Department of Medicine D, Meir Medical Center, Kfar Saba, Israel.
Autoimmun Rev. 2011 Jul;10(9):563-8. doi: 10.1016/j.autrev.2011.04.010. Epub 2011 May 5.
Rheumatoid arthritis (RA) therapy has been revolutionized in recent years following the introduction of three main anti-tumor necrosis factor-alpha inhibitors (anti-TNF) agents, infliximab, adalimumab and etanercept. Evidence in the literature indicates that patients treated with anti-TNF agents are at increased risk for bacterial infections, but it is not clear if this is a result of the treatment or of disease severity. The treatment has been recognized as a clear risk factor for reactivation of latent TB infections. So far, observational studies have not indicated any increased overall risk of cancer in RA patients treated with anti-TNF. The overall risk of lymphoma in these patients does not appear to differ greatly from that recorded among untreated patients, but rather is associated with the degree of disease activity rather than the type of therapy. There is a consensus in the literature that the likelihood of drug survival with infliximab is inferior to both adalimumab and etanercept, mostly due to increased risk of infection or allergic reactions. Due to the lack of head to head studies, there is no agreement as to which agent has the highest rates of treatment response and disease remission.
近年来，随着三种主要的抗肿瘤坏死因子-α抑制剂（抗 TNF）药物——英夫利昔单抗、阿达木单抗和依那西普的问世，类风湿关节炎（RA）的治疗发生了革命性变化。文献中的证据表明，接受抗 TNF 治疗的患者发生细菌感染的风险增加，但尚不清楚这是治疗的结果还是疾病严重程度的结果。该治疗已被确认为潜伏性结核感染再激活的明确危险因素。到目前为止，观察性研究并未表明接受抗 TNF 治疗的 RA 患者的总体癌症风险增加。这些患者的淋巴瘤总体风险似乎与未治疗患者的记录没有太大差异，而是与疾病活动程度相关，而不是与治疗类型相关。文献中普遍认为，英夫利昔单抗的药物生存率低于阿达木单抗和依那西普，主要是由于感染或过敏反应的风险增加。由于缺乏头对头研究，因此对于哪种药物具有最高的治疗反应和疾病缓解率尚无共识。
