IBD: 炎症性肠病对维多珠单抗失应答的预测因素

2018-10-21 MedSci MedSci原创

临床工作中有部分患者对维多珠单抗(VDZ)的会出现失应答(LOR),本项研究就这一现象进行了评估,并试图寻找影响对维多珠单抗应答的危险因素。

背景
临床工作中有部分患者对维多珠单抗(VDZ)的会出现失应答(LOR),本项研究就这一现象进行了评估,并试图寻找影响对维多珠单抗应答的危险因素。

方法
研究人员回顾性研究了2014年5月至2016年12月间接受维多珠单抗治疗的炎症性肠病(IBD)患者的临床资料。Kaplan-Meier用于确定LOR与VDZ的比率。使用单变量和多变量Cox比例风险回归确定LOR的独立预测因子。

结果
使用VDZ后出现失应答的累积发生率在6个月时为20%,在12个月时为35%,克罗恩病的发病率略低于溃疡性结肠炎(6个月15%vs 18%和12个月30%vs 39%,P= 0.03) 。在多变量分析中,VDZ使用前对肿瘤坏死因子(TNF)拮抗剂的LOR与LOR至VDZ的风险增加相关[(HR)1.93;95%(CI)1.25-2.97]。对于克罗恩病患者,较高的基线C反应蛋白浓度与LOR至VDZ的风险增加相关(HR 1.01 / mg / dL,95%(CI) 1.01-1.02)。VDZ输注间隔从8周缩短至每4周或6周可以是失应答的患者恢复49%,18%患者获得缓解。

结论
在VDZ使用前对TNF拮抗剂失应答和较高的基线C-反应蛋白浓度是VDZ 失应答的重要预测因子。将VDZ输注间隔缩短,可以使几乎一半的患者可以重新获得治疗反应。

原始出处:

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    2018-10-23 bnurmamat
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    2018-10-22 深海的鱼

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