感染风险与多发性硬化症中高效疾病修饰剂相关:回顾性队列研究
Jieni Li1, George J Hutton2, Tyler J Varisco1,3
1Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, Texas, USA.
Clinical pharmacology and therapeutics
|November 15, 2024
概括
针对多发性硬化症 (MS) 的高疗效疾病修饰剂 (heDMA) 与中等疗效药物相比,增加了严重感染和尿路感染 (UTI) 的风险. 对于在heDMAs的患者来说,仔细监测至关重要.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 传染性疾病 传染性疾病
背景情况:
- 感染是多发性硬化症 (MS) 患者的一个重要问题,特别是免疫调节性疾病修饰剂 (DMAs).
- 高效的DMA (heDMA) 对于延缓MS进展至关重要,但可能会增加感染风险.
研究的目的:
- 在成年多发性硬化症患者中,比较高效度DMAs (heDMAs) 和中效度DMAs (meDMAs) 之间的感染风险.
- 在MS中识别与heDMA使用相关的特定类型的感染.
主要方法:
- 使用2015-2019年MarketScan商业索赔和遭遇数据库进行回顾性队列研究.
- 包括成人多发性硬化症患者开始服用头部多发性硬化药物 (natalizumab,alemtuzumab,ocrelizumab) 或meDMAs.
- 逆概率治疗权重 (IPTW) 使用考克斯比例危险模型来估计感染风险的调整危险比率 (aHR).
主要成果:
- 开始服用headMAs的患者与服用meDMAs的患者相比,患有严重感染 (aHR: 1.24) 和尿路感染 (UTI;aHR: 1.21) 的风险更高.
- 敏感性分析证实了在不同后续期内一致的发现.
- 在10003名符合条件的患者中,22.92%的患者开始接受头部DMAs.
结论:
- 在MS中,高效的DMA与严重感染和尿路感染的风险增加有关,相对于中度有效的DMA.
- 临床管理应侧重于警监测和主动策略,以减轻治疗heDMAs的MS患者的感染风险.
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