Department of Rheumatology, Jan van Breemen Institute, Dr Jan van Breemenstraat 2, 1056 AB Amsterdam, The Netherlands.
Arthritis Res Ther. 2010;12(5):217. doi: 10.1186/ar3147. Epub 2010 Oct 20.
Therapeutic monoclonal antibodies have revolutionized the treatment of various inflammatory diseases. Immunogenicity against these antibodies has been shown to be clinically important: it is associated with shorter response duration because of diminishing concentrations in the blood and with infusion reactions. Concomitant immunomodulators in the form of methotrexate or azathioprine reduced the immunogenicity of therapeutic antibodies in rheumatoid arthritis, Crohn disease, and juvenile idiopathic arthritis. The occurrence of adverse events does not increase when immunomodulators are added to therapeutic antibodies. The mechanism whereby methotrexate and azathioprine influence immunogenicity remains unclear. Evidence-based consensus on prescribing concomitant immunomodulators is needed.
治疗性单克隆抗体彻底改变了各种炎症性疾病的治疗方法。已证明针对这些抗体的免疫原性具有重要的临床意义：它与血液中浓度降低导致的应答持续时间缩短以及输注反应相关。甲氨蝶呤或巯嘌呤形式的伴随免疫调节剂可降低类风湿关节炎、克罗恩病和幼年特发性关节炎中治疗性抗体的免疫原性。当免疫调节剂加入治疗性抗体时，不良事件的发生并未增加。甲氨蝶呤和巯嘌呤影响免疫原性的机制尚不清楚。需要就开具伴随免疫调节剂达成基于证据的共识。
