Teprotumumab (Tepezza) 用於治療甲狀腺眼病變

Teprotumumab (Tepezza)
是Insulin-like gowth factor -1 (IGF-1) receptor 的人類單株抗體抑制劑
2020年1月被FDA approve用來治療TED

把IGF-1 receptor block掉可以減少發炎反應 使眼眶後組織增生回復 和眼框內 hyaluronan的製造
給法是每3周注射1次 總共8個療程

共79個病人完成phase 2 trial, 76個病人完成phase 3 trial (OPTIC trial)

Proptosis reductions >= 2mm without deterioration of the fellow eye at week 24
Intention- to -treat analysis (P<0.001)
- 77.4% with Teprotumumab
- 14.9% with placebo

Per-Protocal analysis (P<0.001)
-84.8%  with Teprotumumab
-17.1 % with placebo

Number needed to treat 1.6

Similar results were achieved across all subgroups of patients: those aged 65 and older versus younger than aged 65; male versus female; tobacco user versus nonuser; and US versus EU study centers (all P < .001).

Average decrease in proptosis (P < .001)
- Teprotumumab: 3.1 mm
- Placebo       0.4 mm 

實驗中沒有死亡但在teprotumumab組有7個嚴重副作用, Placebo組1個
其中
1例: 腹瀉 1例: 注射相關反應 1例:Hashimoto encephalopathy 使藥物中斷

Adverse event
- Teprotumumab 79.8%
- Placebo 69.8%

Teprotumumab組較多的包括 muscle spasms (25% vs 7%), nausea (17% vs 9%), alopecia (13% vs 8%), and diarrhea (12% vs 8%).
大部分在療程結束後會緩解

Antidrug antibodies有2位, 不常見


Reference:
Teprotumumab Eases Thyroid Eye Disease in All, Including Smokers - Medscape - Apr 22, 2020.

筆記: 肺炎鏈球菌疫苗

PCV 13

• 出生滿6周就可以打
• 結合在白喉CRM197蛋白質載體上 能誘發T細胞產生免疫記憶
• 抗體效價高
• 較貴 (3000+ NTD)

PPV 23

• 2歲以上可以打
• 較無免疫記憶
• 抗體效價較低 免疫力較不持久
• 較便宜(1000+NTD)

PCV 13--> PPV 23 間隔8週以上 (65歲以上隔1年)
PPV 23--> PCV 13 間隔1年以上
PPV 23--> PPV 23 間隔5年


公費: 75歲以上未曾打過可公費接種一劑 PPV23

Ref:
疾管署網站
台大醫院QA