多发性硬化症,利图西马布,低型血球蛋白,以及感染风险
Annette Langer-Gould1, Bonnie H Li1, Jessica B Smith1
1From the Department of Neurology (A.L.-G.), Los Angeles Medical Center, Southern California Permanente Medical Group; Departments of Clinical Science (A.L.-G.) and Health Systems Science (S.X.), Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena; Department of Research and Evaluation (B.H.L., J.B.S., S.X.), Southern California Permanente Medical Group, Pasadena, CA.
较高的利图西马布剂量增加了多发性硬化症患者的感染风险,独立于低血糖球蛋白. 尽量减少rituximab的使用,并管理诸如残疾和肥胖等并发症,是减少感染风险的关键.
科学领域:
- 免疫学 免疫学 免疫学
- 神经学 神经学
- 药理学 药理学是指药理学的学科.
背景情况:
- 像Rituximab这样的B细胞消耗疗法,与多发性硬化症患者的感染风险增加和低血血有关.
- 利图西马布,低血和感染风险之间的确切关系尚未完全理解.
- 确定可修改的风险因素对于管理与治疗相关的感染至关重要.
研究的目的:
- 量化海波母球蛋白血症在多发性硬化症 (pwMS) 患者中中介于利图西马布相关感染风险的程度.
- 为了确定其他可修改的风险因素,有助于感染风险在rituximab治疗 pwMS.
- 为临床实践提供有关B细胞消耗疗法使用和风险减轻的信息.
主要方法:
- 在2008年至2020年期间,对2,482名pwMS患者进行了回顾性队列研究,这些患者接受了Rituximab治疗.
- 分析累计的利图西马布剂量,严重的感染和复发的门诊感染.
- 因果调解分析,以评估低血血的作用,并检查其他共同变量,如身体残疾,慢性肺炎和肥胖症.
主要成果:
- 较高的累计rituximab剂量 (>4g) 与严重 (aHR=1.56) 和门诊感染 (aHR=1.73) 的风险增加有关,这与免疫球蛋白G (IgG) 水平无关.
- 低型球蛋白血症 (IgG < 500 mg/dL) 独立地与严重 (aHR=2.98) 和门诊感染 (aHR=2.06) 的更高风险有关.
- 晚期身体残疾,COPD和肥胖被确定为感染的重要独立可修改的风险因素.
结论:
- 较高的利图西马布剂量会增加pwMS患者的感染风险,即使免疫球蛋白G水平保持在正常水平.
- 低玛环球蛋白血症部分调解了与较高的瑞图西马布暴露相关的严重感染风险.
- 临床医生应致力于最小的有效rituximab剂量,并积极管理并发症,以减轻感染风险.
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