在中度至重度,抗类固醇,甲状腺眼病患者的医疗治疗
David Toro-Tobon1, Kharisa N Rachmasari1, Elizabeth A Bradley2
1Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.
概括
在治疗耐固醇甲状腺眼病 (TED) 方面,teprotumumab和tocilizumab显得有前途,改善了诸如proptosis和diplopia等症状. 这些治疗甲状腺眼病的长期疗效和安全性需要进一步研究.
科学领域:
- 眼科医生 眼科 眼科
- 内分泌学 在内分泌学.
- 免疫学 免疫学 免疫学
背景情况:
- 皮质类固醇治疗是甲状腺眼病 (TED) 的常见治疗方法,但其有效性各不相同.
- 铁穆马布和托西利祖马布是管理中度至重度TED的新兴替代品,特别是在对类固醇耐药的情况下.
研究的目的:
- 评估teprotumumab和tocilizumab在患有耐固醇甲状腺眼病 (TED) 的患者的临床结果和安全性.
- 在TED管理中,将这些新型疗法的疗效与标准类固醇治疗进行比较.
主要方法:
- 一项回顾性病例控制研究,涉及37名中度至重度类固醇耐药性TED患者,接受了teprotumumab或tocilizumab治疗.
- 在治疗开始后的多个时间点评估proptosis,双眼,临床活性评分 (CAS) 和疾病严重程度.
- 接受teprotumumab/tocilizumab的患者与未服用类固醇的对照组 (如有) 之间的结局比较.
主要成果:
- 截至第24周,teprotumumab在位 (81%的反应),双眼 (45.5%的解像度) 和疾病无活化 (85.7%) 中显著改善.
- 托西利祖马布显示了50%的亡反应,100%的疾病失活,以及75%的病例恢复到轻度的疾病严重程度.
- 采用teprotumumab的病例显示出与对照组相似的结果,但在24-52周之间观察到症状恶化的趋势.
- 不良事件包括teprotumumab的眼睛变化 (46.2%) 和高血糖症 (23.1%);没有报告与tocilizumab.
结论:
- 德鲁马布和托西利祖马布有效降低炎症,并改善对类固醇耐药的中度至重度甲状腺眼病 (TED) 患者的临床结果.
- 德鲁马布的疗效与对照药的疗效相当,这表明它在耐固醇TED中具有价值.
- 需要进一步的研究,才能充分了解teprotumumab和tocilizumab在耐固醇TED中的长期有效性和安全性.
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