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肾小球疾病的治疗负担:免疫抑制治疗的进展与挑战

Treatment burden in glomerular diseases: advances and challenges in immunosuppressive therapy.

作者信息

Shankar Mythri, Lamech Tanuj Moses

机构信息

Department of Nephrology, Institute of Nephrourology, Bengaluru, Karnataka, India.

Department of Nephrology, SRM Medical College Hospital and Research Centre, Kattankulathur, Tamilnadu, India.

出版信息

Front Nephrol. 2025 May 1;5:1545373. doi: 10.3389/fneph.2025.1545373. eCollection 2025.

Abstract

Glomerular diseases represent a significant global health challenge, complicated by the intricate management required for their treatment. We examine the treatment burden associated with the immunosuppressive therapies used to manage these conditions, focusing on the efficacy, side effects, and financial implications of commonly used medications such as glucocorticoids, mycophenolate mofetil (MMF), cyclophosphamide, calcineurin inhibitors and Rituximab. Immunosuppressive treatments, while effective in controlling disease activity, can result in a variety of adverse effects ranging from gastrointestinal symptoms and bone marrow suppression to increased infection risks, necessitating careful monitoring and dose adjustments to mitigate these risks. Hence, the need for a balanced approach in therapy management, incorporating regular monitoring and potential dose modifications to enhance patient outcomes while minimizing side effects. Additionally, these treatments have an economic impact, particularly in lower-income regions where access to medication and the cost of medication can limit patient outcomes. There have been certain advancements in treatment modalities, such as the use of enteric-coated formulations and tailored dosing schedules, which aim to improve drug tolerability and adherence. By addressing these critical aspects, we aim to shed light on the ongoing challenges and developments in the management of glomerular diseases, emphasizing the need for continued research and innovation in therapeutic strategies to reduce the overall treatment burden and improve the quality of life for affected individuals.

摘要

肾小球疾病是一项重大的全球健康挑战,其治疗所需的复杂管理使其更加棘手。我们研究了用于治疗这些疾病的免疫抑制疗法所带来的治疗负担,重点关注常用药物(如糖皮质激素、霉酚酸酯(MMF)、环磷酰胺、钙调神经磷酸酶抑制剂和利妥昔单抗)的疗效、副作用和经济影响。免疫抑制治疗虽然能有效控制疾病活动,但可能导致从胃肠道症状、骨髓抑制到感染风险增加等各种不良反应,因此需要仔细监测和调整剂量以降低这些风险。因此,在治疗管理中需要采取平衡的方法,包括定期监测和可能的剂量调整,以改善患者预后并尽量减少副作用。此外,这些治疗具有经济影响,特别是在低收入地区,药物的可及性和成本可能会限制患者的治疗效果。在治疗方式上已经有了一些进展,例如使用肠溶制剂和定制给药方案,旨在提高药物耐受性和依从性。通过解决这些关键问题,我们旨在阐明肾小球疾病管理中持续存在的挑战和进展,强调在治疗策略方面持续研究和创新的必要性,以减轻整体治疗负担并改善受影响个体的生活质量。

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