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艾帕洛利托沃瑞利单抗致乙肝病毒再激活1例的药学监护
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| 篇名： | 艾帕洛利托沃瑞利单抗致乙肝病毒再激活1例的药学监护 |
| TITLE： | Pharmaceutical care of a case of hepatitis B virus reactivation induced by iparomlimab and tuvonralimab |
| 摘要： | 目的 介绍1例艾帕洛利托沃瑞利单抗致乙肝病毒（HBV）再激活的病例，汇总分析免疫检查点抑制剂（ICIs）致该不良反应的临床特点及潜在机制，为该药的临床使用提供参考。方法从临床药师角度出发，回顾性分析1例转移性宫颈癌患者使用艾帕洛利托沃瑞利单抗后出现HBV再激活的治疗过程，并进行不良反应相关性分析，总结ICIs致HBV再激活的临床特点、危险因素、潜在机制、治疗及药学监护要点。结果与结论该患者在使用艾帕洛利托沃瑞利单抗后出现HBV再激活及严重肝损伤，经停药、予甲泼尼龙等对症治疗后病情好转。经诺氏药物不良反应评估量表和我国《药品不良反应报告和监测管理办法》判断，艾帕洛利托沃瑞利单抗与HBV再激活的关联性为“很可能”，且为新的不良反应；艾帕洛利托沃瑞利单抗、紫杉醇与肝损伤的关联性均为“很可能”。接受抗病毒药物规范治疗的乙肝患者在接受ICIs治疗后出现HBV再激活实属罕见；HBV再激活与ICIs致免疫过度激活、破坏免疫平衡有关；临床可予糖皮质激素进行治疗，并行用药前风险评估、治疗期间相关指标监测等药学监护。 |
| ABSTRACT： | OBJECTIVE To report a case of hepatitis B virus （HBV） reactivation induced by iparomlimab and tuvonralimab， summarize the clinical characteristics and potential mechanisms of such adverse reactions induced by immune-checkpoint inhibitors （ICIs）， and provide references for clinical application. METHODS From the perspective of a clinical pharmacist， a retrospective analysis was conducted on the treatment course of a patient with metastatic cervical cancer who experienced HBV reactivation after receiving iparomlimab and tuvonralimab. Additionally， an analysis of the correlation with adverse reactions was performed， and the clinical characteristics， risk factors， potential mechanisms， key points of treatment approaches and pharmaceutical care associated with HBV reactivation induced by ICIs were summarized. RESULTS & CONCLUSIONS The patient developed HBV reactivation and severe liver injury after using iparomlimab and tuvonralimab. The condition improved following drug discontinuation， and symptomatic treatment such as glucocorticoids. According to Naranjo’s Assessment Scale and China’s Measures for the Reporting and Monitoring of Adverse Drug Reactions， the association between iparomlimab and tuvonralimab and HBV reactivation was judged as “highly probable”， and it was identified as a new adverse reaction； the correlation between iparomlimab and tuvonralimab， paclitaxel and liver injury was “highly probable”. HBV reactivation in hepatitis B patients receiving standardized antiviral therapy is very rare after ICIs treatment； HBV reactivation is related to the overactivation of the immune system and disruption of immune balance induced by ICIs. For such patients， glucocorticoids should be administered for treatment， accompanied by pharmaceutical care， including pre- medication risk assessment and monitoring of relevant indicators during treatment. |
| 期刊： | 2025年第36卷第24期 |
| 作者： | 李多慧；许静语；李林；张倩；唐丽琴；吴颖其 |
| AUTHORS： | LI Duohui，XU Jingyu，LI Lin，ZHANG Qian，TANG Liqin，WU Yingqi |
| 关键字： | 艾帕洛利托沃瑞利单抗；宫颈癌；乙肝病毒再激活；不良反应；药学监护 |
| KEYWORDS： | iparomlimab and tuvonralimab； cervical cancer； hepatitis B virus reactivation； adverse reactions；pharmaceutical |
| 阅读数： | 10 次 |
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