肝脏高生物可用性是否会增强口服葡萄糖皮质类药物的效果,而不是皮下葡萄糖皮质类药物的效果?
Eva H van Geel1, Maarten Boers2, Linda Hartman3
1Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, and Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, Amsterdam, The Netherlands. e.h.vangeel@amsterdamumc.nl.
Clinical and experimental rheumatology
|July 8, 2024
概括
低剂量的口服葡萄糖皮质类药物 (GC) 在降低红细胞沉率 (ESR) 方面并不比皮下GC更有效. 这表明系统度峰值,而不是高肝脏生物可用性,解释了口服GC在自身炎症性疾病中的有效性.
科学领域:
- 药理学 药理学是指药理学的学科.
- 免疫学 免疫学 免疫学
- 类风湿病学 类风湿病学
背景情况:
- 葡萄糖皮质醇 (GC) 对于治疗自身炎症性疾病至关重要.
- 低剂量口服GC (≤5 mg/天) 尽管剂量接近或低于生理水平,但仍有效.
- 一个假设提出,口服GC的高肝脏生物可用性解释了它们的疗效.
研究的目的:
- 为了研究一种假设,即高肝脏生物可用性口服低剂量GC增强其免疫抑制作用.
- 为了比较口服与皮下低剂量普得尼索隆在降低红细胞沉率 (ESR) 的疗效.
主要方法:
- 一个随机的,非盲目的交叉试验,涉及10名患有类风湿性或牛皮性关节炎和ESR升高的患者.
- 患者每天服用5毫克的普雷迪尼索隆口服和皮下注射4天,分隔10天的洗期.
- 红细胞沉积率 (ESR) 在每次治疗过程之前和之后都被测量.
主要成果:
- 口服和皮下注射的普雷尼索隆都显著降低了ESR.
- 在口服 (-5.6毫米/小时) 和皮下 (-5.8毫米/小时) 中,ESR的降低是可比的.
- 治疗顺序对结果没有影响.
结论:
- 短期,低剂量口服GC治疗在降低ESR方面并不优于亲肠GC.
- 这些发现反对高肝脏生物可用性在口服低剂量GC治疗效果中的重要作用.
- 给药后系统度峰值是口服生理类固醇剂量临床有效性的更可能解释.
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