Rheumatology Unit, L. Sacco University Hospital, Milan, Italy.
Autoimmun Rev. 2013 Mar;12(5):575-9. doi: 10.1016/j.autrev.2012.10.020. Epub 2012 Dec 3.
Biological drugs have brought new hope to patients with rheumatoid arthritis (RA) in whom previously existing treatments could not control inflammation, joint destruction, or the progression of disability. The five currently available TNF blockers are approved for treating RA patients, but they have different structures, morphology, pharmacokinetic properties, and activity. Randomised clinical trials (RCTs) have shown that they improve the signs and symptoms of both early and long-standing RA and other inflammatory arthritides, prevent radiographic progression, and improve the patients' health-related quality of life. However, they are more effective in combination with methotrexate (MTX) than alone. Combined treatment is generally well tolerated, and seems to be relatively safe in the short term, as confirmed by RCTs, long-term observational studies and in clinical practice. Patients who fail to respond or develop adverse effects - when treated with one anti-TNF agent can be successfully treated with a second TNF antagonist. However, in the case of primary failure, it is possible that biological agents with a different mechanism of action may be more successful. Tocilizumab alone or in combination with MTX is more effective than MTX monotherapy in reducing disease activity over 24 weeks. Abatacept is well tolerated and retains its efficacy over time, as does rituximab in non-responders to other anti-TNF drugs. Finally, although these drugs improve the quality of life of RA patients, they considerably increase direct medical costs.
生物制剂为类风湿关节炎（RA）患者带来了新的希望，这些患者先前的治疗方法无法控制炎症、关节破坏或残疾进展。目前有五种 TNF 阻滞剂被批准用于治疗 RA 患者，但它们具有不同的结构、形态、药代动力学特性和活性。随机临床试验（RCT）表明，它们改善了早期和长期 RA 以及其他炎症性关节炎的症状和体征，预防了影像学进展，并改善了患者的健康相关生活质量。然而，它们与甲氨蝶呤（MTX）联合使用比单独使用更有效。联合治疗通常具有良好的耐受性，并且在 RCT、长期观察性研究和临床实践中证实，在短期看来相对安全。对于那些对一种抗 TNF 药物无反应或出现不良反应的患者，可以成功地用第二种 TNF 拮抗剂进行治疗。然而，在原发性治疗失败的情况下，使用作用机制不同的生物制剂可能会更成功。托珠单抗单独使用或与 MTX 联合使用，在 24 周内比 MTX 单药治疗更能有效降低疾病活动度。阿巴西普具有良好的耐受性，并且随着时间的推移保持其疗效，利妥昔单抗在对其他抗 TNF 药物无反应的患者中也是如此。最后，虽然这些药物改善了 RA 患者的生活质量，但它们大大增加了直接医疗费用。
