在上腺功能不全时优化普得尼索隆或普得尼索隆替代剂
Angelica Sharma1,2, Katharine Lazarus1,2, Deborah Papadopoulou1,2
1Division of Diabetes, Endocrinology and Metabolism, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
Endocrine connections
|June 8, 2023
概括
每天服用一次的普雷尼索隆为上腺功能不足 (AI) 患者提供了一种方便的替代方案. 这项研究确定了普得尼索隆水平的治疗范围,使得有效的剂量定位和改善患者的治疗结果.
科学领域:
- 内分泌学 在内分泌学.
- 药理动力学 药理动力学
- 临床药理学 临床药理学
背景情况:
- 上腺功能衰竭 (AI) 与死亡率的增加有关,可能是由于不适当的葡萄糖皮质激素暴露.
- 标准的皮替代疗法需要每天多次剂量,使坚持复杂并模仿自然皮质醇节奏.
- 每天服用一次的普雷尼索隆为AI管理提供了一个方便的替代方案,有可能改善患者的遵守性.
研究的目的:
- 审查AI患者的普得尼索隆日曲线.
- 为了确定在施用后的不同时间点对普雷迪尼索隆的治疗度范围.
- 为了建立最佳的剂量策略,用于普雷迪尼索隆替代疗法.
主要方法:
- 在2013年8月至2021年5月期间接受了普雷迪尼索隆替代治疗的76名患者的108个普雷迪尼索隆日曲线的分析.
- 使用超高性能液体染色学-并联质谱法量化普得尼索隆度.
- 使用斯皮尔曼相关性,对2小时,4小时和6小时的普雷迪尼索隆水平与验证的8小时水平进行相关性分析.
主要成果:
- 在4小时和8小时水平 (R=0.8829) 和6小时和8小时水平 (R=0.9530) 之间观察到强烈的相关性.
- 已确定的治疗范围:4小时后37-62μg/L,6小时后24-39μg/L,8小时后15-25μg/L.
- 在21名患者中成功降低了普雷尼索隆剂量,其中3人达到每日一次2毫克的剂量,所有患者在随访时都保持良好状态.
结论:
- 这项研究代表了口服普雷迪尼索隆在人类中的最大的药理动力学评估.
- 在大多数患者中,低剂量普雷迪尼索隆 (每天服用2-4毫克一次) 是安全有效的治疗AI.
- 普雷尼索隆剂量可以使用一次时间点测量在服用后4,6或8小时可靠地定位.
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