亚齐思罗米辛用于预防重复的喘息,严重的呼吸道综合体病毒支气管炎
Avraham Beigelman1,2, Mythili Srinivasan3, Charles W Goss4
1Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis.
NEJM evidence
|August 25, 2023
概括
在婴儿中治疗严重呼吸道综合体病毒 (RSV) 支气管炎的阿兹罗密辛治疗并没有预防复发性喘息. 这项研究发现,使用阿齐思罗米来减少RSV后儿童的喘息没有益处.
科学领域:
- 儿科肺病学 儿科肺病学
- 传染性疾病 传染性疾病
- 临床药理学 临床药理学
背景情况:
- 早期严重的呼吸道同胞性病毒 (RSV) 支气管炎是患儿喘的已知危险因素.
- 研究了阿齐思罗米的抗炎性质,以寻找在RSV支气管炎期间减轻呼吸道炎症的潜力.
研究的目的:
- 评估阿齐思罗米在严重RSV支气管炎后减少复发性喘息的有效性.
- 为了确定早期的阿兹罗米辛治疗是否会影响RSV后喘息的长期风险.
主要方法:
- 一项前性,单中心,双盲,安慰剂控制的研究招募了200名患RSV支气管炎住院的婴儿 (1-18个月).
- 参与者接受了口服阿齐思罗米 (总共14天) 或安慰剂,随机分层根据先前的抗生素使用.
- 衡量的主要结局是2至4年的随访期内复发性喘息发病率 (≥3次).
主要成果:
- 阿齐思罗米表现出生物活性,这是14日鼻水中较低的白内素-8水平 (P<0.01) 证明的.
- 然而,阿齐思罗米并没有显著降低RSV后复发性喘息风险 (47%对36%;调整后的危险比,1.45;P=0.11).
- 在曾经接受过抗生素治疗的婴儿中,观察到潜在的复发性喘息风险增加,这些婴儿接受了阿齐思罗米治疗 (危险比率1.79).
结论:
- 在急性严重RSV支气管炎期间进行14天的阿兹罗密辛治疗并没有减少随后2-4年中复发性喘息的发生率.
- 目前的数据表明,在RSV感染后的儿童中,阿齐思罗米对复发性喘息没有预防性益处.
- 对特定子组进行进一步的研究可能是有必要的,考虑到先前未服用抗生素的婴儿的信号.
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