在PR3-ANCA阳性患者中与中度至重度活性的性结肠炎:一个多中心的现实世界试点研究中的利图西马布
Qi Yu1, Yiyu Cheng1, Huan Wang1
1Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Frontiers in pharmacology
|November 10, 2025
概括
利图西马布 (RTX) 在治疗PR3-ANCA阳性性性结肠炎 (UC) 患者中表现出高于因弗力西马布 (IFX) 的疗效,改善了缓解率和可比的安全性. 这种以生物标志物为指导的方法为这个患者亚组提供了一个有希望的替代方案.
科学领域:
- 胃肠病学和肝病学
- 免疫学和自身免疫性疾病
- 药理学和治疗学 药理学和治疗学
背景情况:
- 性结肠炎 (UC) 患者与PR3-ANCA阳性往往表现出对infliximab (IFX) 的反应较差.
- 这项研究研究了在UC管理中使用PR3-ANCA状态的生物标志物引导治疗.
- 在这个特定的UC亚组中,对于治疗选择的证据有限.
研究的目的:
- 为了比较Rituximab (RTX) 与Infliximab (IFX) 在PR3-ANCA阳性UC患者中的有效性和安全性.
- 在生物标志物定义的UC群体中为未来的随机对照试验生成基于假设的证据.
- 在第22周评估临床和内镜结果.
主要方法:
- 这是一项回顾性,多中心的实验性研究,涉及38名PR3-ANCA阳性UC患者 (12名RTX,26名IFX).
- 利用治疗权重的反向概率 (IPTW) 和多因素物流回归分析 (MLRS) 来控制混因素.
- 评估了临床缓解的初级终点,以及临床反应,内镜反应,改善和缓解率. 安全终点包括机会性感染和不良事件.
主要成果:
- 与IPTW前和后的infliximab (IFX) 相比,rituximab (RTX) 的临床缓解率,反应率和内镜缓解率显著更高.
- 在PR3-ANCA水平下降50%与临床缓解的几率增加7.583倍有关.
- 与IFX (2名患者) 不同,RTX显示出良好的安全性概况,没有提高结核病干扰素测试,与IFX (2名患者) 不一样,在任何组中都没有HBV重新激活或感染.
结论:
- 利图西马布 (RTX) 比因弗利西马布 (IFX) 更有效地在中度至重度活跃的UC患者中实现临床和内镜缓解,这些患者具有PR3-ANCA阳性.
- 在这个患者队列中,RTX的安全性概况与IFX相似.
- 用RTX进行生物标志物指导治疗代表了对PR3-ANCA阳性UC的潜在优越治疗策略.
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