生物制剂治疗大血管炎的进展

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楼主 2019-02-10 15:18:17
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作者: Koster MJ, et al. 翻译: 北医三院李常虹(changhongli@bjmu.edu.cn) 发布者:金银姬 校对:武东


摘要

目的:本文仔细回顾了大动脉炎和巨细胞动脉炎的治疗进展,着重探讨了靶向生物治疗方案对于大血管动脉炎的最新研究进展。

近期发现:生物制剂在大血管动脉炎治疗中的作用正在被人们逐渐认识。肿瘤坏死因子α抑制剂似乎对于治疗大动脉炎有效,但对巨细胞动脉炎疗效甚微。先前的临床资料提示,阿巴西普和托珠单抗可降低巨细胞动脉炎的复发风险。越来越多的观察性研究证据提示,白介素-6拮抗剂对于治疗大动脉炎有效。小规模的非盲研究提示,ustekinumab单抗对于巨细胞动脉炎治疗有效且是安全的。尽管B细胞失调可能在大血管动脉炎致病中发挥作用,但目前支持通过耗竭B细胞来治疗此类疾病的研究证据相对较少。

总结:白介素-6拮抗剂似乎对难治性大血管动脉炎治疗有效,然而对于新发未使用过免疫抑制剂的患者来说,白介素-6拮抗剂的治疗作用尚不明确。阿巴西普和ustekinumab单抗有望成为大血管炎的潜在治疗靶点,但在临床常规使用之前仍需进一步研究证实。



附原文:                                 

Abstract PURPOSE OF REVIEW: This article critically reviews the advances in medical management of giant cell arteritis (GCA) and Takayasu arteritis (TAK) with a focus on recent developments in targeted biologic therapy.RECENT FINDINGS: The role of biologics in the treatment of large vessel vasculitis (LVV) is expanding. TNFα inhibitors appear to be effective in the treatment of TAK but have little benefit in GCA. Preliminary clinical trial data suggest that abatacept and tocilizumab reduce the risk of relapse in GCA. Increasing observational evidence supports the use of interleukin-6 inhibitors in TAK. Based on a small open-label study, ustekinumab appears safe and potentially effective for refractory GCA. A possible role of B cell dysregulation may contribute to pathogenic mechanisms in LVV, but support for the use of B cell depleting therapy is limited.SUMMARY: Interleukin-6 inhibitors appear efficacious in the treatment of refractory cases of LVV; however, utility in newly diagnosed immunosuppressive-naïve patients is less well established. Abatacept and ustekinumab are promising targets for therapy in LVV but further investigation is needed before routine use is considered.



引自:Koster MJMatteson ELWarrington KJ.Recent advances in the clinical management of giant cell arteritis and Takayasu arteritis. Curr Opin Rheumatol.2016,28(3):211-7.



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