液相色谱-质谱技术对利妥昔单抗及其类似药结构表征和相似性的研究

目的 应用液相色谱-质谱法(liquid chromatography-mass spectromety,LC/MS)和液相色谱-非数据依赖二级质谱数据采集技术(liquid chromatography-data independent acquisition mass spectromety,LC/MSE)对利妥昔单抗及其类似药进行结构表征和相似性研究.方法 用LC/MS对利妥昔单抗及其类似药的完整蛋白及轻链和重链的相对分子质量进行测定;用基于LC/MSE的肽图分析确定利妥昔单抗及其类似药的氨基酸全序列;用LC/荧光检测法分析利妥昔单抗的糖基化修饰结构及相对含量.结果 LC/MS可准确测定利妥昔单抗的相对分子质量.基于LC/MSE的肽图分析显示,利妥昔单抗的氨基酸序列覆盖率＞99％.LC/荧光检测法对利妥昔单抗的糖谱分析具有较好的重复性.利妥昔单抗类似药与原研药的相对分子质量和糖型信息相符、氨基酸序列完全一致、糖谱相似.结论 LC/MS和LC/MSE可用于利妥昔单抗及其类似药的结构表征和相似性比较,这为今后其他单克隆抗体结构表征平台的建立提供了依据.     

利妥昔单抗生物类似药——rituximab-abbs

Rituximab-abbs是利妥昔单抗的生物类似药,也是美国食品药品监督管理局批准的首个利妥昔单抗生物类似药,目前该药已相继在韩国、欧洲、美国以及加拿大上市,主要用于治疗成人非霍奇金淋巴瘤等血液系统恶性肿瘤、类风湿性关节炎以及肉芽肿性血管炎和显微镜下多血管炎。尽管生物类似药与原研药在结构及临床特性上均高度相似,但其有效性及安全性问题仍需予以重视。为加深临床工作者对该药的理解,本文针对其药理机制、药动学特性及临床应用等作一综述。     

测定人血清中利妥昔单抗及其生物类似物浓度ELISA方法的建立及验证

目的:建立和验证测定人血清中利妥昔单抗和生物类似物的酶联免疫吸附分析(ELISA)方法,用于生物类似药的药动学评估。方法:在96孔板中包被rat anti Rituximab (MCA2260)以捕获人血清中的抗CD20人鼠嵌合单抗(TQB2303)或者利妥昔单抗,加入生物素标记MCA2260与被捕获TQB2303或者利妥昔单抗结合,以链霉亲和素-辣根过氧化物酶偶联试剂作为检测试剂。从选择性、特异性、精密度和准确度、稀释线性、钩状效应和平行性等方面分别验证了本方法在定量分析人血清中利妥昔单抗和TQB2303浓度时的可靠性。结果:本方法检测利妥昔单抗和TQB2303的灵敏度为19. 53 ng·m L-1;用2个待测物5个浓度水平验证样品的数据,统计计算方法的批间精密度和准确度分别在10. 1%～22. 4%和1. 8%～6. 1%范围内;方法的选择性、特异性和2～2 000倍稀释范围内稀释线性均符合指导原则的要求;方法在1 000. 00～1 000 000. 00ng·m L-1浓度范围内无钩状效应,受试药物TQB2303的稳定性可以支持从样品采集到样品测定的整个过程。此外本实验用真...     

利妥昔单抗治疗B细胞濑巴现状

抗CD20单抗利妥昔单抗(rituximab)是治疗B细胞非霍奇金淋巴瘤(B-NHL)的单克隆抗体药物.文章介绍利妥昔单抗单药治疗、联合其他化疗药物治疗以及靶向放射免疫治疗B细胞非霍奇金淋巴瘤的疗效,研究提示,利妥昔单抗与其他化疗药物联合应用治疗B-NHL具有增效或协同作用,可显著提高疗效,延长缓解期.     

利妥昔单抗治疗B细胞淋巴瘤现状

抗CD20单抗利妥昔单抗（rituximab）是治疗B细胞非霍奇金淋巴瘤（B-NHL）的单克隆抗体药物。文章介绍利妥昔单抗单药治疗、联合其他化疗药物治疗以及靶向放射免疫治疗B细胞非霍奇金淋巴瘤的疗效，研究提示，利妥昔单抗与其他化疗药物联合应用治疗B-NHL具有增效或协同作用，可显著提高疗效，延长缓解期。     

重组嵌合抗CD20单抗PUM100单次给药药代动力学研究

目的:研究国产重组嵌合抗CD20单抗PUM100经静脉单次给药后在食蟹猴体内的药代动力学,与相同条件下利妥昔单抗的药代动力学参数进行比较,评价二者的生物等效性关系。方法:12只食蟹猴按体重均衡法分为4组,分别单次给予不同剂量(10,30 mg.kg-1)的PUM100和利妥昔单抗,在不同时间点采血分离血清,用ELISA法测定血清中药物浓度;根据非房室统计矩模型用WinNolin药代软件对测定结果进行曲线拟合并计算药代动力学参数。结果:食蟹猴经静脉推注单次给予不同剂量(10,30 mg.kg-1)的PUM100后,半衰期(t1/2)分别为(111.3±10.8)和(154.0±39.1)h,全身清除率(CL)与表观分布容积(Vss)较接近,C0及AUC0-inf与给药剂量正相关,且两个剂量对应时间点的血药浓度存在显著性差异;PUM100与等剂量利妥昔单抗的主要药代动力学参数无显著性差异。结论:PUM100与等剂量利妥昔单抗的血清药物浓度-时间曲线特征相同,说明PUM100在试验剂量范围内与利妥昔单抗具有生物等效性。     

曲妥珠单抗生物类似药质量“相似性评价标准”探讨

近年来,我国已经批准了多个生物类似药注册上市。在开展生物类似药药学研究与评价时,候选药与原研药的质量相似性是"生物类似药"药学研究的核心,也是其作为类似药开展注册临床试验及支持上市申请的基础和前提。但是,工业界与监管界在建立质量"相似性评价标准"面临诸多挑战,如:原研药物可获得批次有限;原研药物在其生命周期内可能发生质量漂移;不同厂家的关键质量属性的检测方法存在差异;用于评价标准制定的统计方法难于统一等。本文以曲妥珠单抗为例,系统整理了原研药生产企业及9家生物类似药生产企业累计的69批原研药数据并进行统计分析,结合产品关键质量属性的风险识别,拟定了曲妥珠单抗质量"相似性评价标准"。该标准经已披露的类似药质量数据验证了其合理性,以期为国内曲妥珠单抗生物类似药的药学开发与评价提供参考。     

标准化护理干预在利妥昔单抗治疗中的临床应用

目的：探讨标准化护理干预在预防利妥昔单抗治疗中不良反应的作用。方法对使用利妥昔单抗治疗的患者采用标准化护理干预,从而达到预防利妥昔单抗使用中的不良反应的目的。结果标准化护理干预有效的防止了利妥昔单抗药物的严重不良反应的发生,确保了患者的用药安全。结论标准化护量干预使患者满意度增加,护理工作的效率得到了提高,值得临床推广。     

利妥昔单抗对于非霍奇金淋巴瘤的治疗及其药物经济学

目的:阐述利妥昔单抗对于非霍奇金淋巴瘤的疗效和药物的不良反应,并尝试探讨其药物经济学。方法:借鉴国外的研究并结合本院血液科对于这方面的探索,采用非传统的药物经济学模式来评价利妥昔单抗的治疗方案。结果:从药物经济学的角度而言,利妥昔单抗联合环磷酰胺 多柔比星(阿霉素) 长春新碱 泼尼松(CHOP)方案治疗非霍奇金淋巴瘤较传统单用CHOP方案优势明显。结论:利妥昔单抗具有较好的疗效和安全性,也是治疗非霍奇金淋巴瘤较经济的方法。     

利妥昔单抗联合化疗治疗非霍奇金淋巴瘤的药物经济学评价

目的：系统评价利妥昔单抗联合化疗治疗非霍奇金淋巴瘤的药物经济学价值。方法：用计算机检索PubMed、ScienceDirect、Springer Link、Elsevier等英文数据库以及CNKI、维普、万方等中文数据库1998-2013年间公开发表的利妥昔单抗联合化疗治疗非霍奇金淋巴瘤的药物经济学评价文献,对文献质量、研究结果进行系统评价。结果：所有英文文献的ICER值均在各国的意愿支付范围内：国内外利妥昔单抗药物经济学评价在数据来源、研究方法等方面存在差异。结论：利妥昔单抗联合化疗治疗非霍奇金淋巴瘤在国外具有成本一效果;需开展高质量的研究来探索利妥昔单抗联合化疗治疗非霍奇金淋巴瘤在我国的经济性。     

利妥昔单抗联合自体外周血干细胞移植治疗非霍奇金淋巴瘤

目的：探讨利妥昔单抗联合自体外周血干细胞移植(autologous peripheral blood stem cell transplan- tation,APBSCT)治疗CD20阳性非霍奇金淋巴瘤(non-Hodgkin's lymphoma,NHL)的可行性和有效性。方法：对4例CD20阳性NHL病人进行了5次利妥昔单抗联合APBSCT的治疗。利妥昔单抗于使用动员药物的前2 d使用,375 mg·m~(-2)静脉注射1次,观察病人使用利妥昔单抗的不良反应、动员效果及移植后的造血重建、并发症、临床转归。结果：所有病人均对利妥昔单抗耐受良好,动员后可采得足量CD34~+细胞,植入后在8～11 d内达造血重建,粒缺期出现短暂低热,无出血表现。移植后所有病人已随访5～44 mo。结论：利妥昔单抗联合APBSCT治疗CD20阳性NHL是一种耐受良好及效果良好的方法。     

Combination chemotherapy and rituximab

Rituximab is a human-mouse chimeric monoclonal antibody that has demonstrated efficacy against non-Hodgkin's lymphoma (NHL). There is a powerful rationale for combining rituximab treatment with chemotherapeutic agents that have also shown efficacy in NHL, since the mechanisms of action are distinct and there is also evidence that rituximab may sensitize chemoresistant tumor cells to the actions of cytotoxic drugs. A study of rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) chemoimmunotherapy has been carried out in 40 patients with low-grade NHL. In the 35 patients who completed the study, the overall response rate was 100%, with 63% achieving a complete response. Median time to progression has not yet been reached at 47.2+ months. Molecular analysis (polymerase chain reaction) showed that CHOP plus rituximab (unlike CHOP alone) could completely clear blood and bone marrow of cells containing the bcl-2 gene translocation, a molecular marker of NHL cells. Rituximab can therefore add to the efficacy of CHOP without significantly increasing toxicity. A further study is underway to determine whether similar efficacy with less overall toxicity can be achieved using rituximab in combination with fludarabine.     

Rituximab in B-cell disorders other than non-Hodgkin's lymphoma

Rituximab is a human/mouse chimeric monoclonal antibody that binds to the CD20 antigen and is expressed at all stages of B-cell development. Rituximab has demonstrated efficacy as monotherapy and in combination with chemotherapy in the treatment of both indolent and aggressive non-Hodgkin's lymphoma (NHL). Rituximab treatment results in rapid depletion of B-cells and this has led to the consideration of other B-cell disorders as candidates for rituximab therapy. Recent studies have demonstrated the efficacy of rituximab in a variety of such disorders, including chronic lymphocytic leukemia (CLL), post-transplant lymphoproliferative disorder (PTLD), Waldenstr?m's macroglobulinemia (WM), multiple myeloma (MM), idiopathic thrombocytopenic purpura (ITP), hairy-cell leukemia (HCL) and cold agglutinin disease (CAD). In patients with CLL, increasing the dose and/or frequency of rituximab treatment has given improved response rates compared with the standard dose schedule used in NHL, and combination immunochemotherapy has yielded an overall response rate of 92% (with a 60% complete response rate). Clinical trials have also demonstrated evidence of efficacy for rituximab in PTLD, WM and relapsed or refractory ITP. Efficacy of rituximab in CAD and relapsed or refractory HCL has also been demonstrated in small studies and case reports. Available data thus indicate that rituximab can be an effective therapy in a wide range of CD20+ lymphoid disorders.     

利妥昔单抗治疗恶性淋巴瘤的进展

利妥昔单抗（人源化CD20单克隆抗体，商品名美罗华）是首个批准用于治疗表达CD20恶性淋巴省的单克隆抗体，广泛应用于低度恶性非雷奇金琳巴瘤（NHL）、侵袭性NHL，亦试用于霍奇金淋巴瘤（HL）及其他B细胞性恶性肿瘤。刊蚤昔单抗联合细胞毒性药物的疗效已在B细胞NHL的有关临床试验中得到证实。目前该药已被批准用于侵袭性淋巴瘤和惰性淋巴瘤的一线治疗，其维持治疗滤泡性淋巴瘤亦得出鼓舞人心的结果．利妥昔单抗已成为治疗B细胞性恶性淋巴瘤的重要手段之一。     

Population pharmacokinetics of rituximab with or without plasmapheresis in kidney patients with antibody-mediated disease

Aims

Both rituximab and plasmapheresis can be associated in the treatment of immune-mediated kidney diseases. The real impact of plasmapheresis on rituximab pharmacokinetics is unknown. The aim of this study was to compare rituximab pharmacokinetics between patients requiring plasmapheresis and others without plasmapheresis.

Methods

The study included 20 patients receiving one or several infusions of rituximab. In 10 patients, plasmapheresis sessions were also performed (between two and six sessions per patient). Rituximab concentrations were measured in blood samples in all patients and in discarded plasma obtained by plasmapheresis using an enzyme-linked immunosorbent assay method. Data were analysed according to a population pharmacokinetic approach.

Results

The mean percentage of rituximab removed during the first plasmapheresis session ranged between 47 and 54% when plasmapheresis was performed between 24 and 72 h after rituximab infusion. Rituximab pharmacokinetics was adequately described by a two-compartment model with first-order elimination. Plasmapheresis had a significant impact on rituximab pharmacokinetics, with an increase of rituximab clearance by a factor of 261 (95% confidence interval 146–376), i.e. from 6.64 to 1733 ml h⁻¹. Plasmapheresis performed 24 h after rituximab infusion decreased the rituximab area under the curve by 26%.

Conclusions

Plasmapheresis removed an important amount of rituximab when performed less than 3 days after infusion. The removal of rituximab led to a significant decrease of the area under the curve. This pharmacokinetic observation should be taken into account for rituximab dosing, e.g. an additional third rituximab infusion may be recommended when three plasmapheresis sessions are performed after the first rituximab infusion.     

利妥昔单抗在血液系统临床应用研究新进展

利妥昔单抗为人鼠嵌合型单克隆抗体,已被FDA批准用于复发或难治性的CD20阳性的B细胞低度恶性或滤泡型非霍奇金淋巴瘤(NHL)的治疗.它能特异性结合B淋巴细胞表面CD20抗原,杀伤体内的B淋巴细胞.临床主要用于治疗各种一线或二线B细胞NHL,可以单独应用,亦可与化疗药物联合应用,目前还尝试用于慢性淋巴细胞白血病、多发性骨髓瘤、特发行血小板减少性紫癜等的治疗.     

Rituximab in autologous stem cell transplantation for follicular lymphoma

Contamination of stem cell harvests with residual tumor cells is a significant problem hampering the success of autologous peripheral blood stem cell transplantation in non-Hodgkin's lymphoma (NHL). Techniques have therefore been introduced to attempt to remove these cells, either in vivo, prior to harvesting, or ex vivo, before reinfusion into the patient. Rituximab is a human-mouse chimeric anti-CD20 monoclonal antibody that has been administered to patients prior to stem cell harvesting, to purge the blood of residual malignant cells. Clinical studies have shown that rituximab is safe to use during stem cell mobilization since administration did not adversely affect the yield of CD34+ stem cells or the functional capability of these progenitors. Rituximab was also effective in purging stem cell harvests of malignant cells. Translocation of the bcl-2 gene was found in a significantly smaller proportion of stem cell harvests from patients who had received a purging infusion of rituximab than controls. Rituximab may also be useful as salvage therapy following post-transplant relapse or as maintenance therapy for patients in remission. Prospective randomized trials will ultimately define the role of rituximab in the autologous transplantation setting.     

Rituximab: as first-line maintenance therapy following rituximab-containing therapy for follicular lymphoma

Rituximab is a recombinant chimeric murine/human monoclonal IgG(1-κ) antibody. It binds specifically to the CD20 antigen on normal and malignant B lymphocytes and produces complement-dependent and antibody-dependent cytotoxicity and induces apoptosis in these cells. Prolonged treatment with rituximab in patients with follicular lymphoma results in a sustained reduction in circulating B lymphocytes. Two years of single-agent maintenance therapy with rituximab significantly prolonged progression-free survival (primary endpoint) compared with observation in patients with follicular lymphoma who were responsive to first-line induction therapy with rituximab plus chemotherapy. Furthermore, maintenance therapy with rituximab significantly delayed the time to the next antilymphoma treatment and the next chemotherapy compared with observation in these patients. Rituximab had an acceptable tolerability profile as single-agent maintenance therapy in patients with follicular lymphoma with no new or unexpected adverse events compared with induction therapy.     

利妥昔单抗生物类似药的超说明书用药病种遴选量化评估

目的 通过循证医学的方法对3个不同厂家利妥昔单抗进行超说明书用药病种药品遴选量化评估，为医疗机构合理用药及药品遴选提供依据。方法 参考《中国医疗机构药品评价与遴选快速指南》，通过收集3个不同厂家的利妥昔单抗（商品名：美罗华^®、汉利康^®、达伯华^®）药学特性、有效性、安全性、经济性、医保属性、基本药物、贮藏条件、药品有效期、全球使用情况和生产企业状况等数据，对利妥昔单抗在类风湿性关节炎（RA）、免疫性血小板减少症（ITP）、肉芽肿性/显微镜下多血管炎（GPA/MPA）中的应用进行遴选量化评估。结果 3种利妥昔单抗治疗RA中，美罗华^®得分64，达伯华^®得分70，汉利康^®得分为72，治疗RA时可优选汉利康^®；3种利妥昔单抗治疗ITP及GPA/MPA中，达伯华^®得分最高，分别为68及71，治疗ITP及GPA/MPA可优选达伯华。结论 3种利妥昔单抗均可进入医院用药目录，治疗RA推荐汉利康^®，治疗GPA/MPA推荐达伯华^®，治疗ITP弱推荐达伯华^®。