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度伐利尤单抗致重度皮肤毒性反应1例的药学监护
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| 篇名： | 度伐利尤单抗致重度皮肤毒性反应1例的药学监护 |
| TITLE： | Pharmaceutical care for a case of severe dermal toxicity induced by durvalumab |
| 摘要： | 目的 为正确识别、应对度伐利尤单抗致免疫相关皮肤毒性反应（irCAEs）及保障临床用药安全提供参考。方法临床药师参与度伐利尤单抗致1例胆囊癌患者发生irCAEs的诊治过程，通过系统查阅患者既往史、用药史，协助医生判断该不良反应与所用药物的关联性；同时，临床药师对该不良反应进行分级评估，提出停用度伐利尤单抗、调整糖皮质激素用法等建议，协助医生重启免疫治疗，并开展用药宣教等药学监护。结果该患者irCAEs的发生“很可能”与度伐利尤单抗相关，且为重度。医生采纳临床药师意见，患者经对症治疗后皮肤症状好转，带药出院。待患者糖皮质激素治疗结束后，医生以替雷利珠单抗重启免疫治疗，患者未再发生相关不良反应。结论度伐利尤单抗可导致重度皮肤斑丘疹等irCAEs。临床应及时寻找并停用可疑药物，立即采取有效的对症治疗措施并积极重启免疫治疗，以保证患者治疗的延续性和安全性。 |
| ABSTRACT： | OBJECTIVE To provide references for the accurate identification and management of immune-related cutaneous adverse events （irCAEs） caused by durvalumab， and ensuring safe clinical drug use. METHODS Clinical pharmacists participated in the diagnosis and treatment process of a patient with gallbladder cancer who developed irCAEs caused by durvalumab. The clinical pharmacists systematically reviewed the patient’s past medical history and medication history， and assisted physicians in assessing the association between adverse drug reactions and administered drugs. Meanwhile， the clinical pharmacists conducted a graded assessment of the adverse reaction， proposed recommendations such as discontinuing durvalumab and adjusting the administration regimen of glucocorticoids， assisted physicians in restarting immunotherapy， and carried out medication education and other pharmaceutical care. RESULTS The occurrence of irCAEs in this patient was “highly likely” related to durvalumab and was classified as severe. The physicians adopted the clinical pharmacist’s opinion， and after symptomatic treatment， the patient’s skin symptoms improved， and discharged with medication. After the completion of glucocorticoid therapy for the patient， the physician restarted immunotherapy with tislelizumab， and no related adverse reactions occurred again in the patient. CONCLUSIONS Durvalumab can cause irCAEs such as severe skin maculopapular rash. In clinical practice， it is crucial to promptly identify and discontinue suspicious drugs， immediately implement effective symptomatic treatment measures， and actively resume immunotherapy to ensure the continuity and safety of the patient’s treatment. |
| 期刊： | 2026年第37卷第01期 |
| 作者： | 季留连；覃正碧；柳鹏程；邓晓文；刘丽丽；姚立娟；刘婷婷；顾萍辰 |
| AUTHORS： | JI Liulian，QIN Zhengbi，LIU Pengcheng，DENG Xiaowen，LIU Lili，YAO Lijuan，LIU Tingting，GU Pingchen |
| 关键字： | 度伐利尤单抗；免疫相关皮肤毒性反应；药学监护；免疫检查点抑制剂 |
| KEYWORDS： | durvalumab； immune-related cutaneous adverse events； pharmaceutical care； immune checkpoint inhibitors |
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