Am J Hematol;骨髓衰竭患者长期使用艾曲波帕治疗会导致铁耗竭

2022-03-30 将军的九分裤 MedSci原创

艾曲波帕 (EPAG) 已被批准用于治疗再生障碍性贫血和免疫性血小板减少症,部分患者需要长期治疗。由于多价阳离子螯合,长期治疗会导致一直以来被低估的铁耗竭。

艾曲波帕 (EPAG) 已被批准用于治疗再生障碍性贫血和免疫性血小板减少症,部分患者需要长期治疗。由于多价阳离子螯合,长期治疗会导致一直以来被低估的铁耗竭。

一研究团队对在 NIH 治疗再生障碍性贫血、骨髓增生异常综合征和单系血细胞减少症的患者进行了回顾性研究,将接受 EPAG 治疗的患者与接受免疫抑制治疗但没有 EPAG 的历史队列进行了比较。

图1:在长期使用艾曲波帕时,铁的消耗可以模拟复发  

他们检查了铁参数、治疗持续时间、反应评估、复发率和常见的人口统计学参数。研究团队在 11 项研究中纳入了 521 名接受(n = 315)或不接受 EPAG(n = 206)治疗的受试者,并进行了多年随访(分别为 3.6 年和 8.5 年)。

图2:艾曲波帕调动了不稳定的铁离子池

研究结果显示,EPAG 暴露持续时间与铁蛋白减少相关(p = 4 × 10-14),无论反应、最大剂量或初始铁过载程度如何。与历史反应者(47.5 个月,p = 8 × 10-10 )相比,清除遵循一级动力学,清除速度更快(半衰期 15.3 个月)。

图3:长期使用艾曲波帕治疗会导致铁缺乏

研究发现,铁耗竭的风险取决于基线铁蛋白和治疗持续时间。基线铁蛋白与骨髓衰竭对 EPAG 的反应或复发风险无关,铁清除时间与疾病反应无关。

总的来说,本研究认为EPAG 能够有效地螯合全身铁,与临床上可用的螯合剂效果相当。长期使用会消耗身体的铁含量并最终导致缺铁性贫血。

 

原始出处:

Young DJ, Fan X, Groarke EM, Patel B, Desmond R, Winkler T, Larochelle A, Calvo KR, Young NS, Dunbar CE. Long-term eltrombopag for bone marrow failure depletes iron. Am J Hematol. 2022 Mar 21. doi: 10.1002/ajh.26543. Epub ahead of print. PMID: 35312200.

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    2022-03-31 1071334_4669

    那可以治疗铁过载

    0

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    2022-03-31 fengyi812
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