2001 年至 2018 年美国治疗格林-巴利综合征的静脉注射免疫球蛋白和血浆置换处方模式。

IF 2.8 3区 医学 Q2 CLINICAL NEUROLOGY Muscle & Nerve Pub Date : 2024-12-01 Epub Date: 2024-09-26 DOI:10.1002/mus.28265
Amro M Stino, Evan L Reynolds, Maya Watanabe, Brian C Callaghan
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引用次数: 0

摘要

导言/目的:随机对照试验表明,重复静脉注射免疫球蛋白(IVIG)和血浆置换(PLEX)后再注射 IVIG(联合疗法)对格林-巴利综合征(GBS)无应答者没有额外的治疗效果。此外,如何区分 GBS 和急性起病型 CIDP(A-CIDP)尤其具有挑战性,并对治疗产生影响。我们的目的是评估是否存在重复使用 IVIG、联合治疗以及从 GBS 到 CIDP 的诊断重新分类:我们对 2001 年至 2018 年美国 GBS 患者的大型医疗数据库进行了一项回顾性研究。我们确定了最初被诊断为 GBS,后来又被重新分类为 CIDP 的患者。我们建立了多变量逻辑回归模型,以确定患者因素与重复IVIG用药、联合治疗以及从GBS到CIDP的诊断重新分类之间的关联:我们发现了 2325 名 GBS 患者。共有39.7%的患者接受了重复IVIG治疗,6.1%的患者接受了联合治疗。最初被诊断为 GBS 后又被重新分类为 CIDP 的患者比例为 32.0%。随着时间的推移,重复IVIG、联合疗法和诊断重新分类保持稳定。女性(OR 0.79,95% CI 0.65-0.96)和中高净值(OR 0.64,95% CI 0.45-0.90)与重复IVIG治疗有关,而亚洲人种与诊断从GBS重新分类为CIDP有关(OR 1.77,95% CI 1.09-2.86):讨论:在较新的试验表明对无应答者有害之前,重复使用IVIG在GBS中非常普遍,尽管有强有力的证据表明无应答者不宜使用IVIG/PLEX联合疗法,但该疗法仍在继续。此外,近三分之一最初被诊断为 GBS 的患者随后被诊断为 CIDP,但原因尚不清楚。
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Intravenous immunoglobulin and plasma exchange prescribing patterns for Guillain-Barre Syndrome in the United States-2001 to 2018.

Introduction/aims: Randomized controlled trials show that repeat intravenous immunoglobulin (IVIG) dosing and plasma exchange (PLEX) followed by IVIG (combination therapy) have no additional therapeutic benefit in Guillain-Barre Syndrome (GBS) non-responders. Furthermore, the delineation between GBS and Acute Onset CIDP (A-CIDP) can be particularly challenging and carries therapeutic implications. We aimed to evaluate the presence of repeat IVIG, combination therapy, and diagnostic reclassification from GBS to CIDP.

Methods: We performed a retrospective study of a large healthcare database for patients with GBS in the US from 2001 to 2018. We identified individuals initially diagnosed with GBS and later re-classified as CIDP. Multivariable logistic regression models were developed to determine associations between patient factors and repeat IVIG dosing, combination therapy, and diagnostic re-classification from GBS to CIDP.

Results: We identified 2325 patients with GBS. A total of 39.7% received repeat IVIG and 6.1% received combination therapy. The proportion of individuals initially diagnosed with GBS and then re-classified as CIDP was 32.0%. Repeat IVIG, combination therapy, and diagnostic reclassification remained stable over time. Female sex (OR 0.79, 95% CI 0.65-0.96) and medium-high net worth (OR 0.64, 95% CI 0.45-0.90) associated with repeat IVIG therapy, while Asian ethnicity associated with diagnostic re-classification from GBS to CIDP (OR 1.77, 95% CI 1.09-2.86).

Discussion: Repeat IVIG dosing was quite common in GBS before newer trials suggesting harm in non-responders, and IVIG/PLEX combination therapy continues to persist despite strong evidence against use in non-responders. Further, nearly one in three patients initially diagnosed with GBS is subsequently diagnosed with CIDP, but the reasons are unclear.

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来源期刊
Muscle & Nerve
Muscle & Nerve 医学-临床神经学
CiteScore
6.40
自引率
5.90%
发文量
287
审稿时长
3-6 weeks
期刊介绍: Muscle & Nerve is an international and interdisciplinary publication of original contributions, in both health and disease, concerning studies of the muscle, the neuromuscular junction, the peripheral motor, sensory and autonomic neurons, and the central nervous system where the behavior of the peripheral nervous system is clarified. Appearing monthly, Muscle & Nerve publishes clinical studies and clinically relevant research reports in the fields of anatomy, biochemistry, cell biology, electrophysiology and electrodiagnosis, epidemiology, genetics, immunology, pathology, pharmacology, physiology, toxicology, and virology. The Journal welcomes articles and reports on basic clinical electrophysiology and electrodiagnosis. We expedite some papers dealing with timely topics to keep up with the fast-moving pace of science, based on the referees'' recommendation.
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