하이닥

안녕하세요.

저는 약 10여년전 itp가 발병하였고, 스테로이드로 질병이 잘 조절되지 않아 리툭시맙 치료를 받았습니다. 이후 7년 정도 스테로이드 치료없이 정상수치를 유지하였고, 그러다 반년 전 다시 재발(수치8000)하여 곧바로 리툭시맙 재치료를 했습니다.

재치료 이후 현재까지 혈소판 15-20만 이상의 정상수치를 유지중입니다.

약물 내성에 관하여 몇 가지 질문드릴 것이 있는데요.

1. 리툭시맙도 내성이 생길 수 있다고 하는데, 혹시 itp에서의 내성 발현이 빈번하게 나타나는 것일까요?

아래는 itp에 리툭시맙 재치료를 한 연구자료인데요.

Overall, 28 patients with relapse received retreatment with rituximab 12 to 68 months after the first course of rituximab: 19 patients received two courses, five patients received three courses, one patient received four courses and three patients received five courses. The response to retreatment was not evaluable in two patients, including one who received rituximab at last follow-up and another who received concurrent treatment with a thrombopoietin receptor agonist. In the two patients with no response to rituximab at the first course, retreatment also resulted in no response. Among the 24 evaluable patients with response to the first course, 22 (92%) showed response to the second course. In 19 patients (79%), the pattern of response (CR or R) was similar to the first course (17 CR, 2 R), it was worse (from CR to R) in one patient and was better in the remaining two (from R to CR, Figure S1A). The median duration of the response to retreatment in the 22 responders was 23 [12.25-27.75] months for the first course and 23.5 [13-36] months for the retreatment. The duration of response to retreatment was similar (±3 months) to the first course in three patients; was increased in 12 patients (54%, with a median increase of 14.5 [10-21.25] months); and was decreased in five patients (with a median decrease of 14 [10-21] months, Figure S1B). Nine patients with CR after retreatment and thereafter showed relapse received 16 other rituximab courses (one to three new retreatments). At the end of follow-up, 14 (50%) patients showed sustained response after one (n = 8) to four additional courses of rituximab, at a median follow-up of 75.5 [64.25-79.75] months after the first infusion, and after a median follow-up of 30 [16.25-39.25] months after the last rituximab infusion. The safety was good, and only three patients had a new infectious event (patients 6, 16 and 20, Table 1). None died.

요컨데 최초 반응 환자군에서 재치료 시 "1)반응패턴 유사한 경우가 많고, 2)관해유지기간은 비슷하거나 늘어나는 경우가 많다"고 하는데,

만약 itp에 대한 리툭시맙의 내성발현이 일반적이라면 재치료 시 관해유지기간이 짧아진다는 결론이 도출되어야 맞는 것 같은데..

이러한 추정이 타당한가요?

2. 내성발현이 일반적이지 않다면 수년 이상의 텀을 두고 '리툭시맙을 유지요법 수단?'정도로 고려하여 치료전략을 설정하는 것도 유효할까요?

완치되었다고 생각했는데.. 갑자기 재발을 해버렸습니다 ㅠㅠ

만약 또 재발을 해도, 이 약을 써서 효과성이 나타날 수 있다면 좋은 치료전략일 것 같아 질문드립니다.

질문이 너무 길어 죄송스럽네요. 읽어주셔서 감사합니다.

https://onlinelibrary.wiley.com/doi/full/10.1002/ajh.25632 위 글의 원문입니다..