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ARD：风湿病和肌肉骨骼疾病患者暂时停用霉酚酸酯增强SARS-CoV-2疫苗接种的体液反应

2021-09-28 MedSci原创 MedSci原创

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该病例系列分析在24名RMD患者中接种ARS-CoV-2疫苗前后停止霉酚酸酯的影响。

     霉酚酸酯是风湿病和肌肉骨骼疾病（RMD）许多器官和危及生命体征的主要治疗方法。与大多数RMD患者相比，服用霉酚酸酯的患者接种SARS-CoV-2 mRNA疫苗体液反应减弱。美国风湿病学院最近建议在在这个弱势群体中接种疫苗后停用霉酚酸酯1周以增强免疫原性。因此，该病例系列分析在24名RMD患者中接种ARS-CoV-2疫苗前后停止霉酚酸酯的影响。

      Logistic回归用于评估抗体反应和停止霉酚酸酯的关联性，调整logistic回归分析校正年龄、性别、种族、疫苗类型（mRNA VS腺病毒载体）、使用利妥昔单抗和糖皮质激素这些临床特征。Wilcoxon秩和检验用于比较停止霉酚酸酯和继续使用的患者之间抗受体结合区（anti-RBD）抗体滴度。

      接种疫苗中位数为32（28-35）天后，22/24停用霉酚酸酯的患者中可检测到抗体反应，与继续使用霉酚酸酯的患者（112/171）相比显著增高（92% vs 65%, p=0.01）。停用霉酚酸酯的患者阳性抗体反应可能性更高（OR 5.8, 95% CI 1.3 -25.5，p=0.02）。通过校正logistic回归分析后，停用霉酚酸酯与阳性抗体反应的关联仍然存在统计学差异（aOR 7.24, 95% CI 1.72-44.31, p=0.01）。由于不满足罕见病假设，OR值不能理解为抗体阳性反应的相对概率。停药组的anti-RBD Ig滴度显著高于未停药组（125 vs 7 U/L, p=0.004）。两位患者因为在疫苗接种前后疾病爆发而局部使用或口服了糖皮质激素。

结论：

     初步结果显示风湿病和肌肉骨骼疾病患者在接种SARS-CoV-2疫苗前后停用霉酚酸酯是安全的，可以增强抗体反应。 

出处：

Connolly CM, Chiang TP, Boyarsky BJ, Ruddy JA, Teles M, Alejo JL, Massie A, Werbel WA, Shah AA, Christopher-Stine L, Garonzik-Wang J, Segev DL, Paik JJ. Temporary hold of mycophenolate augments humoral response to SARS-CoV-2 vaccination in patients with rheumatic and musculoskeletal diseases: a case series. Ann Rheum Dis. 2021 Sep 23:annrheumdis-2021-221252. doi: 10.1136/annrheumdis-2021-221252. Epub ahead of print. PMID: 34556484.

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    2021-12-11 hukaixun

    #SARS-CoV#

    0

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    2021-12-01 hmwwww

    #疾病患者#

    0

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    2021-10-01 lishiwen

    #疫苗接种#

    0

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    2021-10-01 小刀医生

    #SARS#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1938039, encodeId=5d361938039d9, content=<a href='/topic/show?id=02de15902d3' target=_blank style='color:#2F92EE;'>#SARS-CoV#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15902, encryptionId=02de15902d3, topicName=SARS-CoV)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ab940, createdName=hukaixun, createdTime=Sat Dec 11 18:09:36 CST 2021, time=2021-12-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1799172, encodeId=13401e9917211, content=<a href='/topic/show?id=38e0e0670ff' target=_blank style='color:#2F92EE;'>#疾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70670, encryptionId=38e0e0670ff, topicName=疾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c859411, createdName=hmwwww, createdTime=Wed Dec 01 19:09:36 CST 2021, time=2021-12-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1258100, encodeId=ef6d125810076, content=<a href='/topic/show?id=f538e0501e9' target=_blank style='color:#2F92EE;'>#疫苗接种#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70501, encryptionId=f538e0501e9, topicName=疫苗接种)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5c0050, createdName=lishiwen, createdTime=Fri Oct 01 02:09:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1321307, encodeId=8891132130ec4, content=<a href='/topic/show?id=ac0d159007f' target=_blank style='color:#2F92EE;'>#SARS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15900, encryptionId=ac0d159007f, topicName=SARS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8306486, createdName=小刀医生, createdTime=Fri Oct 01 02:09:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1503535, encodeId=e7ed150353523, content=<a href='/topic/show?id=77079889e8e' target=_blank style='color:#2F92EE;'>#霉酚酸酯#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98897, encryptionId=77079889e8e, topicName=霉酚酸酯)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fd989654253, createdName=yuanming10, createdTime=Fri Oct 01 02:09:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1557199, encodeId=57f8155e1991d, content=<a href='/topic/show?id=25ad81034c0' target=_blank style='color:#2F92EE;'>#肌肉骨骼疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81034, encryptionId=25ad81034c0, topicName=肌肉骨骼疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2a9a14881396, createdName=longqijun253, createdTime=Fri Oct 01 02:09:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1596112, encodeId=e55c15961124e, content=<a href='/topic/show?id=2d5481030ea' target=_blank style='color:#2F92EE;'>#肌肉骨骼#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81030, encryptionId=2d5481030ea, topicName=肌肉骨骼)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b94118335590, createdName=huirong, createdTime=Fri Oct 01 02:09:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056065, encodeId=4a0210560652d, content=那不停用会有相反结果吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cfc84293490, createdName=13f0c37dm61暂无昵称, createdTime=Wed Sep 29 13:05:23 CST 2021, time=2021-09-29, status=1, ipAttribution=)]
    2021-10-01 yuanming10

    #霉酚酸酯#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1938039, encodeId=5d361938039d9, content=<a href='/topic/show?id=02de15902d3' target=_blank style='color:#2F92EE;'>#SARS-CoV#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15902, encryptionId=02de15902d3, topicName=SARS-CoV)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ab940, createdName=hukaixun, createdTime=Sat Dec 11 18:09:36 CST 2021, time=2021-12-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1799172, encodeId=13401e9917211, content=<a href='/topic/show?id=38e0e0670ff' target=_blank style='color:#2F92EE;'>#疾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70670, encryptionId=38e0e0670ff, topicName=疾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c859411, createdName=hmwwww, createdTime=Wed Dec 01 19:09:36 CST 2021, time=2021-12-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1258100, encodeId=ef6d125810076, content=<a href='/topic/show?id=f538e0501e9' target=_blank style='color:#2F92EE;'>#疫苗接种#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70501, encryptionId=f538e0501e9, topicName=疫苗接种)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5c0050, createdName=lishiwen, createdTime=Fri Oct 01 02:09:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1321307, encodeId=8891132130ec4, content=<a href='/topic/show?id=ac0d159007f' target=_blank style='color:#2F92EE;'>#SARS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15900, encryptionId=ac0d159007f, topicName=SARS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8306486, createdName=小刀医生, createdTime=Fri Oct 01 02:09:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1503535, encodeId=e7ed150353523, content=<a href='/topic/show?id=77079889e8e' target=_blank style='color:#2F92EE;'>#霉酚酸酯#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98897, encryptionId=77079889e8e, topicName=霉酚酸酯)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fd989654253, createdName=yuanming10, createdTime=Fri Oct 01 02:09:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1557199, encodeId=57f8155e1991d, content=<a href='/topic/show?id=25ad81034c0' target=_blank style='color:#2F92EE;'>#肌肉骨骼疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81034, encryptionId=25ad81034c0, topicName=肌肉骨骼疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2a9a14881396, createdName=longqijun253, createdTime=Fri Oct 01 02:09:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1596112, encodeId=e55c15961124e, content=<a href='/topic/show?id=2d5481030ea' target=_blank style='color:#2F92EE;'>#肌肉骨骼#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81030, encryptionId=2d5481030ea, topicName=肌肉骨骼)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b94118335590, createdName=huirong, createdTime=Fri Oct 01 02:09:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056065, encodeId=4a0210560652d, content=那不停用会有相反结果吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cfc84293490, createdName=13f0c37dm61暂无昵称, createdTime=Wed Sep 29 13:05:23 CST 2021, time=2021-09-29, status=1, ipAttribution=)]
    2021-10-01 longqijun253

    #肌肉骨骼疾病#

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1938039, encodeId=5d361938039d9, content=<a href='/topic/show?id=02de15902d3' target=_blank style='color:#2F92EE;'>#SARS-CoV#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15902, encryptionId=02de15902d3, topicName=SARS-CoV)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ab940, createdName=hukaixun, createdTime=Sat Dec 11 18:09:36 CST 2021, time=2021-12-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1799172, encodeId=13401e9917211, content=<a href='/topic/show?id=38e0e0670ff' target=_blank style='color:#2F92EE;'>#疾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70670, encryptionId=38e0e0670ff, topicName=疾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c859411, createdName=hmwwww, createdTime=Wed Dec 01 19:09:36 CST 2021, time=2021-12-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1258100, encodeId=ef6d125810076, content=<a href='/topic/show?id=f538e0501e9' target=_blank style='color:#2F92EE;'>#疫苗接种#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70501, encryptionId=f538e0501e9, topicName=疫苗接种)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5c0050, createdName=lishiwen, createdTime=Fri Oct 01 02:09:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1321307, encodeId=8891132130ec4, content=<a href='/topic/show?id=ac0d159007f' target=_blank style='color:#2F92EE;'>#SARS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15900, encryptionId=ac0d159007f, topicName=SARS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8306486, createdName=小刀医生, createdTime=Fri Oct 01 02:09:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1503535, encodeId=e7ed150353523, content=<a href='/topic/show?id=77079889e8e' target=_blank style='color:#2F92EE;'>#霉酚酸酯#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98897, encryptionId=77079889e8e, topicName=霉酚酸酯)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fd989654253, createdName=yuanming10, createdTime=Fri Oct 01 02:09:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1557199, encodeId=57f8155e1991d, content=<a href='/topic/show?id=25ad81034c0' target=_blank style='color:#2F92EE;'>#肌肉骨骼疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81034, encryptionId=25ad81034c0, topicName=肌肉骨骼疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2a9a14881396, createdName=longqijun253, createdTime=Fri Oct 01 02:09:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1596112, encodeId=e55c15961124e, content=<a href='/topic/show?id=2d5481030ea' target=_blank style='color:#2F92EE;'>#肌肉骨骼#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81030, encryptionId=2d5481030ea, topicName=肌肉骨骼)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b94118335590, createdName=huirong, createdTime=Fri Oct 01 02:09:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056065, encodeId=4a0210560652d, content=那不停用会有相反结果吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cfc84293490, createdName=13f0c37dm61暂无昵称, createdTime=Wed Sep 29 13:05:23 CST 2021, time=2021-09-29, status=1, ipAttribution=)]
    2021-10-01 huirong

    #肌肉骨骼#

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1938039, encodeId=5d361938039d9, content=<a href='/topic/show?id=02de15902d3' target=_blank style='color:#2F92EE;'>#SARS-CoV#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15902, encryptionId=02de15902d3, topicName=SARS-CoV)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6ab940, createdName=hukaixun, createdTime=Sat Dec 11 18:09:36 CST 2021, time=2021-12-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1799172, encodeId=13401e9917211, content=<a href='/topic/show?id=38e0e0670ff' target=_blank style='color:#2F92EE;'>#疾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70670, encryptionId=38e0e0670ff, topicName=疾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c859411, createdName=hmwwww, createdTime=Wed Dec 01 19:09:36 CST 2021, time=2021-12-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1258100, encodeId=ef6d125810076, content=<a href='/topic/show?id=f538e0501e9' target=_blank style='color:#2F92EE;'>#疫苗接种#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70501, encryptionId=f538e0501e9, topicName=疫苗接种)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5c0050, createdName=lishiwen, createdTime=Fri Oct 01 02:09:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1321307, encodeId=8891132130ec4, content=<a href='/topic/show?id=ac0d159007f' target=_blank style='color:#2F92EE;'>#SARS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=15900, encryptionId=ac0d159007f, topicName=SARS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8306486, createdName=小刀医生, createdTime=Fri Oct 01 02:09:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1503535, encodeId=e7ed150353523, content=<a href='/topic/show?id=77079889e8e' target=_blank style='color:#2F92EE;'>#霉酚酸酯#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98897, encryptionId=77079889e8e, topicName=霉酚酸酯)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fd989654253, createdName=yuanming10, createdTime=Fri Oct 01 02:09:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1557199, encodeId=57f8155e1991d, content=<a href='/topic/show?id=25ad81034c0' target=_blank style='color:#2F92EE;'>#肌肉骨骼疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81034, encryptionId=25ad81034c0, topicName=肌肉骨骼疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2a9a14881396, createdName=longqijun253, createdTime=Fri Oct 01 02:09:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1596112, encodeId=e55c15961124e, content=<a href='/topic/show?id=2d5481030ea' target=_blank style='color:#2F92EE;'>#肌肉骨骼#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81030, encryptionId=2d5481030ea, topicName=肌肉骨骼)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b94118335590, createdName=huirong, createdTime=Fri Oct 01 02:09:36 CST 2021, time=2021-10-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1056065, encodeId=4a0210560652d, content=那不停用会有相反结果吗, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cfc84293490, createdName=13f0c37dm61暂无昵称, createdTime=Wed Sep 29 13:05:23 CST 2021, time=2021-09-29, status=1, ipAttribution=)]
    2021-09-29 13f0c37dm61暂无昵称

    那不停用会有相反结果吗

    0