請用此 Handle URI 來引用此文件：
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/52531完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 朱家瑜(Chia-Yu Chu) | |
| dc.contributor.author | Yi-Chun Hsieh | en |
| dc.contributor.author | 謝宜均 | zh_TW |
| dc.date.accessioned | 2021-06-15T16:17:40Z | - |
| dc.date.available | 2020-08-26 | |
| dc.date.copyright | 2020-08-26 | |
| dc.date.issued | 2019 | |
| dc.date.submitted | 2020-08-11 | |
| dc.identifier.citation | Anandan, V., Jameela, W. A., Sowmiya, R., Kumar, M. M. S., Lavanya, P. (2017). Rituximab: A Magic Bullet for Pemphigus. Journal of clinical and diagnostic research : JCDR, 11(4), WC01-WC06. doi:10.7860/JCDR/2017/21868.9717 Chen, D. M., Odueyungbo, A., Csinady, E., Gearhart, L., Lehane, P., Cheu, M., . . . Joly, P. (2019). Rituximab is an effective treatment in patients with pemphigus vulgaris and demonstrates a steroid-sparing effect. Br J Dermatol. doi:10.1111/bjd.18482 Cho, Y. T., Chu, C. Y., Wang, L. F. (2015). First-line combination therapy with rituximab and corticosteroids provides a high complete remission rate in moderate-to-severe bullous pemphigoid. Br J Dermatol, 173(1), 302-304. doi:10.1111/bjd.13633 Didona, D., Maglie, R., Eming, R., Hertl, M. (2019). Pemphigus: Current and Future Therapeutic Strategies. Front Immunol, 10, 1418. doi:10.3389/fimmu.2019.01418 Freeman, C. L., Sehn, L. H. (2018). A tale of two antibodies: obinutuzumab versus rituximab. Br J Haematol, 182(1), 29-45. doi:10.1111/bjh.15232 Groves, R. W. (2009). Pemphigus: a brief review. Clin Med (Lond), 9(4), 371-375. doi:10.7861/clinmedicine.9-4-371 Hertl, M., Jedlickova, H., Karpati, S., Marinovic, B., Uzun, S., Yayli, S., . . . Jonkman, M. F. (2015). Pemphigus. S2 Guideline for diagnosis and treatment--guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV). J Eur Acad Dermatol Venereol, 29(3), 405-414. doi:10.1111/jdv.12772 James, K. A., Culton, D. A., Diaz, L. A. (2011). Diagnosis and clinical features of pemphigus foliaceus. Dermatologic clinics, 29(3), 405-viii. doi:10.1016/j.det.2011.03.012 Joly, P., Maho-Vaillant, M., Prost-Squarcioni, C., Hebert, V., Houivet, E., Calbo, S., . . . Musette, P. (2017). First-line rituximab combined with short-term prednisone versus prednisone alone for the treatment of pemphigus (Ritux 3): a prospective, multicentre, parallel-group, open-label randomised trial. Lancet, 389(10083), 2031-2040. doi:10.1016/s0140-6736(17)30070-3 Kanwar, A. J., Vinay, K., Sawatkar, G. U., Dogra, S., Minz, R. W., Shear, N. H., . . . Hashimoto, T. (2014). Clinical and immunological outcomes of high- and low-dose rituximab treatments in patients with pemphigus: a randomized, comparative, observer-blinded study. Br J Dermatol, 170(6), 1341-1349. doi:10.1111/bjd.12972 Kasperkiewicz, M., Ellebrecht, C. T., Takahashi, H., Yamagami, J., Zillikens, D., Payne, A. S., Amagai, M. (2017). Pemphigus. Nat Rev Dis Primers, 3, 17026. doi:10.1038/nrdp.2017.26 Kasperkiewicz, M., Shimanovich, I., Meier, M., Schumacher, N., Westermann, L., Kramer, J., . . . Schmidt, E. (2012). Treatment of severe pemphigus with a combination of immunoadsorption, rituximab, pulsed dexamethasone and azathioprine/mycophenolate mofetil: a pilot study of 23 patients. Br J Dermatol, 166(1), 154-160. doi:10.1111/j.1365-2133.2011.10585.x Kridin, K. (2018). Pemphigus group: overview, epidemiology, mortality, and comorbidities. Immunol Res, 66(2), 255-270. doi:10.1007/s12026-018-8986-7 Kridin, K., Zelber-Sagi, S., Bergman, R. (2017). Pemphigus Vulgaris and Pemphigus Foliaceus: Differences in Epidemiology and Mortality. Acta Derm Venereol, 97(9), 1095-1099. doi:10.2340/00015555-2706 Kushner, C. J., Wang, S., Tovanabutra, N., Tsai, D. E., Werth, V. P., Payne, A. S. (2019). Factors Associated With Complete Remission After Rituximab Therapy for Pemphigus. JAMA Dermatol. doi:10.1001/jamadermatol.2019.3236 Lunardon, L., Tsai, K. J., Propert, K. J., Fett, N., Stanley, J. R., Werth, V. P., . . . Payne, A. S. (2012). Adjuvant rituximab therapy of pemphigus: a single-center experience with 31 patients. Arch Dermatol, 148(9), 1031-1036. doi:10.1001/archdermatol.2012.1522 MacIsaac, J., Siddiqui, R., Jamula, E., Li, N., Baker, S., Webert, K. E., . . . Arnold, D. M. (2018). Systematic review of rituximab for autoimmune diseases: a potential alternative to intravenous immune globulin. Transfusion, 58(11), 2729-2735. doi:10.1111/trf.14841 Mark Ballow, M. A. F., MD. (2019). Secondary immunodeficiency induced by biologic therapies. Retrieved from https://www.uptodate.com/contents/secondary-immunodeficiency-induced-by-biologic-therapies?search=rituximab sectionRank=1 usage_type=default anchor=H447873800 source=machineLearning selectedTitle=5~146 display_rank=4#H447873800 Murrell, D. F., Dick, S., Ahmed, A. R., Amagai, M., Barnadas, M. A., Borradori, L., . . . Werth, V. P. (2008). Consensus statement on definitions of disease, end points, and therapeutic response for pemphigus. J Am Acad Dermatol, 58(6), 1043-1046. doi:10.1016/j.jaad.2008.01.012 Murrell, D. F., Pena, S., Joly, P., Marinovic, B., Hashimoto, T., Diaz, L. A., . . . Werth, V. P. (2020). Diagnosis and management of pemphigus: Recommendations of an international panel of experts. J Am Acad Dermatol, 82(3), 575-585.e571. doi:10.1016/j.jaad.2018.02.021 Ruocco, V., Ruocco, E., Lo Schiavo, A., Brunetti, G., Guerrera, L. P., Wolf, R. (2013). Pemphigus: etiology, pathogenesis, and inducing or triggering factors: facts and controversies. Clin Dermatol, 31(4), 374-381. doi:10.1016/j.clindermatol.2013.01.004 Schmidt et al. (2019). Pemphigus. The Lancet, 394(10201), 882-894. doi:https://doi.org/10.1016/S0140-6736(19)31778-7 Suran L. Fernando, J. L. a. M. S. (2013). In Pemphigus Vulgaris and Pemphigus Foliaceus. Wang, H. H., Liu, C. W., Li, Y. C., Huang, Y. C. (2015). Efficacy of rituximab for pemphigus: a systematic review and meta-analysis of different regimens. Acta Derm Venereol, 95(8), 928-932. doi:10.2340/00015555-2116 | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/52531 | - |
| dc.description.abstract | 天疱瘡是一種罕見的自體免疫疾病，好發於中年人。其主要特點會在皮膚或黏膜上出現水疱、疼痛的破皮傷口，甚至皮膚糜爛。天疱瘡主要是因為患者體內產生了對抗表皮的自體免疫抗體，而攻擊原本正常的表皮，特別是細胞膜表面的蛋白desmoglein 1 (Dsg 1) 與desmoglein 3 (Dsg 3)而導致表皮細胞鬆解。臨床上可以觀察到很多因反覆性口腔潰瘍、長時間無法治癒而到皮膚科求診的案例，患者也可以合併有皮膚淺層的水疱與潰瘍。病理切片下會看到棘狀層分解形成的表皮內水疱，免疫螢光染色下則可見到表皮細胞間呈現網狀排列之免疫球蛋白沉積。
天疱瘡目前的主流治療方式是使用高劑量的類固醇。這是最常使用，療效也最快的治療方式；近年來，抗CD20 抗體生物製劑「莫須瘤(rituximab)」則成為新的治療方式。它是一種單株抗體，首先在1997 年於美國核准用於治療淋巴癌，它在B 淋巴細胞上與CD20 抗原結合後促使B 細胞溶解，可以有效除去淋巴球中的B 細胞，因此可用於治療自體免疫疾病。多篇研究指出「莫須瘤(rituximab)」可以有效治療天疱瘡，美國食品藥物管理局(FDA)亦於2018 年6月7 日核准該藥使用於尋常型天疱瘡之適應症，惟最佳劑量尚未有隨機分配之臨床試驗證實，故筆者以系統性文獻回顧與統合分析探討現有臨床數據後，設計一隨機分派、開放性臨床試驗，用以確定不同劑量模式之「莫須瘤(rituximab)」使用於天疱瘡病人的療效性與安全性。 | zh_TW |
| dc.description.abstract | Pemphigus is a rare, yet life-threatening disease. It is characterized by erosions andblisters on the skin and mucous membranes. The disease often occurs in middle agedpeople. The surface of keratinocytes is targeted by autoantibodies against antigens onthe skin. Two main desmogleins are associated with this autoimmune intraepithelialblistering skin disease, desmoglein 1 and desmoglein 3. The antibody directed against epidermal adhesion complexes (desmosomes) leads to loss of cell cell adhesion, a phenomenon called acantholysis.
Some patients suffer from oral ulcers at first, then blisters which are flaccid and are easily broken, leading to often-painful lesions or erosions on the skin. Direct immunofluorescence(DIF) examination may show the presence of intercellular deposition ofimmunoglobulins. Systemic corticosteroids have been the mainstay of pemphigus therapy for many years. An anti-CD 20 antibody, rituximab, acts by depleting B cells, has shown efficacy in patients with pemphigus subjects. It has also been approved by the U.S. Food and Drug Administration (FDA) in 2018 for the treatment of pemphigus vulgaris, although the best dose regimen has not been verified. Hence, we conducted this meta analysis on the efficacy and safety of rituximab in the treatment of pemphigus, and also established a randomized, open-labeled study protocol to determine the best dosing regimen of rituximab for treatment of pemphigus. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-15T16:17:40Z (GMT). No. of bitstreams: 1 U0001-0608202016541400.pdf: 1822675 bytes, checksum: afde926f2aabc91f8f399360d0c8e191 (MD5) Previous issue date: 2019 | en |
| dc.description.tableofcontents | 誌謝 ................................................................ ii 中文摘要 ............................................................ iii Abstract .............................................................iv 1 Introduction ....................................................... 1 1.1 Overview of Pemphigus ........................................... .1 1.2 Rituximab ........................................................ 2 1.3 Literature review ................................................ 2 1.4 Aim of this study ................................................ 3 2 Method ............................................................. 4 3 Results ............................................................ 5 4 Discussion ......................................................... 5 5 Prospect ........................................................... 6 CLINICAL TRIAL PROTOCOL .............................................. 7 List of Abbreviations ............................................... 10 Schedule of assessment .............................................. 12 Appendix I .......................................................... 32 Appendix II ......................................................... 33 Appendix III ........................................................ 34 Table 3 ............................................................. 35 Reference ........................................................... 36 | |
| dc.language.iso | en | |
| dc.subject | 莫須瘤 | zh_TW |
| dc.subject | 天疱瘡 | zh_TW |
| dc.subject | 類固醇 | zh_TW |
| dc.subject | B淋 | zh_TW |
| dc.subject | pemphigus:rituximab | en |
| dc.subject | corticosteroids | en |
| dc.subject | B cells | en |
| dc.subject | protocol | en |
| dc.title | 使用莫須瘤在天疱瘡治療之有效性與安全性-系統性文獻回顧與統合分析 | zh_TW |
| dc.title | A systematic review and meta-analysis on the efficacy and safety of rituximab in the treatment of pemphigus | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 108-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 林家齊 (Chia-Chi Lin),詹智傑(Chih-Chieh Chan) | |
| dc.subject.keyword | 天疱瘡,莫須瘤,類固醇,B淋, | zh_TW |
| dc.subject.keyword | pemphigus:rituximab,corticosteroids,B cells,protocol, | en |
| dc.relation.page | 38 | |
| dc.identifier.doi | 10.6342/NTU202002558 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2020-08-11 | |
| dc.contributor.author-college | 醫學院 | zh_TW |
| dc.contributor.author-dept | 臨床醫學研究所 | zh_TW |
| 顯示於系所單位： | 臨床醫學研究所 | |
文件中的檔案：
| 檔案 | 大小 | 格式 | |
|---|---|---|---|
| U0001-0608202016541400.pdf 未授權公開取用 | 1.78 MB | Adobe PDF |
系統中的文件，除了特別指名其著作權條款之外，均受到著作權保護，並且保留所有的權利。