IBD: 体重指数不影响乌司他单抗在克罗恩病中的临床疗效

2021-05-21 MedSci原创 MedSci原创

克罗恩病(CD)是一种慢性发炎性胃肠道(GI)疾病,发病率逐年提高,生物制剂如乌司他单抗的使用大大减少了CD的长期并发症如狭窄,瘘管和手术切除的风险。

      克罗恩病(CD)是一种慢性发炎性胃肠道(GI)疾病,发病率逐年提高,生物制剂如乌司他单抗的使用大大减少了CD的长期并发症如狭窄,瘘管和手术切除的风险。这些药物的使用剂量都是根据患者的体重来计算的,但是肥胖症在全世界越来越普遍,在美国,超过35%的成年人有肥胖,研究表明,肥胖与患者治疗失败率较高相关。因此,体重是不是会影响药物的疗效目前还不清楚,本项研究对体重指数(BMI)对于药物治疗进行了相关研究。

 

      对于乌斯他单抗的体重指数(BMI)与功效之间的关系的研究数据是使用来自于接受44周维持治疗的IBD患者的数据库。研究的主要终点是临床缓解(CR)率,临床缓解的定义为克罗恩病活动指数<150。根据研究入选时的BMI将患者分为以下亚组:体重<18.5 kg/m2,正常18.5至25 kg/m2,超重25至<30 kg/m2,肥胖≥30kg/m2。该χ 2进行了线性趋势测试以比较3个队列之间的频率。多变量回归分析评估了BMI与CR和无皮质类固醇CR疗效结果之间的可能联系,并对单变量分析中发现的重要变量进行了调整。

 

      该分析总共包括254例接受乌斯他单抗治疗的患者。第44周时,BMI体重不足患者(28名患者中的19名),正常的患者(117名中的60名),超重的患者(71名中的32名)的CR率没有差异,调整协变量后,多变量逻辑分析未发现BMI是CR的重要预测指标。与超重或肥胖的患者相比,肥胖患者在第44周的乌斯他单抗药物水平显着降低(2.98 mcg / mL)。体重不足或正常BMI的患者的药物浓度则正常(4.43 mcg / mL ;IQR,2.82; P = 0.014)。

图:体重对于临床缓解的影响

       本项研究证实尽管BMI影响乌斯他单抗的药物水平,但BMI对临床疗效没有影响。

 

 

原始出处:

Emily C L Wong. Et al. Body Mass Index Does Not Impact Clinical Efficacy of Ustekinumab in Crohn’s Disease: A Post Hoc Analysis of the IM-UNITI Trial. Inflammatory Bowel Diseases.2021.

 

 

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    2021-05-23 bnurmamat
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    2021-05-21 内科新手

    谢谢梅斯提供这么好的信息,学到很多

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    2021-05-21 易水河

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    0

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