5PSQ-146膦甲酸酯的“实际生活”有效性和安全性评价

A. Perez, A. Pueyo, J. P. Pascual, A. C. Navasal, L. C. Poderoso, M. Moreno, A. P. Rello, A. Martínez, R. A. Sazatornil
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引用次数: 0

摘要

背景和重要性巨细胞病毒(CMV)感染是导致死亡的重要原因,特别是在血液病患者中。Foscarnet已被用于治疗更昔洛韦耐药巨细胞病毒感染。迄今为止,仅有少数评估膦甲酸酯安全性和有效性的研究报告。目的评价磷磷在某三甲医院治疗巨细胞病毒感染的有效性和安全性。材料与方法对2018年1月至2020年4月接受氟膦酸钠治疗巨细胞病毒血症的患者进行回顾性观察研究。收集的变量包括:年龄、性别、病理、治疗时间、模式、基础(开始使用foscarnet)和最终(停用foscarnet时)病毒载量(VL)、基础和最低点肾小球滤液(GF)和代谢毒性(基础和最低点血清电解质)。结果由电子病历和处方软件(Farmatools)获得。结果39例患者,男性22例,平均年龄55.8±14.9岁(26 ~ 82岁)。71.8%为血液病患者,其中41.0%接受过骨髓移植。平均治疗时间11±6.6 d(1-27)。69.2%的患者给药模式为90mg /kg/ 12h。23.0%的患者在VL检测不到的情况下开始预防性治疗。在其余患者中,中位基础VL为1135 IU/mL(3.34-65400), 46.1%的患者无法检测到最终VL,而在没有负面影响的患者中,中位最终VL为215 IU/mL(34.5-6690)。VL平均降低90.4±17.9%(18-100)。GF减少64.1%(65岁以上平均减少25.6±21.2%和36.7±22.0%)。代谢毒性,根据CTCAE分级(V.4.0),研究了低钾血症(10.2%的患者为1级,33.3%的患者为2级和3级,5.1%的患者为4级,其余未改变)和低磷血症(10.2%的患者为1级,33.3%的患者为2级和3级,2.5%的患者为4级)。此外,还观察到低镁血症(12.8%为1级)和低钙血症(28.2%为2级,33.3%为3级)。41.0%的患者在氟膦酸钠治疗期间或治疗后立即死亡。平均年龄61±14.4(27-82)岁,81.2%出现血液学病理。结论及相关性尽管观察到高死亡率,但磷膦酸钠能有效减少巨细胞病毒感染引起的病毒血症,病毒阴性率高。需要进一步的研究来扩展毒性数据并提高护理质量。参考文献和/或致谢利益冲突无利益冲突
本文章由计算机程序翻译,如有差异,请以英文原文为准。
5PSQ-146 ‘Real life’ effectiveness and safety assessment of foscarnet
Background and importance Cytomegalovirus (CMV) infection is an important cause of mortality, especially in haematological patients. Foscarnet has been used to treat ganciclovir resistant CMV infections. Only a few studies assessing safety and effectiveness of foscarnet have been reported so far. Aim and objectives To evaluate the effectiveness and safety of foscarnet in the treatment of CMV infection in a third level hospital. Material and methods A retrospective observational study was conducted in patients who received foscarnet as treatment for CMV viraemia from January 2018 to April 2020. Variables collected were: age, sex, pathology, time of treatment, pattern, basal (start of foscarnet) and final (when foscarnet was suspended) viral load (VL), basal and nadir glomerular filtrate (GF) and metabolic toxicity (basal and nadir serum electrolytes). The results were obtained from the electronic history and prescription software (Farmatools). Results 39 patients, 22 men, were included, and mean age was 55.8±14.9 years (26–82). 71.8% were haematological patients, of whom 41.0% had received bone marrow transplantation. Mean time in treatment was 11±6.6 days (1–27). The dosage pattern was 90 mg/kg/12 hours in 69.2%. 23.0% started treatment as prophylaxis with undetectable VL. In the remaining patients, median basal VL was 1135 IU/mL (3.34–65400), final VL was undetectable in 46.1% and in those who did not negatively affect the median final VL was 215 IU/mL (34.5–6690). Mean reduction in VL was 90.4±17.9% (18–100). There was a 64.1% reduction in GF (mean reduction of 25.6±21.2% and 36.7±22.0% over >65 years). Metabolic toxicity, according to the CTCAE classification (V.4.0), hypokalaemia (grade 1 in 10.2% patients, grades 2 and 3 in 33.3%, grade 4 in 5.1% and the rest were not altered) and hypophosphataemia (grade 1 in 10.2%, grades 2 and 3 in 33.3% and grade 4 in 2.5%) were studied. In addition, hypomagnesaemia (grade 1 in 12.8%) and hypocalcaemia (grade 2 in 28.2% and grade 3 in 33.3%) were also observed. 41.0% of patients died during or immediately after treatment with foscarnet. Their average age was 61±14.4 (27–82) years and 81.2% presented haematological pathologies. Conclusion and relevance Despite the high mortality observed, foscarnet effectively reduced viraemia due to CMV infection, with a high rate of viral negativisation. Further studies are needed to extend the toxicity data and improve the quality of care. References and/or acknowledgements Conflict of interest No conflict of interest
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