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提奥普林戒药对维多利祖马布治疗性结肠炎患者的影响:一项随机对照试验
Aviv Pudipeddi1, Sudarshan Paramsothy1, Viraj Kariyawasam2
1Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
在接受vedolizumab治疗的性结肠炎患者中,提奥普林的停用并没有改变药物水平,但增加了疾病活性. 组织学活性和先前的抗TNF使用预测了提奥普林戒药后的复发.
科学领域:
- 胃肠病学 胃肠病学
- 临床药理学 临床药理学
- 免疫抑制疗法是一种免疫抑制疗法.
背景情况:
- 性结肠炎 (UC) 患者在维多利祖马布和提奥普林的缓解期的最佳管理尚未确定.
- 在这群人群中研究氨酸降级对于治疗优化至关重要.
研究的目的:
- 评估提奥普林戒断对UC缓解期患者中韦多利祖马布最低度的影响.
- 评估提奥普林取消对UC患者在vedolizumab治疗中的临床,内镜和组织学结局的影响.
主要方法:
- 一个多中心随机对照试验,涉及UC患者在 vedolizumab 和 thiopurine 稳定缓解.
- 患者被随机分配到停止或继续治疗西奥普林.
- 关键结局包括vedolizumab的最低度,临床复发率和各种缓解标志物 (便calprotectin,CRP,内镜,组织学).
主要成果:
- 提奥普林的戒断在48周没有显著影响vedolizumab的最低度.
- 然而,提奥普林戒断组显示出明显更高的便calprotectin,组织学活性和结合的组织内镜活性.
- 组织学活性和先前的抗瘤亡因子暴露被确定为在提奥普林取消后临床复发的预测因素.
结论:
- 在接受vedolizumab治疗的UC患者中,提奥普林的停药不会影响药物水平,但可能会危及缓解,增加炎症标志物和组织学活性.
- 在这种患者群体中降低硫氨酸升级时,需要仔细考虑和监测.
- 复发的预测因素,包括组织学活性和先前的抗TNF使用,应指导治疗决策.
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