在开始全身牛皮治疗之前,结核查和预防治疗的护理标准不一致
Christoph Zeyen1, Ruben Heuer1, Brit Haecker2
1Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
概括
预防性结核病 (TB) 治疗在开始使用甲状腺素 (MTX) 或IL-17/IL-23/IL-12/23p40抑制剂治疗潜在结核病感染 (LTBI) 之前是不一致的. 需要对LTBI查和治疗进行标准化,以防止这些疗法患者的结核病重新激活.
科学领域:
- 皮肤病学 皮肤病学
- 传染病流行病学 传染病流行病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 间接证据表明,使用TNF抑制剂的结核病 (TB) 再激活风险需要预防性结核病感染 (LTBI) 的预防性治疗.
- 有限的直接证据表明,使用甲醇 (MTX) 或IL-17/IL-23/IL-12/23p40抑制剂对结核病复激活风险是有限的.
- 评估目前的LTBI查和预防治疗实践对于更新欧洲和德国牛皮指南至关重要.
研究的目的:
- 在开始使用甲状腺素 (MTX) 或IL-17/IL-23/IL-12/23p40抑制剂之前,评估目前的潜在结核病感染 (LTBI) 查和预防性结核病治疗实践.
- 为了确定皮肤科医生治疗牛皮或其他炎症疾病的患者之间的LTBI管理的变化.
- 在接受特定免疫调节疗法的患者中,提供有关结核病复激活风险的指导方针更新信息.
主要方法:
- 一项在线调查分发给德国,欧洲和国际上的皮肤科医生.
- 收集和分析了326个完整的反应,以评估LTBI查和预防性结核病治疗实践.
- 数据集中在使用预防性结核病治疗与MTX和IL-17/IL-23/IL-12/23p40抑制剂一起的使用上.
主要成果:
- 在MTX启动之前,45%的受访者进行了LTBI查,在IL-17/IL-23/IL-12/23p40抑制剂之前,95%的受访者进行了LTBI查.
- 预防性结核病治疗在38%的MTX病例中得到了一致的使用,但在31%的病例中没有使用.
- 对于IL-17/IL-23/IL-12/23p40抑制剂,66%的人总是或几乎总是使用预防性结核病治疗,而9%的人从未或几乎从未使用过.
结论:
- 针对MTX的LTBI查和预防性结核病治疗的做法缺乏标准化.
- 虽然LTBI查IL-17/IL-23/IL-12/23p40抑制剂是常见的,但很大一部分患者仍在没有预防性结核病治疗的情况下接受这些治疗.
- 进一步标准化LTBI管理是必要的,以减轻与免疫调节疗法相关的结核病再激活风险.
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