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托西利祖马布作为加密球菌后感染性炎症反应综合征 (PIIRS) 中皮质类固醇的潜在辅助疗法:两例病例的报告
Jessica C Hargarten1, Seher H Anjum1, Kenneth Ssebambulidde1
1Laboratory of Clinical Immunology and Microbiology (LCIM), Division of Intramural Research (DIR), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bldg 10, Rm 11C208, Bethesda, MD, 20892, USA.
Journal of clinical immunology
|October 9, 2023
概括
托西利祖马布作为加密球菌脑膜炎相关的后感染性炎症反应综合征 (c-PIIRS) 的辅助疗法具有前景. 这种治疗可以减少对皮质类固醇的依赖,并改善以前健康的个体的患者结果.
科学领域:
- 神经免疫学 神经免疫学
- 传染性疾病 传染性疾病
- 药理学 药理学是指药理学的学科.
背景情况:
- 非艾滋病毒加密球菌脑膜炎 (CM) 可能导致严重的炎症并发症,加密球菌-PIIRS,尽管接受了抗真菌治疗,但仍表现为神经衰退.
- 这种综合症是由于对真菌抗原的过度活性免疫反应引起的,导致宿主受损,并且通常需要长时间的皮质类固醇治疗.
- 目前的治疗方法面临挑战,包括长时间的类固醇缩小,耐火病例和显著的副作用,需要新的辅助疗法.
研究的目的:
- 研究tocilizumab的潜在疗效,一个IL-6受体抑制剂,作为加密球菌-PIIRS的辅助治疗在以前健康的个体.
- 评估tocilizumab是否可以帮助降低皮质类固醇剂量,并减轻与长期使用类固醇相关的不良影响在c-PIIRS管理.
主要方法:
- 两名先前健康的患者被诊断为非艾滋病毒c-PIIRS,他们接受了托西利祖马布治疗 (4-8毫克/千克每2周),同时继续服用稳定的普得尼松剂量.
- 治疗决策受到对内血管破裂和不治症状的担忧的影响,尽管高剂量皮质类固醇.
主要成果:
- 两位患者在开始服用tocilizumab后都表现出快速的免疫改善.
- 1号患者体验到血管稳定,而2号患者表现出症状缓解,包括改善头痛和认知功能 (MOCA评分).
- 患者表现出脑脊液炎症标记的改善,没有显著的不良事件,真菌培养仍然是负面的.
结论:
- 托西利祖马布似乎是一种安全且潜在有效的辅助治疗CM相关PIIRS.
- 需要进一步的研究来证实这些发现,并确定托西利祖马布在管理c-PIIRS中的作用.
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