Bos W E M, Thio H B, Neumann H A M, van der Fits L, Prens E P
Erasmus MC, afd. Dermatologie & Venereologie, Postbus 2040, 3000 CA Rotterdam.
Ned Tijdschr Geneeskd. 2006 May 13;150(19):1065-70.
The chronic skin disease psoriasis frequently requires long-term systemic treatment with agents that suppresses the immune system with little specificity, which can lead to systemic side effects. Today, using recombinant techniques, it is possible to produce modified proteins, the so-called biologicals, that target specific molecules in the inflammatory process. For the biologicals etanercept, infliximab, adalimumab, efalizumab and alefacept, the clinical efficacy expressed in the rates of partial remission (75% reduction in skin lesions) in patients with plaque psoriasis range from 12 to 88%, compared with 22 to 87% for existing systemic therapies for psoriasis. The side effects of biologicals are usually mild to moderate, but can sometimes be severe. The biologicals should be prescribed with caution, given that they have been on the market for a relatively short period, and because all forms of immune suppression carry an increased risk of oncologic degeneration. The guideline of the Dutch Society of Dermatology and Venereology states that the use of a biological may be considered when a patient cannot tolerate or is unresponsive to conventional systemic therapy, or has an increased risk of adverse events. Biologicals increase the number of options for treatment-resistant plaque psoriasis, which allows therapy to be tailored to the individual patient.
慢性皮肤病银屑病常常需要使用对免疫系统抑制缺乏特异性的药物进行长期全身治疗，这可能会导致全身副作用。如今，利用重组技术能够生产修饰蛋白，即所谓的生物制剂，这些生物制剂可作用于炎症过程中的特定分子。对于生物制剂依那西普、英夫利昔单抗、阿达木单抗、依法利珠单抗和阿法赛特，斑块状银屑病患者的部分缓解率（皮肤损伤减少75%）所体现的临床疗效在12%至88%之间，而银屑病现有全身治疗方法的部分缓解率为22%至87%。生物制剂的副作用通常为轻至中度，但有时也可能很严重。鉴于生物制剂上市时间相对较短，且所有形式的免疫抑制都会增加肿瘤退变风险，因此开具生物制剂时应谨慎。荷兰皮肤病与性病学会的指南指出，当患者无法耐受传统全身治疗或对其无反应，或不良事件风险增加时，可考虑使用生物制剂。生物制剂增加了治疗抵抗性斑块状银屑病的治疗选择，从而能够为个体患者量身定制治疗方案。
