在用单克隆抗体治疗NMOSD中向B细胞的过程中复发
Shugang Cao1,2, Xingyue Zhou3, Jing Du1
1Department of Neurology, Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, China.
Journal of neurology
|May 18, 2025
概括
针对B细胞的单克隆抗体 (mAb) 治疗对神经髓炎光学谱系障碍 (NMOSD) 有效,但可能会出现复发. 在治疗前的高发作频率和残疾预测在NMOSD的B细胞消耗疗法期间复发风险.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 临床治疗学 临床治疗学
背景情况:
- B细胞枯竭是治疗神经髓炎光学谱系障碍 (NMOSD) 的关键策略,旨在实现持续缓解.
- 然而,并非所有患者都对向B细胞的单克隆抗体 (mAb) 疗法有有效的反应,因此需要确定复发预测因素.
研究的目的:
- 调查与接受B细胞向mAb治疗的NMOSD患者复发相关的临床和免疫风险因素.
- 在接受B细胞消耗疗法的NMOSD患者中确定治疗失败的预测因素.
主要方法:
- 在2014年7月至2024年9月期间,对101名NMOSD患者进行了逆向分析,这些患者接受了inebilizumab或rituximab治疗.
- 评估基线临床特征,B细胞计数和复发数据,使用Cox比例危险模型.
- 在mAb治疗之前和之后的年度复发率 (ARR) 的比较.
主要成果:
- 在治疗后观察到ARR显著降低 (p=0.002).
- 在治疗前,较高的复发风险与集群发作 (p<0.001) 和扩展残疾状况量表 (EDSS) 分数≥6 (p=0.006) 相关.
- 在mAb治疗期间复发的预测因素包括发作频率,疾病持续时间,ARR和EDSS得分≥6.6.
- 复发时较低的CD19+B细胞水平 (<1%) 与更高的先前攻击频率和集群攻击相关.
结论:
- 治疗前的发作频率和累积残疾是NMOSDB细胞向mAb治疗期间复发的重要预测因素.
- 预防集群攻击对于改善治疗结果和减少mAb治疗失败在NMOSD中至关重要.
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