AP&T: 在开始抗TNFα治疗期间早期发现抗药物抗体水平升高预示着治疗效果不佳

2021-05-11 MedSci原创 MedSci原创

抗肿瘤坏死因子(TNF-α)的药物如阿达木单抗(ADA)和英夫利西单抗(IFX)的药物谷浓度水平与治疗应答之间存在着相关关系。

      抗肿瘤坏死因子(TNF-α)的药物如阿达木单抗(ADA)和英夫利西单抗(IFX)的药物谷浓度水平与治疗应答之间存在着相关关系,谷浓度较低会导致原发性无应答(PNR)和继发性失应答(LOR)的出现。如何早期判断这样的现象的发生是药物治疗中一项很关键的问题。有研究显示在在抗TNF治疗的诱导阶段,抗药物抗体的出现要比药物浓度水平变化更早,因此,本项研究旨在探究在诱导治疗期间早期发现抗药物抗体是否可预测抗肿瘤坏死因子治疗的终止。

 

      在这项前瞻性研究中,研究人员招募了开始接受抗TNF治疗的炎症性肠病(IBD)患者,并在24个月内定期随访,以防无反应或丧失反应(LOR)或需要治疗的不良事件的发生。使用药物耐受测定法在第2周对阿达木单抗(ADA)以及在第2周和第6周对英夫利昔单抗(IFX)测量抗TNF水平和抗药物抗体,然后对抗药物抗体浓度和治疗反应之间进行相关性研究。

 

      总共有108名患者患者入选(接受ADA治疗的有54名)。在第2周时,在76%和67%的患者中检测到了针对ADA和IFX的抗体。与没有阳性抗体的患者相比, ADA抗药抗体≥2.0µg / mL的患者,停药时间显着缩短(P <0.001),在第2周时为4.0 µg / mL的患者中停药的几率更大(HR = 13.89,95%CI [4.08-47.31])。ADA和IFX抗体可预测24个月内治疗失败概率,敏感性为79%和62%,特异性和阳性预测值为100%。在多变量分析中,第2周时针对ADA或IFX的抗体是与治疗中止相关的唯一因素。

图:抗药抗体与疾病应答的关系

      本项研究证实使用药物耐受性检测抗肿瘤坏死因子的抗药抗体能及早发现抗TNF抗体的患病率很高,并且它们的出现预示着将药物停止治疗的几率大大增加。

 

 

原始出处:

Quentin Tournier. Et al. Early detection of anti‐drug antibodies during initiation of anti‐tumour necrosis factor therapy predicts treatment discontinuation in inflammatory bowel disease. Aliment Pharmacol Ther. 2021.

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    2021-06-13 mfx808
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  5. [GetPortalCommentsPageByObjectIdResponse(id=1670804, encodeId=33d816e0804eb, content=<a href='/topic/show?id=abd35513ed5' target=_blank style='color:#2F92EE;'>#抗TNF#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55137, encryptionId=abd35513ed5, topicName=抗TNF)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7dc326754916, createdName=mfx808, createdTime=Sun Jun 13 12:52:05 CST 2021, time=2021-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1894218, encodeId=205e1894218f0, content=<a href='/topic/show?id=5e456463eee' target=_blank style='color:#2F92EE;'>#治疗效果#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64637, encryptionId=5e456463eee, topicName=治疗效果)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=373a131, createdName=jxrzshh, createdTime=Sat Mar 19 03:52:05 CST 2022, time=2022-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995765, encodeId=77031995e6576, content=<a href='/topic/show?id=ba231e5989a' target=_blank style='color:#2F92EE;'>#TNFα#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17598, encryptionId=ba231e5989a, topicName=TNFα)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=柳叶一刀, createdTime=Wed Jul 28 19:52:05 CST 2021, time=2021-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1331316, encodeId=411913313161c, content=<a href='/topic/show?id=35e7593559a' target=_blank style='color:#2F92EE;'>#早期发现#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59355, encryptionId=35e7593559a, topicName=早期发现)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9cb02500048, createdName=ms6832696159214430, createdTime=Thu May 13 12:52:05 CST 2021, time=2021-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1401794, encodeId=75b51401e9415, content=<a href='/topic/show?id=17e21e57943' target=_blank style='color:#2F92EE;'>#TNF#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17579, encryptionId=17e21e57943, topicName=TNF)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqjVbfRD4f4vibEcZVcvato8Qib1gGtZJiayXCMFgHrkeErSiaxdYMiabKGxY2an9muxWCkUJbjFPViaC6A/132, createdBy=e4fb2361580, createdName=snowpeakxu, createdTime=Thu May 13 12:52:05 CST 2021, time=2021-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032911, encodeId=eea51032911a8, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Wed May 12 00:52:05 CST 2021, time=2021-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047346, encodeId=ef2f104e34672, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Wed May 12 00:52:05 CST 2021, time=2021-05-12, status=1, ipAttribution=)]
    2021-05-13 snowpeakxu
  6. [GetPortalCommentsPageByObjectIdResponse(id=1670804, encodeId=33d816e0804eb, content=<a href='/topic/show?id=abd35513ed5' target=_blank style='color:#2F92EE;'>#抗TNF#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=55137, encryptionId=abd35513ed5, topicName=抗TNF)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7dc326754916, createdName=mfx808, createdTime=Sun Jun 13 12:52:05 CST 2021, time=2021-06-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1894218, encodeId=205e1894218f0, content=<a href='/topic/show?id=5e456463eee' target=_blank style='color:#2F92EE;'>#治疗效果#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64637, encryptionId=5e456463eee, topicName=治疗效果)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=373a131, createdName=jxrzshh, createdTime=Sat Mar 19 03:52:05 CST 2022, time=2022-03-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995765, encodeId=77031995e6576, content=<a href='/topic/show?id=ba231e5989a' target=_blank style='color:#2F92EE;'>#TNFα#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17598, encryptionId=ba231e5989a, topicName=TNFα)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=778d36, createdName=柳叶一刀, createdTime=Wed Jul 28 19:52:05 CST 2021, time=2021-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1331316, encodeId=411913313161c, content=<a href='/topic/show?id=35e7593559a' target=_blank style='color:#2F92EE;'>#早期发现#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59355, encryptionId=35e7593559a, topicName=早期发现)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9cb02500048, createdName=ms6832696159214430, createdTime=Thu May 13 12:52:05 CST 2021, time=2021-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1401794, encodeId=75b51401e9415, content=<a href='/topic/show?id=17e21e57943' target=_blank style='color:#2F92EE;'>#TNF#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17579, encryptionId=17e21e57943, topicName=TNF)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqjVbfRD4f4vibEcZVcvato8Qib1gGtZJiayXCMFgHrkeErSiaxdYMiabKGxY2an9muxWCkUJbjFPViaC6A/132, createdBy=e4fb2361580, createdName=snowpeakxu, createdTime=Thu May 13 12:52:05 CST 2021, time=2021-05-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032911, encodeId=eea51032911a8, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Wed May 12 00:52:05 CST 2021, time=2021-05-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047346, encodeId=ef2f104e34672, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Wed May 12 00:52:05 CST 2021, time=2021-05-12, status=1, ipAttribution=)]
    2021-05-12 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

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    2021-05-12 CHANGE

    疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的

    0

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