一种bstract
Considerations in managing FDG PET-positive sarcoidosis with infliximab therapyhttp://ow.ly/u0qur
From the authors:
我们感兴趣地阅读了Mohapatra及其同事关于我们的论文“英夫利昔单抗在难治性FDG FDG宠物阳性结节病中的有效性” [[1]。我们同意智慧h Mohapatra and colleagues that the term refractory sarcoidosis is still under discussion. We defined refractory sarcoidosis in the methods section as “patients with severe sarcoidosis, unresponsive to first- and second-line treatment, or who have experienced severe side-effects from these agents”. Diagnosis of sarcoidosis was made according to American Thoracic Society/European Respiratory Society criteria [2], including biopsy. These criteria also describe exclusion of other differential diagnoses. Using the described definition for refractory sarcoidosis yields a very heterogeneous group of patients, consisting of sarcoidosis patients that need third line immunosuppressive therapies,例如biologicals such as infliximab.
mohapatra and colleagues also mention the costs of routinely performing 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) scans in sarcoidosis. Because of costs, but also radiation exposure, we do not recommend routine use of FDG PET scans in all patients with sarcoidosis. However, infliximab is a very expensive drug and our study does show additional benefit of performing an FDG PET scan prior to the start of treatment to predict treatment response [1]。我们认为,这证明了在某些严重结节病患者中使用FDG PET进行个性化治疗决策。
此外,作者指出了用英夫利昔单抗治疗的患者结核病的风险。我们同意英夫利昔单抗治疗与结核病的重新激活的风险增加有关[3]。therefore, all patients were screened for active or latent tuberculosis prior to treatment initiation, as noted in the exclusion criteria in the methods section [1]。通过干扰素释放测定法进行筛查,任何患者均未发现潜在或活性结核病。然而,在荷兰,结核病不是地方性的,在世界其他地区,这个问题可能有所不同[4]。
最后,作者提出了一个关于结节病的病因的非常有趣的问题,并提及mycobacterium tuberculosisas one of the aetiological agents for sarcoidosis. Although the aetiology of sarcoidosis remains unresolved, we agree that mycobacterial antigens are an interesting candidate [5]。However, many other infectious causes, such as fungi,疏螺旋体,,,,and痤疮丙酸杆菌以前已证明与结节病有关6-9]。此外,非传染性原因,例如无机物质和遗传学,也与这种疾病的病因有关[6,,,,10]。一种s current treatment for sarcoidosis, including infliximab, is not considered curative and merely reduces inflammation, elusive insights into disease aetiology will probably lead to new, possibly curative therapies in the future [11]。
Footnotes
利益冲突:没有声明。
- Received一种ugust 28, 2015.
- 公认september 1, 2015.
- Copyright ©ERS 2016