂疗效欠佳,建议换用二线治疗药如甲氨蝶呤、米托蒽醌或环磷酰胺等。基于该患儿的个体差异,建议选择霉酚酸酯治疗,并对其进行药学监护。结论:临床药师对该患儿提出了个体化治疗建议,进一步促进了临床用药的安全性、有效性和合理性。

Objective： To summarize the drug selection for preventive therapy of neuromyelitis optica spectrum disorder（ NMOSD） attack so as to improve the understanding of the preventive therapy for the disease and provide reference for making better clinical choice. Methods： The related literatures in recent years about NMOSD attack’s preventive therapy were searched through Pub Med,then the choice of immunosuppressants for the disease was analyzed and concluded. The choice of immunosuppressants for one pediatric patient with NMOSD was discussed. Results： The authors think the most effective option for preventive therapy of NMOSD attack is rituximab,followed by mycophenolate,and then azathioprine. If the therapeutic effect is poor with the above-mentioned three immunosuppressants,the second-line drugs such as methotrexate,mitoxantrone or cyclophosphamide,etc.,are suggested to be used. For the pediatric patient with NMOSD in our hospital,the pharmacists recommended the physicians to select mycophenolate mofetil and conducted pharmaceutical care after drug administration. Conclusion：The individualized therapy suggestion given by the clinical pharmacist for the pediatric patient promoted the safety,effectiveness and rationality of clinical therapy.