Whelan Bryan R, Isenberg David A
Department of Medicine, Centre for Rheumatology, University College London, London, UK.
Curr Opin Hematol. 2009 Jul;16(4):280-4. doi: 10.1097/MOH.0b013e32832c1f53.
mAb therapies are being used more frequently in all medical conditions, including the autoimmune rheumatic diseases. Autoimmune myositis, vasculitis and primary Sjogren's syndrome are rare diseases in which these therapies are being used without the support of large-scale randomized controlled trials. We have summarized the evidence that does exist to support the use of mAb therapies in these diseases.
There have been a number of open-label trials and case reports using mainly rituximab and antitumour necrosis factor-alpha agents to treat these diseases. The results have in general shown efficacy, the main exception being the use of antitumour necrosis factor-alpha agents with cyclophosphamide for the treatment of vasculitis.
mAb therapies have shown efficacy in the treatment of patients with autoimmune rheumatic diseases who have failed conventional therapy. Their use ahead of conventional immunosuppressive strategies cannot be supported on the basis of current evidence.
单克隆抗体（mAb）疗法在包括自身免疫性风湿性疾病在内的所有医疗状况中使用得越来越频繁。自身免疫性肌炎、血管炎和原发性干燥综合征是罕见疾病，在这些疾病中，这些疗法在缺乏大规模随机对照试验支持的情况下被使用。我们总结了现有支持在这些疾病中使用mAb疗法的证据。
有多项开放标签试验和病例报告，主要使用利妥昔单抗和抗肿瘤坏死因子-α制剂来治疗这些疾病。总体结果显示有效，主要例外是使用抗肿瘤坏死因子-α制剂联合环磷酰胺治疗血管炎。
mAb疗法已显示对常规治疗无效的自身免疫性风湿性疾病患者有效。基于目前的证据，无法支持在常规免疫抑制策略之前使用它们。
