回顾性队列研究关于对初始生物的初级不响应的预测价值,以期在患有炎症性肠病的患者中对未来的生物使用
Mahesh Krishna1,2, Ellen J Spartz3, Laura Maas4
1Yale University School of Medicine, New Haven, CT, USA. mahesh.krishna@yale.edu.
Digestive diseases and sciences
|January 4, 2025
概括
对第一个生物药物的初级不响应 (PNR) 并不能预测炎症性肠病 (IBD) 的第二个生物药物的失败. 患有IBD的患者在随后的生物药物治疗中成功率相似,无论最初的反应如何.
科学领域:
- 胃肠病学 胃肠病学
- 免疫学 免疫学 免疫学
- 药理学 药理学是指药理学的学科.
背景情况:
- 对于炎症性肠病 (IBD) 的治疗方法的不断增长的武器库提供了扩展的治疗选择,特别是在最初的生物失败后.
- 有限的研究存在于预测价值的初级不响应 (PNR) 给第一个生物在随后的生物成功IBD患者.
- 这项研究旨在确定第一种生物药物的PNR是否能够预测IBD患者对随后的生物治疗的反应.
研究的目的:
- 调查对第一个生物药物的初级不响应 (PNR) 对炎症性肠病 (IBD) 患者随后的生物疗法的成功的预测值.
主要方法:
- 一个多中心的回顾性图表审查包括了至少接受两种生物疗法的IBD患者.
- 初级无反应 (PNR) 被定义为六周治疗后没有临床改善,导致药物停止.
- 患者被分为PNR,二次响应丧失 (SLOR) 或对第一个生物的不耐受性组.
主要成果:
- 在249名患者中,87人患有PNR,96人患有SLOR,66人对他们的第一个生物药物不耐受.
- 与克罗恩病 (CD) (25.0%) 相比,性结肠炎 (UC) 和IBD未分类 (IC) 的PNR率显著更高 (41.3%和56.3%).
- 作为第一个生物药物,阿达利穆马布的使用与PNR率 (42.7%) 与因弗利西马布 (23.0%) 相比显著更高. 与SLOR或不耐受症组相比,PNR患者的第二次生物不响应率并不高.
结论:
- 性结肠炎和IBD未分类的患者的PNR率较高,但对二线生物药物保持良好反应率.
- 由于PNR比率较高,阿达利穆马布作为初始生物药物可能不太理想,相比于infliximab.
- 对第二种生物药物的反应在PNR对第一个生物药物的反应后同样有可能发生,对于类内和类外药物切换的成功率相似.
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