TNF - α抑制剂治疗银屑病和银屑病性关节炎。
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托宾，柯比，B
TNF - α抑制剂治疗银屑病和银屑病性关节炎。
BioDrugs。2005; 19(1): 47-57。
- PubMed ID
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15691217 (PubMed视图］
- 摘要
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牛皮癣是一种慢性炎症性皮肤病，可导致患者严重的生理和心理困扰。银屑病关节炎(PsA)最初被认为是一种相当轻微的疾病，现在被认为是一种进行性和破坏性的关节炎。迄今为止，针对这两种情况的治疗都是非特异性的，无法保持长期的缓解。此外，目前的许多疗法都有严重的副作用，限制了它们的有效性。然而，在分子水平上对银屑病和PsA发病机制的阐明以及选择性生物制剂的开发已经导致银屑病患者可用的药箱的极大扩展。两种药物(英夫利昔单抗和依那西普)选择性阻断细胞因子肿瘤坏死因子(TNF)- α的作用，并已在临床试验中证明有效治疗银屑病的皮肤和关节表现。第三种抗tnf α药物(阿达木单抗Humira)获批用于类风湿性关节炎的治疗;然而，迄今为止还没有关于其在PsA或银屑病中的应用的研究发表。已知TNF - α在银屑病患者的皮肤和滑膜中均升高，这两种药物在银屑病和PsA中的阻断效果证实了其在发病机制中的作用。随机、双盲、安慰剂对照试验已在治疗银屑病和PsA两种药物中进行; 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.