Hochberg Marc C, Lebwohl Mark G, Plevy Scott E, Hobbs Kathryn F, Yocum David E
Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore 21201, USA.
Semin Arthritis Rheum. 2005 Jun;34(6):819-36. doi: 10.1016/j.semarthrit.2004.11.006.
To review the benefits and risks associated with the use of the tumor necrosis factor (TNF)-blockers in various indications (eg, rheumatoid arthritis [RA], Crohn's disease [CD], psoriasis).
The members of the consensus panel were selected based on their expertise. Centocor, Inc provided an educational grant to the Center for Health Care Education to facilitate the consensus panel. Peer-reviewed articles discussing clinical studies and clinical experiences with TNF-blockers form the basis of this review. Emerging data that have not been peer-reviewed are also included.
The TNF-blockers infliximab, etanercept, and adalimumab are all approved for treatment of RA. All 3 are effective, and there are currently no published data from head-to-head clinical trials to support using 1 agent over another. Preliminary data from small, retrospective studies indicate that switching among agents to overcome inadequate efficacy or poor tolerability is beneficial in some patients. The only TNF-blocker currently approved for the induction and maintenance of remission in CD is infliximab. Preliminary data indicate that etanercept and infliximab are effective in treating psoriasis. Some risks associated with TNF-blockers have become apparent, including congestive heart failure, demyelinating diseases, and systemic lupus erythematosus, but in most cases can be identified and managed. Several of these risks (eg, lymphoma and serious infections) are associated with either the condition per se or the concomitant medication use. Simple screening procedures help manage the risk of tuberculosis infection; however, it is recommended that physicians and patients be alert to the development of any new infection so that appropriate treatment may be initiated promptly. Rare infusion reactions, particularly with infliximab, may also be effectively managed.
TNF-blockers are effective and may be safely used for short- and long-term management of RA or CD. TNF-blockers also show efficacy in other emerging indications.
回顾肿瘤坏死因子（TNF）阻滞剂在各种适应证（如类风湿关节炎[RA]、克罗恩病[CD]、银屑病）使用中的获益与风险。
共识小组的成员根据其专业知识进行挑选。Centocor公司向医疗保健教育中心提供了一笔教育资助，以推动共识小组的工作。讨论TNF阻滞剂临床研究和临床经验的同行评审文章构成了本综述的基础。尚未经过同行评审的新出现数据也被纳入。
TNF阻滞剂英夫利昔单抗、依那西普和阿达木单抗均被批准用于治疗RA。这三种药物都有效，目前尚无来自头对头临床试验的已发表数据支持使用一种药物优于另一种药物。小型回顾性研究的初步数据表明，在一些患者中，为克服疗效不佳或耐受性差而在药物之间切换是有益的。目前唯一被批准用于诱导和维持CD缓解的TNF阻滞剂是英夫利昔单抗。初步数据表明依那西普和英夫利昔单抗在治疗银屑病方面有效。与TNF阻滞剂相关的一些风险已变得明显，包括充血性心力衰竭、脱髓鞘疾病和系统性红斑狼疮，但在大多数情况下可以识别和处理。其中一些风险（如淋巴瘤和严重感染）与疾病本身或同时使用的药物有关。简单的筛查程序有助于管理结核感染风险；然而，建议医生和患者警惕任何新感染的发生，以便能及时启动适当治疗。罕见的输液反应，尤其是与英夫利昔单抗相关的反应，也可以得到有效处理。
TNF阻滞剂有效，可安全用于RA或CD的短期和长期治疗。TNF阻滞剂在其他新出现的适应证中也显示出疗效。
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