肿瘤坏死因子α抑制剂治疗牛皮癣和银屑病关节炎。
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托宾,柯比B
肿瘤坏死因子α抑制剂治疗牛皮癣和银屑病关节炎。
BioDrugs。2005;19 (1):47-57。
- PubMed ID
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15691217 (在PubMed]
- 文摘
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牛皮癣是一种慢性炎症性皮肤病,可能导致重大对患者生理和心理上的痛苦。银屑病关节炎(PsA),最初被认为是相当轻微的疾病,现在公认的进步和破坏性关节炎。到目前为止,已非特异性治疗这两种条件,无法维持长期的缓解。此外,许多现有的疗法有显著的负面影响,限制了其效用。然而,说明牛皮癣的发病机理和PsA在分子水平和选择性生物制剂的发展导致了一个巨大的扩张牛皮癣患者的医疗设备。两个代理(英夫利昔单抗和道)选择性地阻断细胞因子的作用肿瘤坏死因子(TNF) t1和在临床试验中已经证明有效的治疗牛皮癣的皮肤和关节表现。第三个anti-TNFα代理(adalimumab抗)许可用于治疗类风湿性关节炎;然而,没有研究已经出版日期在其使用PsA或牛皮癣。众所周知,肿瘤坏死因子α是高架在银屑病患者的皮肤和滑膜和封锁了这两个代理的有效性在银屑病和PsA证实其在其发病机制中的作用。随机、双盲、安慰剂对照试验执行代理治疗牛皮癣和PsA; in the case of etanercept these have been to support US FDA approval for use in psoriatic arthropathy. These studies are supported by smaller cohorts in open-label studies and anecdotal reports in the literature. Anti-TNF alpha therapy has proved to have disease-reducing activity in PsA and psoriasis and appears to be well tolerated. These studies have generally featured small numbers of patients and, until a larger cohort of treated patients is available, vigilance must be exercised. A considerable body of post-marketing safety data exists on the use of infliximab in rheumatoid arthritis and Crohn disease and for etanercept in rheumatoid arthritis and PsA. Certain issues, particularly the risk of infection, have emerged as features of the use of these agents. It remains to be seen whether effects seen in other disease entities may be extrapolated to psoriatic patients. More long-term data and experience are needed to define the role of anti-TNF alpha agents in the management of psoriasis and PsA. In particular, more studies are required to elucidate the finer points of co-medication; in some studies both agents have been used with other medications but there have been no formal trials of various possible combinations.