Tamási László, Szekanecz Zoltán
Szent Ferenc Kórház Reumatológiai Osztály, Miskolc.
Orv Hetil. 2007 Apr 8;148 Suppl 1:63-70. doi: 10.1556/OH.2007.28038.
The concept of biological therapy arises from the specific targeting of a factor, e.g. a cytokine, involved in the inflammatory cascade. Thus, biologicals disrupt the complex network of autoimmune-inflammatory events. Today, rheumatoid arthritis is a prototype disease in this context as most compounds have been tried in this disease. Recently, biological therapy has been introduced to the treatment of other diseases including various forms of arthritis, such as ankylosing spondylitis and psoriatic arthritis, as well as systemic autoimmune disorders, such as systemic lupus erythematosus, scleroderma, inflammatory myopathies and Sjogren's syndrome. Anti-tumor necrosis factor-alpha (TNF-alpha) agents play a central role in biological therapy as these agents have been successfully tried in most of these diseases. When seeking for specific targets for biologicals, pathogenic factors of the disease, such as Th1 or Th2 type responses, should be evaluated. Some mostly T-cell mediated diseases, such as rheumatoid arthritis, ankylosing spondylitis, psoriasis, polymyositis, polyarticular juvenile arthritis respond well to anti-TNF agents and T cell targeting, while others, such as lupus, Sjogren's syndrome, dermatomyositis may rather respond to anti-B cell biologicals. In this review, authors discuss the most recent advances in the biological therapy of arthritis and systemic autoimmune diseases including issues of efficacy and safety.
生物疗法的概念源于对炎症级联反应中涉及的特定因子（如细胞因子）的特异性靶向作用。因此，生物制剂会破坏自身免疫性炎症事件的复杂网络。如今，类风湿性关节炎在这方面是一种典型疾病，因为大多数化合物都已在该疾病中进行了试验。最近，生物疗法已被引入到其他疾病的治疗中，包括各种形式的关节炎，如强直性脊柱炎和银屑病关节炎，以及全身性自身免疫性疾病，如系统性红斑狼疮、硬皮病、炎性肌病和干燥综合征。抗肿瘤坏死因子-α（TNF-α）药物在生物疗法中起着核心作用，因为这些药物已在大多数此类疾病中成功进行了试验。在寻找生物制剂的特定靶点时，应评估疾病的致病因素，如Th1或Th2型反应。一些主要由T细胞介导的疾病，如类风湿性关节炎、强直性脊柱炎、银屑病、多发性肌炎、多关节幼年型关节炎，对抗TNF药物和T细胞靶向治疗反应良好，而其他疾病，如狼疮、干燥综合征、皮肌炎，可能对抗B细胞生物制剂反应更佳。在这篇综述中，作者讨论了关节炎和全身性自身免疫性疾病生物疗法的最新进展，包括疗效和安全性问题。
