Department of Dermatology, Western Infirmary, Glasgow G11 6NT, UK.
Br J Dermatol. 2012 Nov;167 Suppl 3:12-20. doi: 10.1111/j.1365-2133.2012.11209.x.
A number of biologic agents, including the tumour necrosis factor (TNF) antagonists etanercept, adalimumab and infliximab, and the interleukin (IL)-12/IL-23 antagonist ustekinumab, are available for the treatment of moderate-to-severe plaque psoriasis in the U.K. Currently, the selection of the first biologic, and the choice of sequential biologics in the event of efficacy/tolerability concerns, is made using a limited evidence base. The efficacy of biologics, the potential mechanisms of primary and secondary failure and the evidence for sequencing therapy among TNF antagonists and between TNF antagonists and IL-12/IL-23 blockade are reviewed. As psoriasis biologics registers begin to produce long-term safety and efficacy data, therapy decisions in plaque psoriasis may become more objective, and it may be possible to individualize treatment based on clinical or pharmacogenetic information.
英国有多种生物制剂可供选择，用于治疗中重度斑块型银屑病，包括肿瘤坏死因子（TNF）拮抗剂依那西普、阿达木单抗和英夫利昔单抗，以及白细胞介素（IL）-12/IL-23 拮抗剂乌司奴单抗。目前，在疗效/耐受性方面，首先选择哪种生物制剂，以及在出现疗效/耐受性问题时选择哪种后续生物制剂，都是基于有限的证据。本文综述了 TNF 拮抗剂和 TNF 拮抗剂与 IL-12/IL-23 阻断剂之间生物制剂的疗效、原发性和继发性失败的潜在机制，以及序贯治疗的证据。随着银屑病生物制剂登记开始产生长期安全性和疗效数据，斑块型银屑病的治疗决策可能会变得更加客观，并且根据临床或药物遗传学信息，可能可以实现个体化治疗。
