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Ann Rheum Dis:系统性红斑狼疮中使用B细胞生物标记物预测和管理利妥昔单抗无应答

2017-07-07 xiangting MedSci原创

用抗CD20药物治疗可以通过B细胞监测进行指导,并应当旨在实现完全减轻。

这项研究旨在探讨系统性红斑狼疮(SLE)中利妥昔单抗原发性和继发性无应答的相关因素,并评估继发性非减轻无应答者(2NDNR)的管理

对 125例利妥昔单抗治疗12年以上的SLE患者进行前瞻性研究。主要临床应答定义为所有活跃的不列颠群岛狼疮评估组(BILAG)-2004改善至C级或更好,没有A/B急性发作。部分应答者定义为持续的BILAG B。使用高灵敏度流式细胞仪测量B细胞亚群。2NDNR患者,由输液反应和缺陷性减轻定义,使用奥瑞珠单抗或奥法木单抗治疗。

117例患者有可供评估的数据。在周期1(C1)中,96/117(82%)达到了BILAG应答(主要=50%,部分=32%)。在多变量分析中,年龄较轻(OR = 0.97,95%,0.94-1.00),6周时B细胞减少(OR 3.22,95%,CI 1.24-8.33)增加主要应答的几率。完全减轻可由正常补体和较低的前利妥昔单抗成浆细胞预测,并与利妥昔单抗后严重感染的增加无关。77例(72例有数据)C1应答者在临床复发时再治疗。其中61/72(85%)在第2周期(C2)有应答。在11个C2无应答者中,9例符合2NDNR标准(发生率为12%),并检测到抗利妥昔单抗抗体阳性。缺乏伴随的免疫抑制剂和更高的前利妥昔单抗成浆细胞可以预测2NDNR。5例转为使用奥瑞珠单抗或奥法木单抗治疗,并全部减轻和应答。

用抗CD20药物治疗可以通过B细胞监测进行指导,并应当旨在实现完全减轻。2NDNR与抗利妥昔单抗抗体相关,并转化为人源化药物恢复减轻和反应。在SLE中,抗CD20抗体的替代物可能会更有效。

原始出处:

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beContent=null, objectType=article, channel=null, level=null, likeNumber=131, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=77962, encryptionId=15ece796246, topicName=细胞生物)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=eedf36252858, createdName=wetgdt, createdTime=Sat Feb 17 06:03:00 CST 2018, time=2018-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1273199, encodeId=39d412e31999a, content=<a href='/topic/show?id=310d383ef5' target=_blank style='color:#2F92EE;'>#B细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3837, encryptionId=310d383ef5, topicName=B细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6eba113, createdName=xiaoyeshuang, createdTime=Sun Jul 09 01:03:00 CST 2017, time=2017-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1345352, 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01:03:00 CST 2017, time=2017-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1387201, encodeId=0a40138e2011f, content=<a href='/topic/show?id=8a3a6814425' target=_blank style='color:#2F92EE;'>#狼疮#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68144, encryptionId=8a3a6814425, topicName=狼疮)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a6e2500005, createdName=sunrural_42825357, createdTime=Sun Jul 09 01:03:00 CST 2017, time=2017-07-09, status=1, ipAttribution=)]
    2017-11-22 wjywjy
  5. [GetPortalCommentsPageByObjectIdResponse(id=2016974, encodeId=c03220169e462, content=<a href='/topic/show?id=9760e69058c' target=_blank style='color:#2F92EE;'>#系统性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=142, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76905, encryptionId=9760e69058c, topicName=系统性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2b9b368, createdName=qingrejiedu, createdTime=Sun Dec 31 01:03:00 CST 2017, time=2017-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1758730, encodeId=18421e587308c, content=<a href='/topic/show?id=1a675894241' target=_blank style='color:#2F92EE;'>#无应答#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58942, encryptionId=1a675894241, topicName=无应答)], attachment=null, authenticateStatus=null, createdAvatar=null, 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01:03:00 CST 2017, time=2017-07-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1387201, encodeId=0a40138e2011f, content=<a href='/topic/show?id=8a3a6814425' target=_blank style='color:#2F92EE;'>#狼疮#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=118, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68144, encryptionId=8a3a6814425, topicName=狼疮)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a6e2500005, createdName=sunrural_42825357, createdTime=Sun Jul 09 01:03:00 CST 2017, time=2017-07-09, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=2016974, encodeId=c03220169e462, content=<a href='/topic/show?id=9760e69058c' target=_blank style='color:#2F92EE;'>#系统性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=142, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76905, encryptionId=9760e69058c, topicName=系统性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2b9b368, createdName=qingrejiedu, createdTime=Sun Dec 31 01:03:00 CST 2017, time=2017-12-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1758730, encodeId=18421e587308c, content=<a href='/topic/show?id=1a675894241' target=_blank style='color:#2F92EE;'>#无应答#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=109, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58942, encryptionId=1a675894241, topicName=无应答)], attachment=null, authenticateStatus=null, createdAvatar=null, 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  7. 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SLE患者常因为活动性SLE或感染住院,并在短时间内再入院。

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