与类固醇配合的mycophenolatemofetil是当前第一线治疗的合理替代方案,用于资源有限的环境中的异形膜性病:一个随机的,开放的标签研究
Manjuri Sharma1, Amit Roy2, Prodip Kumar Doley3
1Professor & Head of Department, Department of Nephrology, Gauhati Medical College and Hospital, Guwahati, Assam, India.
The Journal of the Association of Physicians of India
|June 17, 2024
概括
菌酸莫菲蒂尔 (MMF) 加上类固醇 (S) 和修改后的庞蒂切利疗法 (mPR) 在异常性膜性病 (IMN) 中表现出类似的有效性. 通过减少IMN患者的整体类固醇暴露,MMF + S提供了显著的优势.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 免疫抑制疗法 免疫抑制疗法
- 淋巴细胞疾病 淋巴细胞疾病
背景情况:
- 异形膜性病症 (IMN) 通常用修改的庞蒂切利疗法 (mPR) 治疗,但它存在安全问题.
- 菌酸莫菲蒂尔 (MMF) 加上类固醇 (S) 是一种潜在的替代品,因为它具有更好的耐受性和减少类固醇使用,尽管它不是指南推的治疗方法.
- 这项研究直接比较了MMF + S与mPR在IMN治疗中的安全性和有效性.
研究的目的:
- 为了比较mycophenolate mofetil (MMF) 加上类固醇 (S) 的安全性和有效性,与在患有异常性膜性病 (IMN) 的患者中修改Ponticelli疗法 (mPR) 相比.
- 评估蛋白尿和功能变化作为主要结局措施.
主要方法:
- 一个随机的,开放的标签研究,涉及42名成年患者的活检证明IMN和脏综合征.
- 患者被分配到MMF + S组 (MMF每天两次1克+口服普雷迪尼索隆0.5毫克/公斤/天) 或mPR组 (静脉注射甲基普雷迪尼索隆,然后是口服普雷迪尼索隆和环胺).
- 主要结局是6个月后尿蛋白肌素比率 (UPCR) 的变化.
主要成果:
- 两组MMF + S和mPR都显示了血清白蛋白和估计的淋巴细胞过率 (eGFR) 的显著改善,6个月后蛋白尿和UPCR的减少.
- 在每个月的随访中,在这些参数中没有观察到组之间的显著差异.
- 复合缓解率相似,在货币市场基金+S组中为61.91%,在mPR组中为71.43%.
结论:
- 菌酸莫菲蒂尔 (MMF) 加上类固醇 (S) 和修改的庞蒂切利疗法 (mPR) 在治疗异常性膜性病 (IMN) 中表现出可比的耐受性和有效性.
- 与mPR相比,MMF + S疗法通过减少累积类固醇暴露提供了显著的优势.
- 这些发现支持MMF + S作为IMN的可行和潜在的更安全的替代第一线治疗方案.
相关概念视频
Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
156
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
156
Pulmonary Tuberculosis I
231
Tuberculosis, often called TB, is a contagious illness primarily caused by Mycobacterium tuberculosis. It mainly affects the lung parenchyma but can also impact other body parts.
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
231
Pulmonary Tuberculosis V
177
Medical management of tuberculosis (TB) patients involves a comprehensive approach that includes diagnosis, treatment, and monitoring. The specific strategies can vary depending on the type of tuberculosis (latent or active), the patient's overall health status, and other considerations.
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the...
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the...
177
Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
115
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
115


