系统性硬化症相关的间歇性肺部疾病的治疗选择,对2个国际研究小组的调查
Michael Macklin1, Iazsmin Bauer Ventura1, Dinesh Khanna2
1Section of Rheumatology, Department of Medicine, University of Chicago, Chicago, IL.
概括
菌酸莫菲蒂尔是系统性硬化症相关的间歇性肺病 (SSc-ILD) 的首选一线治疗方法. 组合疗法不太常见,皮质类固醇的使用率高于预期,这表明在SSc-ILD管理中遵守指南的潜在差距.
科学领域:
- 类风湿病学 类风湿病学
- 肺部病理学 肺部病理学
- 临床药理学 临床药理学
背景情况:
- 系统性硬化症相关的间歇性肺病 (SSc-ILD) 的治疗选择已经扩大,包括mycophenolate mofetil (MMF),tocilizumab (TCZ) 和组合疗法.
- 尼丁达尼布等抗纤维素药物也可供使用,与与rituximab (RTX) 和MMF的联合免疫抑制 (CI) 疗法一起使用.
研究的目的:
- 在国际专家中调查SSc-ILD目前的处方模式.
- 评估遵守已确定的治疗指南,并确定SSc-ILD管理的趋势.
主要方法:
- 在2023年10月至2024年3月期间,对硬化皮肤病临床试验联盟和欧洲硬化皮肤病试验和研究小组专家进行了一项国际调查.
- 该调查侧重于治疗偏好,组合疗法使用和SSc-ILD中的皮质类固醇使用.
主要成果:
- 菌酸莫菲提尔 (MMF) 是SSc-ILD的主要第一线疗法 (92%).
- 联合免疫抑制 (CI) 治疗在24%的初始治疗失败的情况下使用,MMF/RTX是最常见的组合 (71%).
- 36%的专家使用皮质类固醇,12%的专家使用>20mg的普雷尼松相当剂,这表明使用类固醇的比例高于预期.
结论:
- 第一线SSc-ILD治疗符合目前的指导方针,但组合治疗的使用仍然有限.
- EVER-ILD试验可能会影响未来的RTX/MMF联合治疗的处方.
- 需要进一步的研究来澄清MMF/TCZ与MMF/RTX和TCZ在非炎症性SSc-ILD配置文件中的疗效. 增加准则的采用可能会改变普得尼松的使用模式.
相关概念视频
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
3.1K
Assessing and diagnosing Chronic Obstructive Pulmonary Disease (COPD) involves a detailed approach that includes a comprehensive review of medical history, physical examination, and a variety of diagnostic tests. This thorough evaluation is essential to ensure an accurate diagnosis and guide effective management strategies.
Medical History
Medical History
3.1K
01:26COPD: Management Using Bronchodilators and Corticosteroids
741
Chronic obstructive pulmonary isease (COPD) involves a group of progressive lung disorders characterized by persistent airflow limitation and chronic respiratory symptoms. Asthma-COPD Overlap Syndrome (ACOS), encompassing features of both asthma and Chronic obstructive pulmonary disease (COPD), is a group of progressive lung disorders that includes chronic bronchitis, emphysema, and refractory (non-reversible) asthma. ACOS leads to complex clinical presentations that combine the inflammatory...
741
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
329
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
329
01:26Asthma-II: Pathophysiology and Classification
4.1K
Asthma is a prevalent chronic respiratory condition marked by inflammation and hyperresponsiveness of the airways. Its pathophysiology involves complex interactions among inflammatory pathways, immune responses, and neural mechanisms.
Additionally, environmental and genetic factors play crucial roles in determining an individual's susceptibility to asthma and the severity of their condition.
Critical processes in asthma pathophysiology include:
Additionally, environmental and genetic factors play crucial roles in determining an individual's susceptibility to asthma and the severity of their condition.
Critical processes in asthma pathophysiology include:
4.1K
01:29Chronic Obstructive Pulmonary Disease-V: Management
3.1K
Managing Chronic Obstructive Pulmonary Disease (COPD) involves a multifaceted approach to reduce symptoms, prevent exacerbations, improve overall health status, and slow disease progression. Key strategies include lifestyle modifications, pharmacotherapy, supportive therapies, and, in some cases, surgery. Here is an overview of the primary COPD management strategies:
Smoking Cessation
Smoking Cessation
3.1K
01:30Asthma-IV: Diagnostic and Management
3.1K
The diagnosis and management of asthma are comprehensive, encompassing clinical assessments, lung function tests, and pharmacological interventions. Here's an overview:
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
3.1K