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Am J Resp Crit Care:吡非尼酮减少特发性肺纤维化患者呼吸相关的住院!

2017-05-06 xing.T MedSci原创

在有关IPF的3期临床试验的汇总分析中,接受吡非尼酮治疗的患者1年期间具有较低的非选择性呼吸呼吸相关的住院风险。在这些任何原因的住院患者中,吡非尼酮与入院后较低的死亡风险相关。

特发性肺纤维化(IPF)患者发生呼吸相关住院比急性IPF恶化的患者更加常见且预后较差。近日,呼吸内科以及重症医学领域权威杂志Am J Resp Crit Care上发表了一篇研究文章,研究人员旨在比较IPF的3期临床试验中采用吡非尼酮与安慰剂住院治疗52周后各种非择期性(全因、呼吸相关和非呼吸相关)住院和死亡的风险。

研究人员将这个3期随机、安慰剂对照的临床试验的个人患者数据进行汇集,这个试验的参与者随机分为吡非尼酮2403毫克/天(n=623)或安慰剂(n=624)治疗。研究人员使用标准的时间-事件方法比较了两组患者治疗52周后的住院风险。在住院患者中,对治疗组别倾向性进行调整后,对住院后死亡风险进行了比较。

该合并分析中共纳入1247例IPF患者,吡非尼酮治疗组患者发生呼吸相关的住院风险较低,相比于安慰剂治疗患者(7% vs. 12%,风险比为0.52,95%可信区间为0.36-0.77,p=0.001),但与全因住院(风险比为0.91,95%可信区间为0.70-1.19,p=0.53)或非呼吸相关的住院(风险比为1.32,95%可信区间为0.92-1.88,p=0.145)无关。在那些因任何原因住院治疗的患者中,在倾向评分校正分析中吡非尼酮治疗与住院后死亡风险降低相关(风险比为0.56,95%可信区间为0.32-0.99,p=0.047)。

在有关IPF的3期临床试验的汇总分析中,接受吡非尼酮治疗的患者1年期间具有较低的非选择性呼吸呼吸相关的住院风险。在这些任何原因的住院患者中,吡非尼酮与入院后较低的死亡风险相关。

原始出处:

Brett Ley , et al. Pirfenidone Reduces Respiratory-related Hospitalizations in Idiopathic Pulmonary Fibrosis. AM J RESP CRIT CARE 2017. https://doi.org/10.1164/rccm.201701-0091OC 

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    2017-05-07 tanxingdoctor

    学习啦谢谢分享

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    2017-05-06 三生有幸9135

    学习一下谢谢分享

    0

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    2017-05-06 1e145228m78(暂无匿称)

    学习了,谢谢作者分享!

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    2017-05-06 尹玉伟

    学习了……厉害厉害

    0

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这个新发现是非常重要的,其原因有两个:(1)对于不能耐受连续给药的患者,间断性使用吡非尼酮但不影响药物功效,以及(2)TGF-β抑制的时机。因为TGF-β是重要的调节性细胞因子抑制免疫反应,传统的在移植后使用中和TGF-β抗体抑制其活性可能通过促进细胞毒性而产生有害后果,而HSCT后期产生的TGF-β已被发现显著驱动cGVHD。因此,推测移植后期使用吡非尼酮对TGF-β“晚期”抑制,不会影响TGF

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