风湿

血小板受体激动剂可增高狼疮合并抗磷脂综合征患者的血栓风险

作者:GuittonZelie ,et al 翻译:北医三院柴静, 审校:赵金霞 来源:中国风湿病公众论坛 日期:2018-06-07
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         血小板受体激动剂可增高狼疮合并抗磷脂综合征患者的血栓风险

        摘要:目的:应用血小板受体激动剂(TPO-RAs)已经升级为ITP的二线治疗,但是这类药物在SLE相关的ITP中的有效性和安全性尚未验证。方法:该研究为2009年到2016年间的多中心回顾性队列研究。参与中心(n=11)为法国成人ITP国家网络中的二级或者三级医院。结果:纳入18例TPO-RAs治疗的SLE-ITP患者;10(55%)例aPL阳性,5例(27%)为明确的抗磷脂综合征。除1例患者外,所有(94%)患者均对TPO-RAs有反应。对TPO-RAs随访平均14.7个月后,4位患者中发生4例动脉栓塞事件(包括1例恶性APS)。在无APS或者aPLs患者中发生2例静脉血栓事件。结论:该研究提示SLE患者开始TPO-RA前应该进行系统的aPLs检查。aPL阳性患者,尤其是明确的APS或者抗凝治疗不是最佳治疗的患者,应该考虑其他治疗(如果可能)。

        附原文:ObjectivesThe use of thrombopoietin-receptor agonists (TPO-RAs) has increased as a second-line therapy in ITP, but the efficacy and safety of such drugs has not been evaluated in SLE-associated ITP.MethodsThis was a multicentre retrospective cohort study from 2009 to 2016. Participating centres (n = 11) were secondary- or tertiary-care hospitals belonging to the French national network for adult ITPResultsWe included 18 patients with SLE-ITP treated with TPO-RAs; 10 (55%) had aPL, 5 (27%) showing definite APS. Except for one patient, all(94%) achieved response with TPO-RAs overall. After a median follow-up of 14.7 months with TPO-RAs, four arterial thrombosis events (including one catastrophic APS) occurred in four patients. Two venous thrombosis events occurred in a patient without APS or aPLs.Conclusion Our results suggest that aPLs should be systematically screened before TPO-RA initiation in patients with SLE. With aPL positivity, alternative therapy should be discussed (if possible), especially in patients with definite APS or suboptimal adherence to anti-coagulation therapy.

        引自:GuittonZelie ,Terriou Louis ,Lega Jean-Christophe ,etal.Risk of thrombosis with anti-phospholipid syndrome in systemic lupus erythematosus treated with thrombopoietin-receptor agonists.Rheumatology (Oxford) 2018 May 10.

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