Boguniewicz M, Jaffe H S, Izu A, Sullivan M J, York D, Geha R S, Leung D Y
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Am J Med. 1990 Apr;88(4):365-70. doi: 10.1016/0002-9343(90)90490-5.
Recombinant gamma interferon (rIFN-gamma) inhibits IgE synthesis in vitro by human peripheral blood mononuclear cells (PBMC). These data suggest a role for rIFN-gamma in the treatment of patients with severe atopic dermatitis (AD) and elevated IgE levels. The purpose of this study was to determine the effect of rIFN-gamma treatment on IgE production in patients with AD.
Twenty-two patients with chronic severe AD were treated with rIFN-gamma. In part I of the study, 14 patients were treated with daily subcutaneous injections at three successive dose levels (0.01 mg/m2, 0.05 mg/m2, and 0.1 mg/m2) for 5 days with 2 days off between each dose level. In part II, eight patients received rIFN-gamma at 0.05 mg/m2, daily for 6 weeks. One patient from part I and eight patients from part II of the study received three times per week maintenance thereby for up to 14 months. Prior to and at selected times during and after treatment, the clinical and immunologic status of the patients was assessed.
In part I, spontaneous de novo IgE synthesis by PBMC was inhibited in 10 patients receiving rIFN-gamma at 0.01 mg/m2 (p = 0.038) and in nine at 0.1 mg/m2 (p = 0.066). There was no reduction of serum IgE levels at any of the three dose levels. Total clinical severity showed improvement at each dose level (p less than 0.04) with worsening 3 days after discontinuation of treatment. In part II, there was no significant inhibition of spontaneous IgE synthesis by PBMC nor was there any reduction of serum IgE. Nevertheless, there was a progressive and significant reduction (p less than 0.01) in total clinical severity over the 6 weeks of daily rIFN-gamma with a sustained improvement during maintenance therapy.
The results of this pilot study suggest that rIFN-gamma may be efficacious in the treatment of AD and that further clinical trials are warranted.
重组γ干扰素（rIFN-γ）在体外可抑制人外周血单核细胞（PBMC）合成IgE。这些数据提示rIFN-γ在治疗重症特应性皮炎（AD）及IgE水平升高的患者中可能发挥作用。本研究的目的是确定rIFN-γ治疗对AD患者IgE产生的影响。
22例慢性重症AD患者接受rIFN-γ治疗。在研究的第一部分，14例患者按三个连续剂量水平（0.01mg/m²、0.05mg/m²和0.1mg/m²）每日皮下注射，共5天，每个剂量水平之间休息2天。在第二部分，8例患者接受0.05mg/m²的rIFN-γ，每日注射，共6周。研究第一部分的1例患者和第二部分的8例患者接受每周三次的维持治疗，最长可达14个月。在治疗前、治疗期间及治疗后的特定时间，对患者的临床和免疫状态进行评估。
在第一部分，接受0.01mg/m² rIFN-γ治疗的10例患者（p = 0.038）和接受0.1mg/m²治疗的9例患者（p = 0.066）中，PBMC自发重新合成IgE受到抑制。在三个剂量水平中的任何一个水平，血清IgE水平均未降低。每个剂量水平的总体临床严重程度均有改善（p < 0.04），停药3天后病情恶化。在第二部分，PBMC自发合成IgE未受到显著抑制，血清IgE也未降低。然而，在每日注射rIFN-γ的6周内，总体临床严重程度有逐渐且显著的降低（p < 0.01），维持治疗期间持续改善。
这项初步研究的结果提示rIFN-γ可能对AD治疗有效，有必要进行进一步的临床试验。
