Arthritis Rheumatol:预测利妥昔单抗治疗风湿和肌肉骨骼疾病期间严重感染和低丙种球蛋白血症的影响

2019-05-30 xiangting MedSci原创

应在基线和每个RTX周期之前监测免疫球蛋白,以识别有SIEs风险的患者。

这项研究旨在评估利妥昔单抗(RTX)治疗风湿和肌肉骨骼疾病(RMDs)期间严重感染事件(SIEs)的预测因子和低丙种球蛋白血症的影响,其中关于SIE发生率、体液反应及其在RTX停药后的持续性。

在单个中心对700例RTX治疗的RMD患者进行了一项回顾性纵向研究。在基线和每个周期后的4-6个月测量免疫球蛋白。使用多因素logistic回归评估SIEs的基线预测因子;对于2-4周期,使用混合效应logistic回归。

507例患者(72%)为类风湿性关节炎,94例(13%)为系统性红斑狼疮,49例(7%)为ANCA相关性血管炎和50例(8%)为其他RMDs。在176例患者中记录了281个SIEs(9.8/100 PY)。SIEs的预测因子包括非RTX特异性合并症(既往SIE病史、癌症、慢性肺病、糖尿病心衰),皮质类固醇剂量高和RTX特异性因素、基线和随后的低IgG(<6g/L)、RTX相关性中性粒细胞减少、IgM高和RTX再治疗时间长,而不是B细胞数量或消耗状态。在103例低IgG患者中,与正常IgG(9.7/100 PY)相比,基线IgG低(16.4/100 PY)或RTX治疗期间/治疗后IgG低(21.3/100 PY)患者的SIEs率更高,5/8例患者(64%)接种疫苗后对肺炎球菌和嗜血杆菌的体液应答受损,仅有4/11例患者(36%)在换用bDMARD后IgG恢复正常。

应在基线和每个RTX周期之前监测免疫球蛋白,以识别有SIEs风险的患者。对于IgG低的患者,应进行个体化的获益-风险评估,因为IgG低是一致的SIE预测因子,并且当RTX换为不同的治疗时会增加感染风险。

原始出处:

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    2019-07-25 xzw113
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    2019-06-01 zhaojie88
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