高剂量葡萄糖皮质激素治疗与免疫检查点抑制剂相关的低体质炎 (CORTICI) 中的葡萄糖皮质激素替代治疗:一个开放的,随机对照试验
Verena Theiler-Schwetz1, Christian Trummer1, Lisa Schmitt1
1Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Annals of medicine
|January 25, 2025
概括
高剂量的葡萄糖皮质类药物不能恢复上腺功能在免疫检查点抑制剂相关的低血清炎的患者和可能会恶化葡萄糖代谢. 建议使用葡萄糖皮质醇替代疗法代替.
科学领域:
- 内分泌学 在内分泌学.
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
背景情况:
- 免疫检查点抑制剂 (ICI) 可以导致缺血炎,这是一种严重的内分泌副作用,导致上腺功能不充分.
- 从ICI相关的低血炎中恢复激素是罕见的,对有效的治疗策略的证据有限.
- 这项研究是第一个随机试验,将高剂量葡萄糖皮质醇与ICI相关的低血压炎的标准葡萄糖皮质醇替代疗法进行比较.
研究的目的:
- 评估和比较高剂量葡萄糖皮质激素治疗与葡萄糖皮质激素替代疗法的疗效,以实现ICI相关性下体炎患者的荷尔蒙恢复.
- 评估不同治疗策略对上腺功能和其他激素轴的影响.
主要方法:
- 一个单中心,开放标签,随机对照研究,涉及ICI相关的低体质炎患者.
- 参与者按1:1随机分配,接受高剂量普雷迪尼索隆 (1毫克/千克),然后逐渐减少和皮,或标准皮替代疗法8周.
- 主要结果是荷尔蒙轴恢复的频率.
主要成果:
- 治疗组中的任何一个患者都没有经历过上腺功能的恢复.
- 每组的1名患者显示,他们的阴道腺功能障碍有所改善.
- 高剂量葡萄糖皮质体治疗对HbA1c水平产生了显著的不利影响,表明对葡萄糖代谢有不良影响.
结论:
- 高剂量葡萄糖皮质激素治疗在ICI相关的低体质炎中恢复上腺功能是无效的.
- 这种治疗策略会对葡萄糖代谢产生不良影响的风险.
- 建议进行葡萄糖皮质体替代疗法,避免高剂量的葡萄糖皮质体,除非有压缩症状.
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