在患有Graves轨道病变风险的患者中,Mycophenolate-sodium治疗的现实有效性
Julius Sander1, Karim Al-Ghazzawi1, Nikolaos Bechrakis1
1Department of Ophthalmology, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
Thyroid research
|October 1, 2025
概括
甲酸 (MPS) 与IV甲基前醇 (IVMP) 结合,有效地使活跃的Graves轨道病变 (GO) 失活,并降低TSH受体抗体. 然而,已经确定的纤维化,如前和运动性问题仍然没有改变,需要进一步治疗和对副作用的监测.
科学领域:
- 眼科医生 眼科 眼科
- 内分泌学 在内分泌学.
- 免疫抑制疗法是一种免疫抑制疗法.
背景情况:
- 格雷夫斯轨道病 (GO) 是一种需要免疫抑制的自身免疫性疾病.
- 甲 (MPS) 现在是中度至重度GO的第一线治疗.
- 关于MPS疗效的现实数据有限,特别是在组合治疗中.
研究的目的:
- 为了回顾分析真实世界的有效性 甲 (MPS) 在治疗Graves的轨道病变 (GO).
- 为了评估MPS作为一线或二线治疗的使用,通常与静脉注射甲基prednisolone (IVMP) 结合使用.
- 评估治疗结果,包括疾病无活化,临床活性,抗体水平和副作用.
主要方法:
- 追溯分析了172名在2019-2023年期间接受治疗的活跃,中度至重度GO患者.
- 患者与静脉注射甲基prednisolone (IVMP) 同时或之后接受MPS.
- 评估结果包括临床活动评分,疾病无活化率,眼动力,proptosis,眼收缩,TSH受体抗体 (TRAb) 水平,以及非甲状腺视神经病变 (DON) 的发展.
主要成果:
- 6个月后临床活动评分 (3.9至2.4) 和TRAb水平显著降低 (p<0.0001).
- 在6个月后60%的患者和12个月后77%的患者实现了疾病无活化.
- 无显著改善proptosis,运动性,或眼收缩;10.5%的开发DON. 在基线后的辐射影响了无活化 (OR 6.18).
结论:
- 与IVMP结合的MPS有效地禁用GO并降低TRAb水平,但不会逆转已有的纤维化变化.
- 对于残留症状,可能需要进一步的手术或康复干预.
- 对DON的密切监测至关重要,替代性免疫抑制剂需要在随机试验中进行调查.
相关概念视频
01:20Myasthenia Gravis: Overview and Treatment
2.8K
Myasthenia gravis is a neuromuscular transmission disorder characterized by weakness and increased fatigability of skeletal muscles. It is an autoimmune disease affecting approximately one in 2000 people, where antibodies against the α1 subunit of nicotinic acetylcholine receptors are produced.
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which...
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which...
2.8K
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
185
In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
185
01:21Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
437
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
437
01:29Therapeutic Drug Monitoring: Affecting Factors
201
Therapeutic Drug Monitoring (TDM) is the clinical practice of measuring specific drug levels in a patient's blood or body tissues to manage and optimize therapy. TDM is crucial for drugs with narrow therapeutic windows, like warfarin and phenytoin, where incorrect doses can lead to treatment failure or severe side effects. This monitoring ensures the dosage administered is within a safe and effective range. The factors affecting therapeutic drug monitoring include:Patient-Specific Factors:a.
201
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
237
In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
237
01:15Myasthenia Gravis: Diagnostic Tests
1.9K
Myasthenia gravis is an autoimmune condition affecting neuromuscular transmission, causing generalized weakness in skeletal muscles. Initial diagnoses rely on patients' signs, symptoms, and medical history. The challenge lies in distinguishing myasthenia from other muscular dystrophies. An important diagnostic feature is the significant improvement of symptoms after administering anticholinesterase inhibitors.
The edrophonium test is a diagnostic tool for myasthenia gravis. It involves...
The edrophonium test is a diagnostic tool for myasthenia gravis. It involves...
1.9K