尿路里图西马布的损失和治疗失败率在膜性脏病的治疗失败率
Marco Allinovi1, Matteo Accinno2, Cecilia Finocchi1
1Nephrology, Dialysis and Transplantation Unit, Careggi University Hospital, Florence, Italy.
概括
在原发性膜性病中,尿路里图西马布的流失与疾病的严重程度和治疗失败有关. 测量尿路里图西马布可以识别需要额外剂量的患者,以获得更好的结果.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 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:
- 利图西马布是对一次性膜性病 (PMN) 的一线治疗方法.
- 大约三分之一的PMN患者表现出对rituximab的耐药性.
- 由于蛋白尿症而导致的尿路里图西马布损失是抗药性的假设原因.
研究的目的:
- 客观地测量PMN患者的尿路里图西马布损失.
- 为了研究尿路里图西马布水平,疾病严重程度和治疗反应之间的关联.
- 为了探索额外的Rituximab剂量的潜在益处在非响应者与尿失.
主要方法:
- 对25名PMN患者进行前性观察性研究,这些患者接受了Rituximab治疗.
- 使用ELISA测量血清和尿液里图西马布水平.
- 确定了尿路里图西马布存在的门值;高尿路里图西马布不响应者接受了第二次治疗.
主要成果:
- 尿路里图西马布的损失与较低的EGFR,较高的蛋白尿和非选择性蛋白尿相关.
- 尿中Rituximab含量高 (≥2μg/mL) 的患者的血清水平较低,反应率较差 (43%与100%相比),以及PLA2R抗体减少的频率较低.
- 在8名重新治疗的非响应患者中,有5名在尿路中失去利图西马布,实现了临床响应.
结论:
- 尿路里图西马布的流失与PMN严重程度,图西马布暴露不足和治疗失败有关.
- 尿路Rituximab测量可以识别患有耐药性风险的患者.
- 这种方法可以指导个性化的Rituximab剂量策略,以改善患者的治疗结果.
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