Youdim Adrienne, Vasiliauskas Eric A, Targan Stephan R, Papadakis Konstantinos A, Ippoliti Andrew, Dubinsky Marla C, Lechago Juan, Paavola Jane, Loane Jaime, Lee Susie K, Gaiennie Joanne, Smith Katie, Do Jason, Abreu Maria T
Department of Medicine, Division of Gastroenterology, Inflammatory Bowel Disease Center, Los Angeles, CA 90048, USA.
Inflamm Bowel Dis. 2004 Jul;10(4):333-8. doi: 10.1097/00054725-200407000-00002.
The anti-TNF-alpha antibody infliximab (Remicade) is highly effective in the treatment of Crohn's disease. A subset of patients experience allergic reactions as a result of antibodies to infliximab (ATIs). The purpose of the current study is to describe the safety and efficacy of adalimumab (Humira) in patients previously allergic or intolerant to infliximab. Adalimumab is an anti-TNF-alpha agent containing only human peptide sequences. Seven patients have been treated with adalimumab who had experienced immediate- or delayed-hypersensitivity reactions to infliximab and one with infliximab-induced lupus. Except for injection site discomfort, adalimumab was well tolerated without signs or symptoms of allergic reactions. One patient who had previously received pooled human immunoglobulin developed a pruritic rash after each dose of adalimumab. Patients with active disease who had previously experienced a robust response to infliximab responded to adalimumab as reflected by an improvement in Harvey-Bradshaw index and inflammatory markers. Based on these preliminary data, adalimumab may be a safe and effective substitute for infliximab-allergic patients. Individuals who have been exposed to human antibodies may be sensitized to other human antibodies such as adalimumab.
抗肿瘤坏死因子-α抗体英夫利昔单抗（类克）在治疗克罗恩病方面疗效显著。一部分患者会因产生抗英夫利昔单抗抗体（ATI）而出现过敏反应。本研究旨在描述阿达木单抗（修美乐）在既往对英夫利昔单抗过敏或不耐受患者中的安全性和有效性。阿达木单抗是一种仅含人肽序列的抗肿瘤坏死因子-α药物。7例曾对英夫利昔单抗发生速发型或迟发型超敏反应的患者以及1例因英夫利昔单抗诱发狼疮的患者接受了阿达木单抗治疗。除注射部位不适外，阿达木单抗耐受性良好，无过敏反应的体征或症状。1例曾接受人免疫球蛋白混合制剂的患者在每次注射阿达木单抗后出现瘙痒性皮疹。既往对英夫利昔单抗反应强烈的活动性疾病患者对阿达木单抗有反应，哈维-布拉德肖指数及炎症标志物改善即反映了这一点。基于这些初步数据，阿达木单抗可能是对英夫利昔单抗过敏患者的一种安全有效的替代药物。接触过人抗体的个体可能会对其他如阿达木单抗等的人抗体产生致敏。
