Nash Peter T, Florin Timothy H J
Rheumatology Research Unit, Department of Medicine, University of Queensland, PO BOX 59, Cottontree, QLD 4558, Australia.
Med J Aust. 2005 Aug 15;183(4):205-8. doi: 10.5694/j.1326-5377.2005.tb06998.x.
The cytokine, tumour necrosis factor-alpha (TNF-alpha) plays a key role in the pathogenesis of many chronic inflammatory and rheumatic diseases, in particular, Crohn's disease, rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. Controlled trials have shown that the TNF inhibitors (etanercept, infliximab and adalimumab) significantly reduce symptoms and signs, improve function and quality of life, and reduce radiologically evident damage in patients with rheumatoid diseases. For reasons that are not entirely clear, etanercept does not work in Crohn's disease. Injection site and intravenous reactions and increased risk of infection (in particular, reactivation of tuberculosis) are associated with the use of these agents. Increased risk of lymphoproliferative disease, the development of lupus-like syndromes and demyelination, including optic neuritis and reactivation of multiple sclerosis, are under evaluation in long-term follow-up studies. The TNF inhibitors are expensive (about $18 000 per year), and in some patients need to be given continuously to maintain benefit, even in the presence of other immunosuppressive therapy.
细胞因子肿瘤坏死因子-α（TNF-α）在许多慢性炎症性和风湿性疾病的发病机制中起关键作用，尤其是克罗恩病、类风湿关节炎、强直性脊柱炎和银屑病关节炎。对照试验表明，TNF抑制剂（依那西普、英夫利昔单抗和阿达木单抗）能显著减轻症状和体征，改善功能和生活质量，并减少类风湿疾病患者的影像学明显损伤。原因尚不完全清楚，依那西普对克罗恩病无效。使用这些药物会出现注射部位和静脉反应，以及感染风险增加（特别是结核病复发）。长期随访研究正在评估淋巴增殖性疾病风险增加、狼疮样综合征的发生以及脱髓鞘，包括视神经炎和多发性硬化症复发的情况。TNF抑制剂价格昂贵（每年约18000美元），而且在一些患者中，即使存在其他免疫抑制治疗，也需要持续给药以维持疗效。
