Chan A T, Flossmann O, Mukhtyar C, Jayne D R W, Luqmani R A
Rheumatology Department, Nuffield Orthopaedic Centre, Windmill Road, Headington Oxford OX3 7LD, UK.
Autoimmun Rev. 2006 Apr;5(4):273-8. doi: 10.1016/j.autrev.2006.01.003. Epub 2006 Feb 20.
The recent development of biologic therapies capable of selectively targeting components of the immune system has revolutionised the treatment of inflammatory arthritides. The steady increase in use of biologic agents coupled with the expansion in the knowledge of the pathogenesis of vascular inflammation has led to their application in the treatment of primary systemic vasculitis. These agents may have a role in addition to or in place of conventional immunosuppression and also be effective when the latter fails to induce remission. The use of biologics as targeted therapies has also, in reverse, improved our understanding of the pathophysiology of vascular inflammation. While the advent of biologics heralds a new era in the management of the systemic vasculitis, evidence for their efficacy is still in its infancy and has yet to match that of conventional immunosuppressants. In this review, we examine the up-to-date evidence for the use of biologics in systemic vasculitis, including TNF-alpha inhibitors, and highlight the challenges facing their use. We examine the rationale for using biologics based on the pathophysiology of vasculitis. Issues of toxicity and pharmacovigilance with the use of biologics are also discussed. Finally, future directions and predictions are presented.
能够选择性靶向免疫系统成分的生物疗法的最新进展彻底改变了炎性关节炎的治疗方式。生物制剂使用量的稳步增加，加之对血管炎症发病机制认识的不断拓展，促使其被应用于原发性系统性血管炎的治疗。这些药物除了可作为传统免疫抑制治疗的补充或替代方案外，在传统治疗无法诱导缓解时也能发挥作用。反过来，将生物制剂用作靶向疗法也增进了我们对血管炎症病理生理学的理解。尽管生物制剂的出现预示着系统性血管炎治疗进入了一个新时代，但其疗效证据仍处于起步阶段，尚未达到传统免疫抑制剂的水平。在本综述中，我们审视了生物制剂用于系统性血管炎（包括肿瘤坏死因子-α抑制剂）的最新证据，并强调了其使用面临的挑战。我们基于血管炎的病理生理学探讨了使用生物制剂的基本原理。还讨论了生物制剂使用中的毒性和药物警戒问题。最后，给出了未来的方向和预测。
