Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu 514-8507, Japan.
Rheumatol Int. 2012 Nov;32(11):3675-8. doi: 10.1007/s00296-011-2124-3. Epub 2011 Sep 7.
We determined whether repeated treatment with the tumor necrosis factor-α (TNF-α) antagonist etanercept can be effective after an initial clinical response to this drug is lost. We describe three female patients with active, refractory rheumatoid arthritis who were administered with a second course of etanercept after eventually becoming refractory to a first course. Disease activity was high in all three patients before initial etanercept therapy, and each of them had clinically responded by 24 weeks. However, the initial clinical effect was lost between 1.5 and 3.5 years thereafter, and tocilizumab was administered, but the effect was lost again between 3 and 18 months later. Two patients did not respond to subsequent treatment with adalimumab and infliximab. Etanercept administered once again reduced disease activity in all three patients, none of whom developed any acute side effects. Etanercept re-administration significantly improved clinical disease activity and inflammatory parameters in three patients with RA who were refractory to biological anti-TNF agents.
我们旨在明确肿瘤坏死因子-α（TNF-α）拮抗剂依那西普在初始治疗有效但之后失效的情况下，重复治疗是否仍有效。我们描述了 3 例对依那西普治疗产生抵抗的女性类风湿关节炎患者，她们在对初始疗程产生抵抗后，接受了第二疗程的依那西普治疗。在开始依那西普治疗前，所有 3 名患者的疾病活动度都很高，且在 24 周时都表现出了临床应答。然而，在那之后的 1.5 到 3.5 年之间，初始的临床效果丧失，随后使用托珠单抗治疗，但在 3 到 18 个月后再次失效。2 名患者对随后的阿达木单抗和英夫利昔单抗治疗无反应。再次给予依那西普治疗后，3 名患者的疾病活动度均降低，且均未出现任何急性副作用。依那西普再次给药可显著改善对生物抗 TNF 药物产生抵抗的 3 例 RA 患者的临床疾病活动度和炎症参数。
