Đánh giá hiệu quả điều trị của phác đồ có Eltrombopag trên bệnh nhân giảm tiểu cầu miễn dịch kháng corticoid

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Lê Cường Bùi, Thị Trang Bùi, Thị Thúy Đoàn, Thị Thúy Hà Hoàng, Dương Bích Trâm Huỳnh, Thanh Chương Lê, Thị Toàn Lê, Thị Ngọc Sang Nguyễn, Thanh Tùng Trần

Ngôn ngữ: vie

Ký hiệu phân loại: 571.964 +Immunochemistry and immune response

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2022

Mô tả vật lý: 410-415

Bộ sưu tập: Metadata

ID: 500810

Thêm vào giỏ

Đánh giá hiệu quả và tính an toàn của Eltrombopag, một chất đồng vận thụ thể throbopoietin đường uống ở những bệnh nhân giảm tiểu cầu miễn dịch (GTCMD) kháng corticoid. Đối tượng và phương pháp: Hồi cứu 43 bệnh nhân GTCMD kháng corticoid (28 nữ, 15 nam) theo dõi điều trị tại khoa Huyết học bệnh viện Chợ Rẫy từ 01/2019 đến 07/2022. Đáp ứng với điều trị được đánh giá dựa trên số lượng tiểu cầu (SLTC) (G/L), đáp ứng hoàn toàn (SLTC >
100 G/L), một phần (30 - 100 G/L hoặc tăng gấp đôi SLTC so với trước điều trị) hoặc không đáp ứng (SLTC <
30 G/L). Đặc điểm dịch tễ, giai đoạn bệnh, mức độ xuất huyết, đáp ứng điều trị là các đặc điểm được ghi nhận và phân tích các mối liên quan. Kết quả: Tuổi trung bình lúc điều trị 46,23 (giới hạn 16 - 87). Trong đó, giai đoạn mới chẩn đoán là 5 (11,6%), dai dẳng 11 (25,6%) và mạn tính 27 (62,8%). 83,7% bệnh nhân khởi động với liều Eltrombopag 50mg/ngày, 16,3% bệnh nhân sử dụng liều 25mg/ngày. Thời gian sử dụng thuốc Eltrombopag trung bình 7,3±7,4 tháng (giới hạn 1 - 36 tháng). Tỉ lệ đáp ứng chung với thuốc là 83,7% (n = 37). Đáp ứng hoàn toàn và một phần ghi nhận lần lượt là 26 bệnh nhân (60,5%) và 11 (25,6%). 6 bệnh nhân không đáp ứng với điều trị Eltrombopag. Thời gian đạt đáp ứng sau điều trị từ 1 đến 16 tuần, trung bình 3,44±3,12 tuần. 29/43 bệnh nhân giảm độ xuất huyết cho với trước điều trị. Trong số bệnh nhân đạt đáp ứng, số bệnh nhân được giảm liều thuốc, ngưng thuốc và giữ được đáp ứng điều trị sau ngưng thuốc lần lượt là 14, 10, 6. Có 21/43 bệnh nhân gián đoạn sử dụng thuốc. Khi so sánh về SLTC trước điều trị, Eltrombopag làm tăng SLTC đáng kể ở tuần điều trị thứ nhất, thứ hai, thứ ba, thứ tư và thứ tám sau điều trị. Kết luận: Kết quả của nghiên cứu đã cho thấy rằng Eltrombopag là một lựa chọn điều trị hiệu quả ở những bệnh nhân GTCMD kháng trị corticoid.The aim of the present study was to evaluate the efficacy of eltrombopag, an oral thrombopoietin receptor agonist, in patients with corticosteroid - resistant immune thrombocytopenia (ITP). Materials and Methods: A total of 43 corticosteroid- resistant ITP patients (28 women, 65.1%
98 men, 34.9%) followed in Cho Ray Hospital were enrolled in this retrospective cohort. Response to treatment was assessed according to platelet count (/mm3 ) and defined as complete (platelet count of >
100,000/mm3), partial (30,000-100,000/mm3 or doubling of platelet count after treatment), or unresponsive (<
30,000/mm3). Clinical findings, descriptive features, response to treatment. Correlations between descriptive, clinical, and hematological parameters were analyzed. Results:The median age at diagnosis was 46.23 (range: 3-95) years and the duration of follow-up was 18.0±6.4 (range: 6-28.2) months. newly diagnosed included 5 (11.6%), persistant 11 (25.6%) and chronic 27 (62.8%). Initial treatment with 50mg/day, 25 mg/day revolade were 83.7%, 16.3% respectively.. Overall response rate was 83.7% (n=36). Complete and partial responses were observed in 26 (60.5%) and 11 (25.6%) patients, respectively. Six patients did not respond to eltrombopag treatment. As the time required for partial or complete response increased, response to treatment was significantly reduced. The time to reach respond after treatment was between 1-16 weeks, mean 3,44±3,12 weeks. Treatment were interrupted in 21/43 patient. Considering thrombocyte count before treatment, eltrombopag significantly increased platelet count at the 1st, 2nd, 3rd, 4th, and 8th weeks of treatment. Conclusion:Results of the current study imply that eltrombopag is an effective therapeutic option even in aldult patients with corticosteroid-resistant ITP.

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