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Combination therapy of Avonex and doxycycline in patients with multiple sclerosis

Authors:

Abstract

Background: Multiple sclerosis is an inflammatory, chronic demyelinating disease of the central nervous system (CNS) with unknown etiology. Multiple sclerosis causes disability in young people. An Immunomodulatory drug like Avonex (IFN β1a) is used to prevent relapses or disease progression. The aim of this study is to evaluate efficacy of combination therapy (Avonex and doxycycline) with standard therapy (Avonex) in remitting-relapsing multiple sclerosis (RRMS).Materials and Method: A double blind clinical trial was conducted. During four-month study period, 46 patients with RRMS, under standard medication (Avonex), were entered into the study. Their EDSS score were between 1-5. They randomly allocated in to two study groups with 23cases in each arm (cases and controls). All cases were allocated to each group based on blocking method. They received Avonex only in control group and Avonex and doxycycline in case group. EDSS was measured in both groups in the beginning and at the end of study. First EDSS and EDSS scores at the end of first, second, third and fourth months in both groups were compared. Number and rate of clinical attacks and side effects of treatment were assessed in both groups. Results: In case group, there was significant changes between the first EDSS and final EDSS score, but there was not any statistically significant finding in control group after 4 months. There was no significant difference between case and control group in EDSS scores during four-month study period and there was not significant difference between case and control groups in clinical attacks. Combination therapy was well tolerated without additive side effects. Conclusion: It seems that combination of both Avonex and doxycycline in RRMS patients were effective, safe, and well tolerated
ﻲﺴﻛادﺲﻳزوﺮﻠﻜﺳا ﻞﭙﻴﺘﻟﻮﻣ و ﻦﻴﻠﻜﻴﺳ
لﻮﺌﺴﻣ هﺪﻨﺴﻳﻮﻧ سردآ :زاﻮﻫا ،نﺎﺘﺴﻠﮔ نﺎﺘﺳرﺎﻤﻴﺑ email: sharafaddinzadeh@yahoo.com
65
ﻲﺸﻫوﮋﭘ ﻪﻟﺎﻘﻣ
ﻲﺴﻛاد و ﺲﻜﻧوآ ﻲﺒﻴﻛﺮﺗ نﺎﻣرد ﻦﻴﻠﻜﻴﺳرد نارﺎﻤﻴﺑ ﻪﺑ ﻼﺘﺒﻣ ﻞﭙﻴﺘﻟﻮﻣ ﺲﻳزوﺮﻠﻜﺳا
فﺮﺷ ﺮﺻﺎﻧﻦﻳﺪﻟاهداز
،
1
يﺪﺠﻣ نﺮﺘﺴﻧﺐﺴﻧ،
1
ﻲﻧﺎﻬﻴﻛ ﺪﻴﺠﻣدﺮﻓ،
1
جوﺮﻣ نﺎﻐﻣرالآﻲﻠﻋ
2
1. رﺎﻳدﺎﺘﺳايرﺎﻤﻴﺑيﺎﻫ ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،بﺎﺼﻋا و ﺰﻐﻣ ﻲﻧﺎﻣرد ﻲﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و زاﻮﻫا رﻮﭘﺎﺷ يﺪﻨﺟ
2. ﻲﻣﻮﻤﻋ ﻚﺷﺰﭘ ،ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،ﻲﻨﻴﻟﺎﺑ تﺎﻘﻴﻘﺤﺗ ﻪﻌﺳﻮﺗﺰﻛﺮﻣ و ﻲﻧﺎﻣرد ﻲﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧزاﻮﻫا رﻮﭘﺎﺷ يﺪﻨﺟ
ﻪﻣﺪﻘﻣ
ﻞــﭙﻴﺘﻟﻮﻣ ﺲﻳزوﺮﻠﻜــﺳا)
MS (و ﻦﻣﺰــﻣ يرﺎــﻤﻴﺑ ﻚــﻳ ﻲﺒــﺼﻋ ﻢﺘــﺴﻴﺳ ﻊﻳﺎــﺷ
ـﻛﺮﻣ ﻲﺒـﺼﻋ ﻢﺘـﺴﻴﺳ ﻒـﻠﺘﺨﻣ ﻖﻃﺎﻨﻣ رد ﻦﻴﻠﻴﻣ ﺐﻳﺮﺨﺗ ﺎﺑ ﻪﻛ ﺖﺳا يﺰﻛﺮﻣ يﺰ
ﻲﻣ ﺺﺨﺸﻣدﻮﺷ.
1،2
ـﺑ ﻪﻌﻣﺎﺟ ناﻮﺟ داﺮﻓا رد يرﺎﻤﻴﺑ ﻦﻳا ﻦﻴﻨـﺳ ﻦﻴـﺑ صﻮـﺼﺧ
40-20 ﻊﻳﺎـﺷ لﺎﺳ ﺎـﺒﻳﺮﻘﺗ نﺎـﻧز و ﺖـﺳا ﺮـﺗ7/1 ﺮـﻴﮔرد نادﺮـﻣ زا ﺮﺘـﺸﻴﺑ ﺮـﺑاﺮﺑ
ﻲﻣﺪﻧﻮﺷ.
5-3
ﻪـﻧﺎﻴﻣروﺎﺧ و ناﺮـﻳا رد ﻪـﺘﻓﺮﮔ مﺎـﺠﻧا تﺎـﻌﻟﺎﻄﻣ ﺮـﻴﺧا لﺎﺳ ﺪﻨﭼ رد
هدﺮـﻛ شراﺰـﮔ ار يرﺎـﻤﻴﺑ ﻦـﻳا يﻻﺎـﺑ عﻮﻴﺷ ﺪـﻧا.
6
و ﺖـﺛارو ،ﻲـﻄﻴﺤﻣ ﻞـﻣاﻮﻋ
ﺖﻧﻮﻔﻋ رد ﻲﺳوﺮﻳو يﺎﻫ ﻲﻠﺻا ﻢﺴﻴﻧﺎﻜﻣ ﺎﻣا ﺪﻨﺘﺴﻫ ﺮﺛﻮﻣ يرﺎﻤﻴﺑ نﺪﻣآ دﻮﺟو
زوﺮﺑ يرﺎﻤﻴﺑ و ﻲﻨﻤﻳادﻮﺧ هﺪﻳﺪﭘ و ﻦﻴـﻠﻴﻣ ﺐﻳﺮﺨﺗ ﺮـﺘﻤﻛ ناﺰـﻴﻣ ﻪـﺑ آ نﻮـﺴﻛ ﺎـﻫ
ﻲــﻣﺪــﺷﺎﺑ. يرﺎــﻤﻴﺑ
MS رﺎــﻬﭼ ﻞﻣﺎــﺷ ﻪــﻛ دراد ﻒــﻠﺘﺨﻣ عﻮــﻧ هﺪــﻨﻨﻛدﻮﻋ-
هﺪﻨﺑﺎﻳدﻮﺒﻬﺑ، ﻪﻴﻟوا هﺪﻧوﺮﺸﻴﭘ، ﻪﻳﻮﻧﺎﺛ هﺪﻧوﺮﺸﻴ، هﺪﻧوﺮﺸﻴﭘ- هﺪﻨﻨﻛدﻮﻋﻲﻣ و ﺪـﺷﺎﺑ
نارﺎﻤﻴﺑ ﺮﺜﻛاﻪﺑ ﻼﺘﺒﻣ عﻮﻧهﺪﻨﻨﻛدﻮﻋ- هﺪﻨﺑﺎﻳدﻮﺒﻬﺑﻲﻣﺪﻨﺷﺎﺑ . ياﺮـﺑ ﻲـﻌﻄﻗ نﺎـﻣرد
نﺎﻣرد و دراﺪﻧ دﻮﺟو نارﺎﻤﻴﺑ ﺎـﻳ يرﺎﻤﻴﺑ ﻦﺘﺧاﺪﻧا ﺮﻴﺧﺎﺗ ﻪﺑ ﺚﻋﺎﺑ ﻂﻘﻓ ﺮﻴﺧا يﺎﻫ
ﻲـﻣ دﻮـﻋ دراﻮﻣ ﺶﻫﺎﻛ ﺪﻧﻮـﺷ .
نوﺮـﻓﺮﺘﻨﻳا ﻞﻣﺎـﺷ ﻲﭘاﺮﺗﻮـﻧﻮﻤﻳا عﻮـﻧ ﺞﻨـﭘ1aβ
ــﻀﻋ نوﺮــﻓﺮﺘﻨﻳا ،ﻲﻧﻼ
1bβ نوﺮــﻓﺮﺘﻨﻳا ،يﺪــﻠﺟﺮﻳز تﺎﺘــﺳاﺮﻤﻴﺗﻼﮔ ،يﺪــﻠﺟﺮﻳز
1aβ ﺮـﺑ ترﺎـﻈﻧ نﺎﻣزﺎـﺳ ﻂـﺳﻮﺗ هﺪﻧوﺮﺸﻴﭘ مﺮﻓ رد نوﺮﺘﻧﺎﺴﻛﻮﺘﻴﻣ و يﺪﻠﺟﺮﻳز
هﺪـﺤﺘﻣ تﻻﺎـﻳا نﺎﻣرد و وراد)
FDA ( ﻪـﺘﻓﺮﮔ راﺮـﻗ ﺪـﻴﻳﺄﺗ درﻮـﻣ ﺪـﻧا . ﻪـﺑ ﺖـﻠﻋ
ﻲــﻠﻋ يرﺎــﻤﻴﺑ ﺖﻓﺮــﺸﻴﭘ و رﺮــﻜﻣ يﺎــﻫدﻮﻋﻪــﻨﻳﺰﻫ و وراد ﺖــﻓﺎﻳرد ﻢــﻏر يﺎــﻫ
قﻮﻓ ا و ﻪـﻌﻣﺎﺟ ناﻮـﺟ و ﺪـﻣآرﺎﻛ ﺮﺸﻗ نﺪﺷ ﺮﻴﮔرد و يرﺎﻤﻴﺑ نﺎﻣرد ناﺮﮔ هدﺎﻌﻟ
هداﻮﻧﺎﺧ ياﺮﺑ نارﺎﻤﻴﺑ زا يراﺪﻬﮕﻧ رد ناواﺮﻓ تﻼﻜﺸﻣ زوﺮﺑ و يرﺎﻤﻴﺑ عﻮﻴﺷ ﺎـﻫ
زﺎﻴﻧ يﻮـﻗ و ﺮﺗﺪﻳﺪﺟ ﻲﻧﺎﻣرد
تﺎﻣاﺪﻗا ﻪﺑ نازرا و ﺮـﺗ سﺎـﺴﺣا ﻪـﻨﻴﻣز ﻦـﻳا رد ﺮـﺗ
ﻲﻣ دﻮﺷ.
ﺮــﺿﺎﺣ لﺎــﺣ رد نوﺮــﻓﺮﺘﻨﻳا
1aβ )ﺲــﻜﻧوآ (رد ﺎــﻤﻴﺑ ﺮــﺜﻛا نارMS عﻮــﻧ
هﺪﻨﻨﻛدﻮﻋ-ﻪﺑ هﺪﻨﺑﺎﻳدﻮﺒﻬﺑ ﻲـﻣ هدﺎﻔﺘـﺳا دراﺪﻧﺎﺘـﺳا يوراد ناﻮﻨﻋ دﻮـﺷ . ﻲـﻓﺮﻃ زا
در تﺎﺒﺛا زا ﺲﭘ مﺮـﻓ مﺎـﻤﺗ رد ﻪﻴﻧﻮﻣﻮﻨﭘ ﺎﻳﺪﻴﻣﻼﻛ يﺎﭘ يﺎـﻫ
MS و ندﻮـﺑ ﺮﺛﻮـﻣ
ﻲﺴﻛاد ﺖـﻬﺟ ﻒﻠﺘﺨﻣ يﺎﻫرﻮﺸﻛ رد ﻲﻔﻠﺘﺨﻣ تﺎﻌﻟﺎﻄﻣ ،نژﻮﺗﺎﭘ ﻦﻳا ﺮﺑ ﻦﻴﻠﻜﻴﺳ
ﻲﺴﻛاد ﺮﺛا ﻲﺳرﺮﺑﺮﺑ ﻦﻴﻠﻜﻴﺳ
MS ﺖﻓﺮﮔ ترﻮﺻ.
11-7،1
لﺎﺳ رد ﺮﮔﺎﻨﻴﻣ ﻪﻌﻟﺎﻄﻣ
2008 داد نﺎﺸﻧ نوﺮﻓﺮﺘﻨﻳا ﺐﻴﻛﺮﺗ
1aβ ﻲﺴﻛاد و ،ﺮﺛﻮـﻣ نﺎـﻣرد ﻚـﻳ ﻦﻴﻠﻜﻴـﺳ
و ﻦﻤﻳا ﻞﻤﺤﺗ ﺎﺑ نارﺎﻤﻴﺑ رد بﻮﺧ يﺮﻳﺬﭘ
MSﺖﺳا.
12
ﻦـﻳا ﻪـﺑ ﻪـﺟﻮﺗ ﺎﺑ ﺎﻣا ﻪـﻛ
و ﺲــﻜﻧوآ ﻲــﺒﻴﻛﺮﺗ نﺎــﻣرد ﺮﻴﺛﺎــﺗ درﻮــﻣ رد يا ﻪــﻌﻟﺎﻄﻣ نﻮﻨﻛﺎــﺗ ﺎــﻣ رﻮــﺸﻛرد
ﻲﺴﻛادوﺮﻠﻜﺳا ﻞﭙﻴﺘﻟﻮﻣ نارﺎﻤﻴﺑ ﺮﺑ ﻦﻴﻠﻜﻴﺳ رد ﻪـﺠﻴﺘﻧ رد ﺖﺳا هﺪﺸﻧ مﺎﺠﻧا ﺲﻳز
ﻪـﺑ ﻢﻴﺘﻓﺮـﮔ ﻢﻴﻤﺼﺗ ﻪﻌﻟﺎﻄﻣ ﻦﻳا ﻲـﺴﻛاد ﺮﻴﺛﺎـﺗ ﻲـﺳرﺮﺑ ﺮـﺑ ﻦﻴﻠﻜﻴـﺳ داﺪـﻌﺗ يور
ﻲﻜﻴﻨﻴﻠﻛ ﻢﺋﻼﻋ و تﻼﻤﺣ
هﺪـﻨﻨﻛدﻮﻋ مﺮﻓ- ﻪـﺑ ﻼﺘـﺒﻣ نارﺎـﻤﻴﺑ هﺪـﻨﺑﺎﻳدﻮﺒﻬﺑMS
ﻢﻳزادﺮﭙﺑ.
شوررﺎﻛ
ردﻦﻳا ﻲﻨﻴﻟﺎﺑ ﻲﻳﺎﻣزآرﺎﻛ ﻪﻌﻟﺎﻄﻣ، 46 رﺎﻤﻴﺑ ﺮﻔﻧ )29 ﺮﻔﻧ نز و17 ﺮﻔﻧدﺮﻣ( ﻪﻛ
ﺨﺸﺗ ﻲﻌﻄﻗ ﺺﻴﻞﭙﻴﺘﻟﻮﻣنآ رد ﺲﻳزوﺮﻠﻜﺳا ﺪـﻟﺎﻧود ﻚﻣ يﺎﻳﺮﺘﻳاﺮﻛ سﺎﺳاﺮﺑ ﺎﻫ
هﺪﻴﻜﭼ
فﺪﻫ و ﻪﻨﻴﻣز:
ﺲﻳزوﺮﻠﻜﺳا ﻞﭙﻴﺘﻟﻮﻣ ﻚﻳﺖﺳا ﻪﺘﺧﺎﻨﺷﺎﻧ يژﻮﻟﻮﻴﺗا و نﻮﻴﺳاﺰﻴﻨﻴﻠﻴﻣد ﺎﺑ هاﺮﻤﻫ يﺰﻛﺮﻣ ﻲﺒﺼﻋ ﻢﺘﺴﻴﺳ ﻦﻣﺰﻣ و ﻲﺑﺎﻬﺘﻟا يرﺎﻤﻴﺑ . يﺎﻫورادا رﻮﺗﻻوﺪﻣﻮﻧﻮﻤﻳ
نوﺮﻓﺮﺘﻨﻳا ﻪﻠﻤﺟ زا
1aβ )ﺲﻜﻧوآ ( هدﺎﻔﺘﺳا نﺎﻣرد ياﺮﺑﻲﻣﺪﻨﻛ يﺮﻴﮔﻮﻠﺟ يرﺎﻤﻴ ﺖﻓﺮﺸﻴﭘ ﺎﻳ دﻮﻋ زا ﺎﺗ دﻮ . ﻪﻌﻟﺎﻄﻣ ﻦﻳا زا فﺪﻫﻪﺴﻳﺎﻘﻣ ﻲﺴﻛاد ﺐﻴﻛﺮﺗﺮﻴﺛﺎﺗ و ﻦﻴﻠﻜﻴﺳ
ﻪﺑ ﺲﻜﻧوآ ﺎﺑ ﺲﻜﻧوآ نارﺎﻤﻴﺑ رد ﻲﻳﺎﻬﻨﺗﻞﭙﻴﺘﻟﻮﻣهﺪﻨﻨﻛدﻮﻋ مﺮﻓ ﺲﻳزوﺮﻠﻜﺳا -ﺖﺳا هﺪﻨﺑﺎﻳدﻮﺒﻬﺑ.
شور و داﻮﻣرﺎﻛ: ﻪﻌﻟﺎﻄﻣ ﻦﻳارﻮﻛﻮﺳود ﻲﻨﻴﻟﺎﺑ ﻲﻳﺎﻣزآرﺎﻛ لﺎﺳ رد85 يور ﺮﺑ 46 ﻴﺑرﺎﻤ )29 و نز17 دﺮﻣ ( هﺪـﻨﻨﻛدﻮﻋ مﺮﻓ ﻪﺑ ﻼﺘﺒﻣ- ﻞـﭙﻴﺘﻟﻮﻣ هﺪـﻨﺑﺎﻳدﻮﺒﻬﺑ ﺲﻳزوﺮﻠﻜـﺳا
ﻪﻌﺟاﺮﻣﻪﺑ هﺪﻨﻨﻛ
زاﻮﻫا نﺎﺘﺴﻠﮔ نﺎﺘﺳرﺎﻤﻴﺑ بﺎﺼﻋا و ﺰﻐﻣ ﻚﻴﻨﻴﻠﻛ تﺪﻣ رد4 هﺎﻣﺪﺷ مﺎﺠﻧا .نارﺎﻤﻴﺑ ﻪﺑ شورBlocking ﺺﻴﺼﺨﺗ ﺎﺑﻲﻓدﺎﺼﺗ ﻪﺑ هوﺮﮔ ود23 يﺮـﻔﻧ و ﺪﻫﺎـﺷ
درﻮﻣ ﺪﻧﺪﺷ ﻢﻴﺴﻘﺗ .ﺲﻜﻧوآ ﻂﻘﻓ ﺪﻫﺎﺷ هوﺮﮔ ﺲﻜﻧوآ ﻲﺒﻴﻛﺮﺗ نﺎﻣرد درﻮﻣ هوﺮﮔ وو ﻲﺴﻛادﺪﻧدﺮﻛ ﺖﻓﺎﻳرد ﻦﻴﻠﻜﻴﺳ . هﺎـﻣ ﺮـﻫ نﺎـﻳﺎﭘ رد و ﻪـﻌﻟﺎﻄﻣ ياﺪـﺘﺑا رد هوﺮـﮔ ﺮﻫ رد
Expanded Disability Scale Score )EDSS( ﺪﺷ ﻪﺘﻓﺮﮔ هزاﺪﻧا نارﺎﻤﻴﺑ . تﻼﻤﺣ داﺪﻌﺗرد هوﺮﮔ ودو EDSS و ﻪﻴﻟواEDSS هﺎﻣ نﺎﻳﺎﭘ مرﺎﻬﭼ و مﻮﺳ ،مود ،لوا يﺎﻫ
ﺮﻫ رد درﻮﻣ هوﺮﮔ ود ﻦﻴﺑ ﺲﭙﺳ و هوﺮﮔﺖﻓﺮﮔ راﺮﻗ ﻪﺴﻳﺎﻘﻣ.
ﻪﺘﻓﺎﻳﺎﻫ: فﻼﺘﺧا ﻦﻴﮕﻧﺎﻴﻣEDSS ﺎﺑ مرﺎﻬﭼ هﺎﻣEDSS ﻪﻴﻟوا ﻲـﻨﻌﻣ ،درﻮﻣ هوﺮﮔ رد راد دﻮـﺑ)004/0p=( ﻲـﻨﻌﻣ فﻼﺘـﺧا ﻦـﻳا ﺪﻫﺎـﺷ هوﺮـﮔ رد ﺎـﻣا دﻮـﺒﻧ راد)803/0p=( .
فﻼﺘﺧا
EDSS هوﺮﮔ ود ﺮﻫ رد لﻮﻃ رد4 ﻲﻨﻌﻣ هﺎﻣدﻮﺒﻧ راد)474/0p=( . ﻦﻴﺑ ﻲـﻨﻌﻣ فﻼﺘـﺧا ﺪﻫﺎـﺷ و درﻮـﻣ هوﺮـﮔ رد تﻼﻤ ﺖـﺷاﺪﻧ دﻮـﺟو يراد)599/0=p ( نﺎـﻣرد
ﭻﻴﻫ نوﺪﺑ ﻲﺒﻴﻛﺮﺗﺪﺷ ﻞﻤﺤﺗ نارﺎﻤﻴﺑرد ﻲﻓﺎﺿا ﻪﺿرﺎﻋ ﻪﻧﻮﮔ .
ﻪﺠﻴﺘﻧيﺮﻴﮔ: ﻪﺑﻲﻣ ﺮﻈﻧﻲﺴﻛاد و ﺲﻜﻧوآ ﻲﺒﻴﻛﺮﺗ نﺎﻣرد ،ﺪﺳرهﺪﻨﻨﻛدﻮﻋ مﺮﻓ نارﺎﻤﻴﺑ رد ﻦﻴﻠﻜﻴﺳ- هﺪﻨﺑﺎﻳدﻮﺒﻬﺑ ﻞـﭙﻴﺘﻟﻮﻣ ﺲﻳزوﺮﻠﻜـﺳا دوﺪـﺣ ﺎـﺗ و ﻞـﻤﺤﺗ ﻞـﺑﺎﻗ ، ﺮﺛﺆـﻣ ي
ﺪﺷﺎﺑ.
] ،ز پ ع ت م12)5 :(68- 65[
هژاوﺪﻴﻠﻛﺎﻫ :ﻞﭙﻴﺘﻟﻮﻣﻲﺴﻛاد ،ﺲﻜﻧوآ ،زوﺮﻠﻜﺳاﻦﻴﻠﻜﻴﺳ
ﺖﻓﺎﻳرد ﺦﻳرﺎﺗ ﻪﻟﺎﻘﻣ :18/12/88
ﻪﻟﺎﻘﻣ شﺮﻳﺬﭘ ﺦﻳرﺎﺗ :17/3/88
هرود ،ناﺪﻫاز ﻲﻜﺷﺰﭘ مﻮﻠﻋ تﺎﻘﻴﻘﺤﺗ ﻪﻠﺠﻣ12 ، هرﺎﻤﺷ 5
66
هﺎﻣ دادﺮﻣ ﺖﻳﺎﻐﻟ ﻦﻳدروﺮﻓ ﺦﻳرﺎﺗ زا و هﺪﻴﺳر ﺪﻴﻳﺎﺗ ﻪﺑ 1385 و ﺰـﻐﻣ ﻚـﻴﻨﻴﻠﻛ ﻪـﺑ
ﺪـﻧدﺮﻛ ﻪـﻌﺟاﺮﻣ زاﻮـﻫا نﺎﺘﺴﻠﮔ نﺎﺘﺳرﺎﻤﻴﺑ بﺎﺼﻋا، ﺪﻧﺪـﺷ ﻲـﺳرﺮﺑ . يﺎـﻫرﺎﻴﻌﻣ
ﻞﻣﺎــﺷ ﻪــﻌﻟﺎﻄﻣ ﻪــﺑ دورو : ﻦﻴــﺑ ﻦــﺳ55-18لﺎــﺳ، ﻪــﺑ ﻼﺘــﺑاﻴﺘﻟﻮﻣ يرﺎــﻤﻴﺑﻞــﭙ
هﺪـﻨﻨﻛدﻮﻋ عﻮﻧ زا ﺲﻳزوﺮﻠﻜﺳا- هﺪـﻨﺑﺎﻳدﻮﺒﻬﺑ )
RRMS(، نوﺮـﻓﺮﺘﻨﻳا ﺎـﺑ نﺎـﻣرد
1aβ ،EDSS ﻦﻴﺑ ﻪﻴﻟوا5-1 ، مﺪﻋ يﺮـﮕﻳد يوراد ﺎـﻳ ﻮﻴﺳﺮﭘﺎﺳﻮﻧﻮﻤﻳا ﺎﺑ نﺎﻣرد
ﻪﺑﺎﻬﻨﺗﻲﻳ اﺮﻤﻫ ﺎﻳه ،نوﺮﻓﺮﺘﻨﻳا ﺎﺑ يرﺎـﻤﻴﺑ ﺮﻳﺎـﺳ ﻪـﺑ ﻼﺘـﺑا مﺪـﻋ ﻦﻣﺰـﻣ يﺎـﻫ ، مﺪـﻋ
رد ﺖﻛﺮﺷ ياﺮﺑ ﻪﻧﺎﻫﺎﮔآ ﻞﻳﺎﻤﺗ ،ﺮﮕﻳد ﻪﻌﻟﺎﻄﻣ رد ﺖﻛﺮﺷ دﻮـﺑ ﺮـﺿﺎﺣ ﻪـﻌﻟﺎﻄ.
ﻞﻣﺎــﺷ ﺰــﻴﻧ ﻪــﻌﻟﺎﻄﻣ زا جوﺮــﺧ يﺎــﻫرﺎﻴﻌﻣ ﻪــﺑ ﻼﺘــﺑا ﺮﻳﺎــﺳيرﺎــﻤﻴﺑيﺎــﻫ ﻲــﺒﻃ
ﺎــﻳ
ﻲﻜﺷﺰﭙﻧاور، نﺎﻣرد ﺎﺑ نوﺮـﻓﺮﺘﻨﻳا زا ﺮـﻴﻏ يرﻮﺗﻻوﺪـﻣﻮﻧﻮﻤﻳا
1aβ ﺎـﻳ ﺎـﺑ نﺎـﻣرد
يﺎﻫورادﻮﻴﺳﺮﭘﺎﺳﻮﻧﻮﻤﻳا و ﺎﻳ يرادرﺎﺑدﻮﺑ ﻲﻫدﺮﻴﺷ.
شور ﻪﺑ نارﺎﻤﻴﺑ
Blocking و ﺪﻫﺎﺷ هوﺮﮔ ود ﻪﺑ ﻲﻓدﺎﺼﺗ ﺺﻴﺼﺨﺗ ﺎﺑ درﻮﻣ
هوﺮﮔ ﺮﻫ رد و هﺪﺷ ﻢﻴﺴﻘﺗ23 ﺪﻨﺘﻓﺮﮔ راﺮﻗ ﺮﻔﻧ . رﻮﻛﻮـﺳود ترﻮـﺻ ﻪـﺑ ﻪﻌﻟﺎﻄﻣ
ﻪﻨﻳﺎﻌﻣ و هدﻮﺑ ﺪﻨﺘـﺷاﺪﻧ ﺮـﺒﺧ ﺖـﺳا هوﺮـﮔ ماﺪـﻛ رد رﺎﻤﻴﺑ ﻪﻛ ﻦﻳا زا رﺎﻤﻴﺑ و ﺮﮔ .
ﺪﻫﺎﺷ هوﺮﮔ نارﺎﻤﻴﺑ ﺲﻜﻧوآ درﻮﻣ هوﺮﮔ و ﻮﺒﺳﻼﭘ هاﺮﻤﻫ ﻪﺑﺲﻜﻧوآ
ﺮـﻤﻫ ﻪـﺑا ه
ﻲﺴﻛادوراد ﺖﻛﺮﺷ ﺖﺧﺎﺳ ﻲﻛارﻮﺧ لﻮﺴﭙﻛ مﺮﻓ ﻪﺑ ﻦﻴﻠﻜﻴﺳ وراد ناﺮﻳا يزﺎﺳ
زود ﺎﺑ
mg100 ﻪﻧازور2 ﺖﺑﻮﻧ ﻪﺑ تﺪﻣ4 ﺪـﻧدﺮﻛ ﺖﻓﺎﻳرد هﺎﻣ . عوﺮـﺷ نﺎـﻣز رد
ﻲـﺳرﺮﺑ مﺎـﺠﻧا هﻮﺤﻧ ،ﻪﻌﻟﺎﻄﻣ مﺎﺠﻧا هﻮﺤﻧ ﺎﺑ نارﺎﻤﻴﺑ ﻪﻌﻟﺎﻄﻣ ضراﻮـﻋ عاﻮـﻧا و ﺎـﻫ
و ﺪﻧﺪﺷ ﺎﻨﺷآ ﻲﻟﺎﻤﺘﺣا ﻲﻳوراد زا و ﺪـﻧدﺮﻛ ﺖﻛﺮـﺷ ﻪﻌﻟﺎﻄﻣ رد ﻪﻧﺎﻫﺎﮔآ نارﺎﻤﻴﺑ
نآﺖﻳﺎﺿر ﺎﻫد ﺖﻛﺮﺷ ياﺮﺑ ﻲﺒﺘﻛ ﻪﻣﺎﻧﺪﺷ ﻪﺘﻓﺮﮔ ﻪﻌﻟﺎﻄﻣ ر . ﻪﻴـﺻﻮﺗ
نارﺎـﻤﻴﺑ ﻪـﺑ
تﻼـﻤﺣ ،ﻲﻳوراد ضراﻮﻋ ﻪﻧﻮﮔﺮﻫ زوﺮﺑ ترﻮﺻ رد ﻪﻌﻟﺎﻄﻣ تﺪﻣ لﻮﻃ رد ﺪﺷ
ﻪﺑ دﻮﻋ ﺎﻳ ﻲﻜﻴﻨﻴﻠﻛ ﺪﻳﺪﺟ ﻢﻳﻼﻋ زوﺮﺑ ترﻮﺻﻪﺑ ﻚﻳژﻮﻟور زا ﺮﺘـﺸﻴﺑ تﺪﻣ24
ﺎـﻳ ﻪـﻌﻟﺎﻄﻣ رد ﺖﻛﺮـﺷ زا فاﺮـﺼﻧا ،نﺪـﺷ ﻪﻠﻣﺎﺣ ﺪﺼﻗ ،ﻲﮕﻠﻣﺎﺣ زوﺮﺑ ،ﺖﻋﺎﺳ
ا ﻚﺷﺰﭘ ﻪﺑ وراد فﺮﺼﻣ زا فاﺮﺼﻧاﺪﻨﻫد عﻼﻃ . درﻮﻣ و
ﺪﻫﺎﺷ هوﺮﮔ ود ﺮﻫ رد
هﺎﻣ نﺎﻳﺎﭘ رد و ﻪﻌﻟﺎﻄﻣ ياﺪﺘﺑا ردمرﺎﻬﭼ و مﻮﺳ ،مود ،لوا يﺎﻫ
EDSS نارﺎـﻤﻴﺑ
و ﺪﺷ ﻪﺒﺳﺎﺤﻣ
EDSS هﺎﻣ رد و هﺎﻣ ﺮﻫ نﺎﻳﺎﭘ ﺎـﺑ مرﺎـﻬﭼ و مﻮـﺳ ،مود ،لوا يﺎـﻫ
EDSS نﻮـﻣزآ ﻖﻳﺮﻃ زا ﻪﻴﻟوا t جوز ﺘﻓﺮﮔ راﺮـﻗ ﻪـﺴﻳﺎﻘﻣ درﻮـﻣ ﺪـﻨ . ﻪـﻠﺣﺮﻣ رد
يﺪﻌﺑ
EDSS رﺎﻤﻴﺑ رد ﺪﻫﺎﺷ و درﻮﻣ هوﺮﮔ رد نا عوﺮﺷ نﺎﻳﺎﭘ و ﻪﻌﻟﺎﻄﻣ هﺎـﻣ ﺮﻫ
يرﺎﻣآ نﻮﻣزآ ﻖﻳﺮﻃ زا
t ﺖـﻓﺮﮔ راﺮـﻗ ﻪـﺴﻳﺎﻘﻣ درﻮﻣ . ﺮـﻔﻧ ﻚـﻳ ﻂـﺳﻮﺗ ﻪـﻨﻳﺎﻌﻣ
ﻪﻨﻳﺎﻌﻣ ﺮﮔ)يرﺎﻤﻴﺑ ﺖﻧﺪﻳزر بﺎـﺼﻋا و ﺰـﻐﻣ يﺎـﻫ ( ﻲـﻣ مﺎـﺠﻧا ﺖـﻓﺮﮔ . نﺎـﻳﺎﭘ رد
تﺪــﻣ4 و ﻲــﻳوراد ضراﻮــﻋ زوﺮــﺑ و دﻮــﻋ ﺎــﻳ ﻲــﻜﻴﻨﻴﻠﻛ تﻼــﻤﺣ داﺪــﻌﺗ هﺎــﻣ
ﻞﻤﺤﺖﻓﺮﮔ راﺮﻗ ﻲﺳرﺮﺑ درﻮﻣ وراد ﻪﺑ ﺖﺒﺴﻧ يﺮﻳﺬﭘ . ﺮـﻫ رد دﻮﻋ دراﻮﻣ داﺪﻌﺗ
ـﻳﺎﭘ
رد هوﺮﮔ تﺪـﻣ نﺎ4 يرﺎـﻣآ نﻮـﻣزآ ﻖـﻳﺮﻃ زا هﺎـﻣ
2
χ راﺮـﻗ ﻪـﺴﻳﺎﻘﻣ درﻮـﻣ
ﺖﻓﺮﮔ . لﻮﻃ رد هﺪﺷ هﺪﻫﺎﺸﻣ ﻲﻧﺎﻣرد ضراﻮﻋ هوﺮﮔ ود ﺮﻫ رد4 ﻪﺑ هﺎﻣ ترﻮﺻ
ﻲﻔﻴﺻﻮﺗﺪﻳدﺮﮔ ﻪﺋارا.
ﻪﺘﻓﺎﻳﺎﻫ
رد ﻪــﻌﻟﺎﻄﻣ ﻦــﻳا46 ﻪــﺑ ﻼﺘﺒﻣرﺎــﻤﻴﺑﻞــﭙﻴﺘﻟﻮﻣزوﺮﻠﻜــﺳاﺲﻳ هﺪــﻨﻨﻛدﻮﻋ مﺮــﻓ
هﺪﻨﺑﺎﻳدﻮﺒﻬﺑرد ﻲﻨﺳ هدوﺪﺤ44-18 لﺎﺳ )ﮕﻧﺎﻴﻣ ﻲﻨﺳ 3/28 ( ﻲـﺳرﺮﺑ درﻮـﻣ
ﺪﻨﺘﻓﺮﮔ راﺮﻗ .اﺪﻌﺗ
ﻦﻳا زاد 29 ﺮﻔﻧ )%63 ( و نز17ﺮﻔﻧ)%37 (ﺪﻧدﻮﺑ دﺮﻣ .EDSS
ﻦﻴﺑ نارﺎﻤﻴﺑ ﻪﻴﻟوا4-1 ) ﻦﻴﮕﻧﺎﻴﻣ7/2( يرﺎﻤﻴﺑ ﻪﺑ ﻼﺘﺑا تﺪﻣ و4 ﺎﺗ هﺎﻣ5/5 لﺎـﺳ
) ﻦﻴﮕﻧﺎﻴﻣ63/2 لﺎﺳ( دﻮﺑ . ﭻﻴﻫ ﺪﻧﺪـﺸﻧ جرﺎـﺧ ﻪـﻌﻟﺎﻄﻣ زا نارﺎـﻤﻴﺑ زا ماﺪﻛ رد و
ﭻﻴﻫﺪﻣﺎﻴﻧ ﺶﻴﭘ ﻲﮕﻠﻣﺎﺣ ،نز نارﺎﻤﻴﺑ زا ﻚﻳ. ﻦﻴﮕﻧﺎـﻴﻣ هوﺮﮔ ود ﺮﻫ رد
EDSS
هﺎﻣ نﺎﻳﺎﭘ رد و ﻪﻴﻟوا و ﺪـﺷ يﺮـﻴﮔ هزاﺪـﻧا مرﺎﻬﭼ و مﻮﺳ ،مود ،لوا يﺎﻫ
EDSS
ﺎﺑ هﺎﻣ ﺮﻫ نﺎﻳﺎﭘ
EDSS ﺖﻓﺮﮔ راﺮﻗ ﻪﺴﻳﺎﻘﻣ درﻮﻣ ﻪﻴﻟوا)لوﺪﺟ1 .(
لوﺪﺟ1: ﻪﺴﻳﺎﻘﻣEDSS ﺎﺑ ﻪﻴﻟواEDSS هﺎﻣ هوﺮﮔ ود رد مرﺎﻬ ﺎﺗ لوا يﺎﻫ
درﻮﻣ و ﺪﻫﺎﺷ
p
ﺪﻫﺎﺷ
p
درﻮﻣ
ه
وﺮﮔ
EDSS
- 652/2 - 696/2
EDSS ﻪﻴﻟوا
479/0 717/2 05/0> 696/2
هﺎﻣ نﺎﻳﺎﭘلوا
05/0> 652/2 328/0 674/2
هﺎﻣ نﺎﻳﺎﭘ مود
503/0 587/2 162/0 609/2
هﺎﻣ نﺎﻳﺎﭘ مﻮﺳ
803/0 630/2 004/0 500/2
هﺎﻣ نﺎﻳﺎﭘمرﺎﻬﭼ
درﻮﻣ هوﺮﮔ رد، فﻼﺘﺧا ﻦﻴﮕﻧﺎﻴﻣ EDSSﻦﻴﮕﻧﺎﻴﻣ ﺎﺑ ﻪﻴﻟوا EDSS رد نﺎﻳﺎﭘ
هﺎﻣﻲﻨﻌﻣ دﻮﺑ مﻮﺳ و مود و لوا يﺎﻫ راد دﻮﺒﻧ)05/0
p=( . ﻦﻴﮕﻧﺎﻴﻣ ﺎﻣاEDSS د ر
ﻦﻴﮕﻧﺎـﻴﻣ ﺎـﺑ مرﺎﻬﭼ هﺎﻣ نﺎﻳﺎﭘ
EDSS ﻲـﻨﻌﻣ توﺎـﻔﺗ يرﺎـﻣآ ﺮـﻈﻧ زا ﻪـﻴﻟوا يراد
ﺖﺷاد )004/0
p= ( ﻲﻨﻌﻳ EDSS ﻪﺑ ﺖﺒﺴﻧ مرﺎﻬﭼ هﺎﻣ نﺎﻳﺎﭘ ردEDSS ﻪﺑ ﻪﻴﻟوا
دﺮﻛ اﺪﻴﭘ ﺶﻫﺎﻛ ﻲﻟﻮﺒﻗ ﻞﺑﺎﻗ راﺪﻘﻣ . ﺪﻫﺎـﺷ هوﺮـﮔ رد ﻪـﺴﻳﺎﻘﻣ ﻦﻴﮕﻧﺎـﻴﻣ
EDSS
ﻦﻴﮕﻧﺎﻴﻣ ﺎﺑ ﻪﻴﻟوا
EDSS رد هﺎﻣ نﺎﻳﺎﭘ ﻲـﻨﻌﻣ مرﺎـﻬﭼ و مﻮﺳ و مود و لوا يﺎﻫراد
دﻮﺒﻧ . ﻪﻌﻟﺎﻄﻣ لﻮﻃ رد داﺪﻌﺗ ﺪﻧﺪﺷ ﻪﻠﻤﺣرﺎﭼد ﻪﻛ ﻲﻧارﺎﻤﻴﺑ ﺪﻫﺎﺷ هوﺮﮔ رد ﻚـﻳ
ﺮﻔﻧ ) ﻪـﺑ ﻲـﻤﻫ ترﻮـﺻ ﺲﻟﺎـﭘ ﺖـﻓﺎﻳرد و يﺮﺘـﺴﺑ ﻪـﺑ ﺮـﺠﻨﻣ ﻪـﻛ ﺪﻳﺪـﺷ يزرﺎـﭘ
ﺪﺷ نﻮﻟوﺰﻴﻧدﺮﭘ ( ،درﻮﻣ هوﺮﮔ رد و ود ﺮـﻔﻧ) ﻚـﻳ ﻪـﺑ ﺮـﻔﻧ ﻲـﻤﻫ ترﻮـﺻ
يزرﺎـﭘ
ﻪﺑ ﺮﻔﻧ ﻚﻳ و ﻒﻴﻔﺧﻲﺑ ترﻮﺻﺪﻧﺪﺸﻧ يﺮﺘﺴﺑ نارﺎﻤﻴﺑ ﻪﻛ ﻲﺴﺣ (دﻮﺑ . فﻼﺘـﺧا
ﻲﻨﻌﻣ هوﺮﮔ ود رد هﺎﻣ رﺎﻬﭼ لﻮﻃ رد تﻼﻤﺣ داﺪﻌﺗ ناﺰﻴﻣدﻮﺒﻧ راد )599/0
p=.(
مﺎﻤﺗﺪﻧداد مﺎﺠﻧا ﻞﻣﺎﻛ ار ﺮﻈﻧ درﻮﻣ نﺎﻣرد هوﺮﮔ ود ﺮﻫ رد نارﺎﻤﻴﺑ . ضراﻮﻋ
رد هﺪﺷ هﺪﻫﺎﺸﻣود نارﺎﻤﻴﺑ ﻪﻛ هدﻮﺑ ﺲﻜﻧوآ ﻪﺑ طﻮﺑﺮﻣ ضراﻮﻋ ﻞﻣﺎﺷ هوﺮﮔ
ﺪﻨﺘﻓﺎﻳ دﻮﺒﻬﺑ ﻲﺘﻣﻼﻋ نﺎﻣرد نوﺪﺑ .ﻲﺴﻛاد ﻪﺑ طﻮﺑﺮﻣ ﻲﻳوراد ضراﻮﻋ ﺎﺑ ﻦﻴﻠﻜﻴﺳ
ﺮﺼﻣ و ﺐﺷ و زور ياﺪﺘﺑا رد وراد فﺮﺼﻣ ،ناواﺮﻓ بآ
فﺮﺼﻣ ﻪﺑ ﻪﻴﺻﻮﺗ ف
اﺮﻤﻫ ﻪﺑ نآه ﺪﺷ فﺮﻃﺮﺑ اﺬﻏ .ﺪﻧدﺮﻛ ﻞﻤﺤﺗ ار نﺎﻣرد نارﺎﻤﻴﺑ ﻪﻤﻫ. فﻼﺘﺧا
ﻦﻴﮕﻧﺎﻴﻣ
EDSS ﻪﻴﻟوا )871/0=p( و EDSS هﺎﻣ نﺎﻳﺎﭘ لوا يﺎﻫ )936/0=p( ،
مود )937/0=
p(مﻮﺳ ، )941/0=p( مرﺎﻬﭼ و )651/0=p( هوﺮﮔ ود ﻦﻴﺑ
ﻲﻨﻌﻣدﻮﺒﻧ راد .
ﺚﺤﺑ
رد رد ﺖﺤﺗ نارﺎﻤﻴﺑ رد ﻪﻌﻟﺎﻄﻣ ﻦﻳا ﻲـﺴﻛاد و ﺲﻜﻧوآ ﻲﺒﻴﻛﺮﺗ نﺎﻣ ﻦﻴﻠﻜﻴـﺳ
ﻦﻴﮕﻧﺎﻴﻣ ،مرﺎﻬﭼ هﺎﻣ نﺎﻳﺎﭘ رد
EDSS ﺶﻫﺎﻛ ﻲﻨﻌﻣﺖﻓﺎﻳ يراد . نارﺎـﻤﻴﺑ ﻦﻳا رد
ﻪﺑ ﺐﻴﻛﺮﺗ ﻦﻳا ﺪـﺸﻧ هﺪﻫﺎـﺸﻣ ﻚﻳژﺮﻨﻴﺳ ضراﻮﻋ و ﺪﺷ ﻞﻤﺤﺗ ﻲﺑﻮﺧ . هوﺮـﮔ رد
ﻦـﻳا ﻲـﻟو دﻮـﺑ ﺪﻫﺎـﺷ هوﺮـﮔ زا ﺮﺘـﺸﻴﺑ ﻪـﻌﻟﺎﻄﻣ تﺪﻣ ﻲﻃ تﻼﻤﺣ داﺪﻌﺗ ،درﻮﻣ
ﻲﻨﻌﻣ توﺎﻔﺗرد تﻼﻤﺣ و دﻮﺒﻧ راد ﻒﻴﻔﺧ درﻮﻣ هوﺮﮔ يﺮﺘﺴﺑ ﻪﺑ ﺮﺠﻨﻣ و دﻮﺑ ﺮﺗ
ﻲﻤﻫ ﻪﻠﻤﺣ ﺪﻫﺎﺷ
هوﺮﮔ رد ﻲﻟو ﺪﺸﻧ ﺖـﻓﺎﻳرد و رﺎـﻤﻴﺑ يﺮﺘـﺴﺑ ﻪـﺑ ﺮـﺠﻨﻣ يزرﺎﭘ
ﻪﺑ يﺪﻳرو نﻮﻟوﺰﻴﻧدﺮﭘ تﺪﻣ5 توﺎـﻔﺗ ﻦـﻳا ﻞﻴﻟد ﺪﻳﺎﺷ ﻪﻛ ﺪﺷ زور ﺖـﻓﺎﻳرد ﺎـﻫ
ﻲﺴﻛادﺪﺷﺎﺑ ﻦﻴﻠﻜﻴﺳ. نارﺎـﻤﻴﺑ رد ﻲـﺒﻴﻛﺮﺗ نﺎـﻣرد ﻪـﺑ ﻲـﻧوﺰﻓا زور ﻪـﻗﻼﻋ
MS
رﺎﻤﻴﺑ ﺮﻴﺳ ﺖﻴﺒﺜﺗ ياﺮﺑ هﺪﻧوﺮـﺸﻴﭘ ﺮﻴـﺳ ﻦﺘـﺴﻜﺷ و تﻼـﻤﺣ داﺪـﻌﺗ ﺶﻫﺎـﻛ و ي
ﺲﻳزوﺮﻠﻜﺳا ﻞﭙﻴﺘﻟﻮﻣ و ﻦﻴﻠﻜﻴﺳ ﻲﺴﻛاد و هداز ﻦﻳﺪﻟا فﺮﺷ ﺮﺻﺎﻧ نارﺎﻜﻤﻫ
67
ﻪﻨﻴﻣز يژﻮﻟﻮﺗﺎﭘدراد دﻮﺟو يرﺎﻤﻴﺑ يا . ندﺮـﻛ كﻮـﻠﺑ ﻪﻴـﻀﻗ ﻦـﻳا ﻲـﻤﻠﻋ ﺖﻠﻋ
ﻢﺴﻴﻧﺎﻜﻣ و ﻒﻠﺘﺨﻣ ﻞﻣاﻮﻋ ﺎﺑ يرﺎﻤﻴﺑ ﻒﻠﺘﺨﻣ يﺎﻫﺮﻴﺴﻣ ﻪﺠﻴﺘﻧ رد و توﺎﻔﺘﻣ يﺎﻫ
ﺖـﺳا ﻲﻌﻤﺠﺗ ﻲﻧﺎﻣرد تاﺮﺛا . ﻲـﺴﻛاد و ﺲـﻜﻧوآ ﻲـﺒﻴﻛﺮﺗ نﺎـﻣرد رد ﻦﻴﻠﻜﻴـﺳ
MSﻪﺑ ﻪﻛ ﻲﻧارﺎﻤﻴﺑ رد ، ﻲـﻤﻧ ﺦـﺳﺎﭘﺎﻬﻨﺗ يرﻮﺗﻻوﺪـﻣﻮﻧﻮﻤﻳا نﺎﻣرد ﻚﻳ ،ﺪـﻨﻫد
ﺪﺷﺎﺑ ﺪﻴﻔﻣ ﺖﺳا ﻦﻜﻤﻣ . ﻪﻌﻟﺎﻄﻣ ﻖﺒﻃ
Silvester رد لﺎﺳ2005 ﻲـﺒﻴﻛﺮﺗ نﺎـﻣرد
ﻲﺴﻛاد و ﺲﻜﻧوآزا ﺲﭘ ﻦﻴﻠﻜﻴﺳ4 يﺰﻐﻣ تﺎﻌﻳﺎﺿ ﻂﺳﻮﺘﻣ داﺪﻌﺗ ﺶﻫﺎﻛ ﺎﺑ هﺎﻣ
ﮓﻧر رد ﺐﺟﺎﺣ هدﺎﻣ ﺎﺑ هﺪﺷ يﺮﻴﮔ
MRI دﻮﺑ هاﺮﻤﻫ.
13
ـﻴﻧ ﺮﮔﺎـﻨﻴﻣ ﻪـﻌﻟﺎﻄﻣ رد
قﻮﻓ ﻲﺒﻴﻛﺮﺗ نﺎﻣرد تﺎﻌﻳﺎـﺿ داﺪـﻌﺗ ﺶﻫﺎـﻛ ﺚﻋﺎﺑ ﺮﻛﺬﻟا
enhance و هﺪﻧﻮـﺷ
ﺶﻫﺎﻛ
EDSSﻞﻤﺤﺗ و ﺪﺷ نارﺎﻤﻴﺑدﻮﺑ بﻮﺧ ﺰﻴﻧ نارﺎﻤﻴﺑ يﺮﻳﺬﭘ.
12
تﺎـﻌﻟﺎﻄﻣ
ﻲـﻣ نﺎﺸﻧ ﻪﻛ دراد دﻮﺟو ﻲﻔﻠﺘﺨﻣ ﻢـﻬﻣ رﻮﺘﻛﺎـﻓ ﻚـﻳ ﻪـﻴﻧﻮﻣﻮﻨﭘ ﺎﻳﺪـﻴﻣﻼﻛ ﺪـﻫد
ﺖﻧﺎﻳراو زا يداﺪﻌﺗ يﺎﻫ
MS ﺖﺳا .Yao ﻲﺘﻧآ دﻮﺟو ﺶﻧارﺎﻜﻤﻫ و يدﺎـﺑ يﺎـﻫ
رد ﻪﻴﻧﻮﻣﻮﻨﭘ ﺎﻳﺪﻴﻣﻼﻛ ﺪﺿ
CSF نارﺎﻤﻴﺑMS ﺪﻧﺪـﺷ ﺮﻛﺬﺘﻣ ار.
7
ﻪـﻌﻟﺎﻄﻣCid و
ﺶﻧارﺎـﻜﻤﻫ داد نﺎـﺸﻧ ﻲـﺘﻧآ يدﺎـﺑ ﺶﻨـﻛاو يﺎـﻫ ﺎـﺑ هﺪـﻨﻫد90
Heat shock
protein
گﺮـﻣ ﻪﺑ ﺮﺠﻨﻣ ﺶﻴـﭘ دﻮﮕﻴﻟوا يﺎﻫزﺎـﺳ ﺖـﺸﻛ ﻂﻴـﺤﻣ رد ﺖﻴـﺳورﺪ
ﻲـﻣ دﻮــﺷ و رد ﻪــﻴﻧﻮﻣﻮﻨﭘ ﺎﻳﺪــﻴﻣﻼﻛ ﻦﻴﺌﺗوﺮـﭘ ﺰﺘﻨــﺳ
CNS ﻦــﻳا گﺮــﻣ ﻪــﺑ ﺮـﺠﻨﻣ
ﺶﻴﭘ ﺎﻫزﺎﺳ ﻲـﻣ ددﺮـﮔ.
9
Dong-Si ﺶﻧارﺎـﻜﻤﻫ و لﺎـﺳ رد2004 ﺪـﻧداد نﺎـﺸﻧ
ﻪﻤﺟﺮﺗ و ﻪﻴﻧﻮﻣﻮﻨﭘ ﺎﻳﺪﻴﻣﻼﻛ عﻮﻴﺷ نآ ﻲﻧژ ي رد
CSF نارﺎﻤﻴﺑ ﻪﺑ ﻼﺘﺒﻣ MS عﻮﻧ
هﺪﻨﻨﻛدﻮﻋ-ﻲﻣ ﺶﻳاﺰﻓا هﺪﻨﺑﺎﻳدﻮﺒﻬﺑ ﺪﺑﺎﻳ.
11
Munger و ﺪـﻧدﺮﻛ نﺎﻴﺑ ﺶﻧارﺎﻜﻤﻫ
ﻞﻳﺪﺒﺗ
MS ﻪﺑ عﻮﻧ هﺪﻧوﺮﺸﻴﭘﺚﻋﺎﺑ ﻲﺘﻧآ ﺢﻄﺳ ﺪﻳﺪﺷ ﺶﻳاﺰﻓا يدﺎـﺑ ﻲـﺻﺎﺼﺘﺧا
نارﺎﻤﻴﺑ مﺮﺳ رد ﻪﻴﻧﻮﻣﻮﻨﭘ ﺎﻳﺪﻴﻣﻼﻛ ﺪﺿﻲﻣددﺮﮔ.
14
ﻪﻌﻟﺎﻄﻣ
Sriram رد ﻪﻴﻧﻮﻣﻮﻨﭘ ﺎﻳﺪﻴﻣﻼﻛ دﻮﺟوCNS نارﺎﻤﻴﺑ ﻪـﺑ ﻼﺘﺒﻣMS ار
ﻮﺘﺴﻴﻫﻮﻧﻮﻤﻳا ﻪﻘﻳﺮﻃ ﻪﺑ تﺎـﺒﺛا لاﺮﭽﻛاﺮﺘـﺳا اﺮﺘﻟوا و رﻻﻮﻜﻟﻮﻣ ،لﺎﻜﻴﻤ دﺮـﻛ.
15
ﻪﻌﻟﺎﻄﻣ
Buljevac ﺶﻧارﺎﻜﻤﻫ وداد نﺎﺸﻧ دﻮـﻋ ﻲـﻜﻴﻨﻴﻠﻛ يﺎﻫدوﺰﻴﭘا ردMS،
ﺖﻧﻮﻔﻋ ﻲﻣ هﺪﻳد نارﺎﻤﻴﺑ مﺮﺳ رد ﻪﻴﻧﻮﻣﻮﻨﭘ ﺎﻳﺪﻴﻣﻼﻛ ﺎﺑ ﻲﺴﻔﻨﺗ ﺪﻳﺪﺟ يﺎﻫ دﻮﺷ.
16
ﻲﺴﻛاد ﺐﻴﻛﺮﺗﻲﻣ ﺲﻜﻧوآ هاﺮﻤﻫ ﻪﺑ ﻦﻴﻠﻜﻴﺳ ﺶﻫﺎـﻛ رد يدوﺪـﺣ ﺎـﺗ ﺪﻧاﻮﺗ
EDSS ﻪﻌﻟﺎﻄﻣ ﺎﺑ ﺖﺳا ﻦﻳا ﺎﻣ دﺎﻬﻨﺸﻴﭘ اﺬﻟ ﺪﺷﺎﺑ ﺮﺛﻮﻣ نارﺎﻤﻴﺑ داﺪـﻌﺗو ﺮﺘﮔرﺰﺑ يا
و ﺮﺘﺸﻴﺑ نارﺎﻤﻴﺑ ﻲـﺳرﺮﺑ و نارﺎـﻤﻴﺑ نﺎﻣرد هرود لﻮﻃ ﺮﻴﻴﻐﺗ ﺮﻴﻈﻧ ﻲﺗاﺮﻴﻴﻐﺗ ناﺰـﻴﻣ
ﻞﻤﺤﺗﺮﻈﻧ درﻮﻣ ﻲﺒﻴﻛﺮﺗ يوراد يﺮﻳﺬﭘ، ﻲﻌﻄﻗ ﺞﻳﺎﺘﻧ ﻪﻨﻴﻣز ﻦﻳا رد يﺮﺗﻪﺑ ﺖـﺳد
دروآ.
يراﺰﮕﺳﺎﭙﺳ
نﺎﻳﺎﭘ زا ﻪﺘﻓﺮﮔﺮﺑ ﻪﻟﺎﻘﻣ ﻦﻳا ﻪﺘﺷر رد ﻲﺼﺼﺨﺗ ياﺮﺘﻛد
ﺬﺧا ﺖﻬﺟ ﻪﻣﺎﻧ ﻲﻠﺧاد
ا و ﺰﻐﻣ ﺖـﺒﺛ هرﺎﻤـﺷ ﺎـﺑ بﺎﺼ38 ﻲـﺸﻫوﮋﭘ ﺖـﻧوﺎﻌﻣ بﻮـﺼﻣ مﻮـﻠﻋ هﺎﮕـﺸﻧاد
زاﻮﻫا رﻮﭘﺎﺷ يﺪﻨﺟ ﻲﻜﺷﺰﭘ ﺦﻳرﺎـﺗ رد ﻪـﻛ ﺖـﺳا20/12/86 ﻪـﺑ نﺎـﻳﺎﭘ هﺪﻴـﺳر
ﺖﺳا.
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هرود ،ناﺪﻫاز ﻲﻜﺷﺰﭘ مﻮﻠﻋ تﺎﻘﻴﻘﺤﺗ ﻪﻠﺠﻣ12 ، هرﺎﻤﺷ 5
68
Combination therapy of Avonex and doxycycline in patients with multiple
sclerosis
Naser Sharafaddinzadeh,
1
Nastaran Majdinasab,
1
Majid Keyhanifard,
1
Armaghan Moravej Aleali
2
Background: Multiple sclerosis is an inflammatory, chronic demyelinating disease of the central nervous system
(CNS) with unknown etiology. Multiple sclerosis causes disability in young people. An Immunomodulatory drug like
Avonex (IFN β1a) is used to prevent relapses or disease progression. The aim of this study is to evaluate efficacy of
combination therapy (Avonex and doxycycline) with standard therapy (Avonex) in remitting-relapsing multiple
sclerosis (RRMS).
Materials and Method: A double blind clinical trial was conducted. During four-month study period, 46 patients with
RRMS, under standard medication (Avonex), were entered into the study. Their EDSS score were between 1-5. They
randomly allocated in to two study groups with 23cases in each arm (cases and controls). All cases were allocated to
each group based on blocking method. They received Avonex only in control group and Avonex and doxycycline in
case group. EDSS was measured in both groups in the beginning and at the end of study. First EDSS and EDSS scores
at the end of first, second, third and fourth months in both groups were compared. Number and rate of clinical attacks
and side effects of treatment were assessed in both groups.
Results: In case group, there was significant changes between the first EDSS and final EDSS score, but there was not
any statistically significant finding in control group after 4 months. There was no significant difference between case
and control group in EDSS scores during four-month study period and there was not significant difference between case
and control groups in clinical attacks. Combination therapy was well tolerated without additive side effects.
Conclusion: It seems that combination of both Avonex and doxycycline in RRMS patients were effective, safe, and
well tolerated. [ZJRMS, 12(5): 65-68]
Keywords: Multiple sclerosis, avonex, doxycycline
1. Assistant Professor of Neurology, Ahwaz Jundishapur University of Medical Sciences and Health Services, Ahwaz, Iran.
2. General Physician, Clinical Research Center, Ahwaz Jundishapur University of Medical Sciences and Health Services, Ahwaz, Iran.
Received: 9/Mar/2010
Accepted: 7/Jun/2010
... Only one patient presented a relapse and insignificant side effects have been noted, additionally, they reported enhancement in IFN-β-1a activity, as well as the reduction in lesions, showed by contrast-enhanced MRI [125]. The combination of Dox and IFN-β-1a blocked inflammation in MS patients by interfering with multiple inflammatory pathways [126]. ...
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