Hodkinson J P
Corporate Medical Affairs, Biotest AG, Dreieich, Germany.
Clin Exp Immunol. 2017 Jun;188(3):353-362. doi: 10.1111/cei.12955. Epub 2017 Apr 17.
Obesity is a very common condition; however, the effect of excess body weight on the appropriate dose of immunoglobulin has not been defined empirically. The proposed pharmacokinetic differences between lean and obese patients and the opportunity to reduce costs has led to the proposition that obese patients should receive proportionally lower doses of immunoglobulin once a certain threshold is reached. Here the theoretical factors which could affect dosing in obese patients are considered alongside the available empirical evidence. The available evidence indicates that obesity may affect the pharmacokinetics of immunoglobulin; however, the effect is likely to be too small to have a clinically important effect on dosing. Wide interpatient individuality and highly variable clinical need mean that obesity should not play a major factor in dosing considerations. However, patients who are obese are more likely to have multiple cardiovascular risk factors and their weight indicates a large dose. This puts these patients at a higher risk of adverse reactions, and therefore caution is advised.
肥胖是一种非常常见的情况；然而，超重对免疫球蛋白合适剂量的影响尚未通过经验确定。瘦人和肥胖患者之间拟议的药代动力学差异以及降低成本的机会，导致有人提出，一旦达到某个阈值，肥胖患者应按比例接受较低剂量的免疫球蛋白。本文将可能影响肥胖患者给药的理论因素与现有的经验证据一并加以考虑。现有证据表明，肥胖可能会影响免疫球蛋白的药代动力学；然而，这种影响可能太小，对给药没有临床重要影响。患者之间广泛的个体差异和高度可变的临床需求意味着肥胖不应在给药考虑中起主要作用。然而，肥胖患者更有可能有多种心血管危险因素，而且他们的体重表明需要大剂量用药。这使这些患者发生不良反应的风险更高，因此建议谨慎用药。
