用Rituximab治疗的类风湿性关节炎患者的感染发生率,时间和剂量依赖性:一项回顾性队列研究
Lara D Veeken1, Merel A A Opdam1,2, Lise M Verhoef1
1Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
Rheumatology (Oxford, England)
|July 6, 2023
概括
利图西马布 (RTX) 的超低剂量显著降低了类风湿性关节炎 (RA) 患者的感染风险. 这一发现支持探索更低的RTX剂量和新的施用方法,以提高RA治疗的安全性.
科学领域:
- 类风湿病学 类风湿病学
- 药理学 药理学是指药理学的学科.
- 传染性疾病 传染性疾病
背景情况:
- 利图西马布 (RTX) 是一种已被认可的类风湿性关节炎 (RA) 治疗方法.
- 有关RTX的感染风险存在担忧,初步数据表明剂量和时间依赖.
研究的目的:
- 评估用RTX治疗的大型现实世界RA患者队列中的感染发病率.
- 研究RTX剂量 (特别是超低剂量) 与感染风险之间的关系.
- 分析自最后一次RTX输注以来的时间对感染发生的影响.
主要方法:
- 在2012-2021年期间,对490名RA患者接受1000,500或200毫克RTX治疗的回顾性队列研究.
- 从电子健康记录中提取了有关患者,疾病,治疗和感染特征的数据.
- 混合效应的Poisson回归被用于分析感染发病率和剂量/时间关系.
主要成果:
- 在1254个患者年中,共记录了819例感染.
- 每100个患者年中的感染发病率为41 (200毫克),54 (500毫克) 和71 (1000毫克).
- 200毫克的RTX剂量显示,与1000毫克 (P=0.004) 相比,调整后发病率比率 (0.35) 显著降低.
- 在注射1000/500毫克剂量后的两个月内,感染发生的频率更高,这表明峰值度的关联.
结论:
- 超低剂量的RTX (200毫克) 与RA患者感染风险降低有关.
- 未来的策略,如超低剂量和皮下RTX给药,可能会进一步减轻感染风险.
相关概念视频
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
38
The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
38
01:23Rheumatic Heart Disease I: Introduction
17
Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
17
01:20Rheumatic Heart Disease IV: Nursing Management
23
AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...
23
01:21Rheumatic Heart Disease III: Medical Management
22
Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
22
01:29Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
200
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
200
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
175
Tumor Necrosis Factor (TNF), a proinflammatory cytokine, contributes significantly to the inflammation seen in Crohn's disease. It exists as soluble TNF and membrane-bound TNF, with actions mediated through TNF receptors (TNFR). TNFR activation leads to the release of proinflammatory cytokines, T-cell activation, collagen production, and leukocyte migration, all contributing to inflammation in Crohn's disease. Anti-TNF monoclonal antibodies, namely infliximab (Remicade), adalimumab...
175