Department of Dermatology, University Hospital Leuven, Belgium.
J Inflamm Res. 2009;2:29-36. doi: 10.2147/jir.s4405. Epub 2009 Aug 9.
Etanercept, a subcutaneously administered fully human soluble tumor necrosis factor (TNF) receptor, was initially approved for the treatment of psoriasis at a dose of 25 mg twice weekly in repeated 24-week cycles with the possibility to double the dose in the first 12 weeks of the first cycle. During intermittent treatment, patients retain their ability to respond to etanercept. Recently, a new dosing schedule of etanercept 50 mg once weekly was approved, based on a study in which PASI-75 (75% improvement of Psoriasis Area and Severity Index) was achieved by 37% and 71% of patients at week 12 and 24. Another study demonstrated a PASI-75 of 57% and 69% in pediatric psoriasis patients receiving etanercept 0.8 mg/kg (up to 50 mg) once weekly for 12 and 24 weeks respectively, resulting in European approval from age 8. Based on recent clinical trials, the antipsoriatic effect of etanercept can be markedly increased in combination with acitretin, methotrexate or UVB. The combination with acitretin appears attractive because of its non-immunosuppressive and chemopreventive properties. Etanercept-methotrexate combination therapy is well established in rheumatologic patients. From a long-term perspective, the combination of TNF-inhibitors with phototherapy (photocarcinogenesis) or cyclosporine (carcinogenesis, infections) warrants great caution however. Finally, combination with topical calcipotriol-betamethasone ointment may increase the speed of response to TNF-inhibitors in the first 4 weeks of treatment.
依那西普是一种皮下注射的全人可溶性肿瘤坏死因子(TNF)受体,最初被批准用于治疗银屑病,剂量为每周两次 25mg,24 周为一个周期,在第一个周期的前 12 周可以将剂量加倍。在间歇性治疗期间,患者保留对依那西普的反应能力。最近,根据一项研究结果,批准了每周一次给予依那西普 50mg 的新剂量方案,该研究显示在第 12 周和第 24 周时分别有 37%和 71%的患者达到 PASI-75(银屑病面积和严重程度指数改善 75%)。另一项研究显示,接受每周一次依那西普 0.8mg/kg(最高 50mg)治疗 12 周和 24 周的儿童银屑病患者分别有 57%和 69%达到 PASI-75,从而获得了欧洲批准,适用年龄为 8 岁及以上。基于最近的临床试验,依那西普与阿维 A、甲氨蝶呤或 UVB 联合使用可显著增强其抗银屑病作用。由于其非免疫抑制和化学预防特性,与阿维 A 的联合使用具有吸引力。依那西普-甲氨蝶呤联合治疗在风湿性疾病患者中已得到广泛应用。从长期来看,TNF 抑制剂与光疗(光致癌作用)或环孢素(致癌作用、感染)联合使用需要高度谨慎。最后,与局部钙泊三醇-倍他米松软膏联合使用可能会在治疗的前 4 周内加快对 TNF 抑制剂的反应速度。