Senabre-Gallego José Miguel, Santos-Ramírez Carlos, Santos-Soler Gregorio, Salas-Heredia Esteban, Sánchez-Barrioluengo Mabel, Barber Xavier, Rosas José
Rheumatology, Hospital Marina Baixa, Villajoyosa, Spain.
Patient Prefer Adherence. 2013 Sep 23;7:961-72. doi: 10.2147/PPA.S33109.
To date, anti-tumor necrosis factor alfa (anti-TNF-α) therapy is the only alternative to nonsteroidal anti-inflammatory drugs for the treatment of ankylosing spondylitis. Etanercept is a soluble TNF receptor, with a mode of action and pharmacokinetics different to those of antibodies and distinctive efficacy and safety. Etanercept has demonstrated efficacy in the treatment of ankylosing spondylitis, with or without radiographic sacroiliitis, and other manifestations of the disease, including peripheral arthritis, enthesitis, and psoriasis. Etanercept is not efficacious in inflammatory bowel disease, and its efficacy in the treatment of uveitis appears to be lower than that of other anti-TNF drugs. Studies of etanercept confirmed regression of bone edema on magnetic resonance imaging of the spine and sacroiliac joint, but failed to reduce radiographic progression, as do the other anti-TNF drugs. It seems that a proportion of patients remain in disease remission when the etanercept dose is reduced or administration intervals are extended. Etanercept is generally well tolerated with an acceptable safety profile in the treatment of ankylosing spondylitis. The most common adverse effect of etanercept treatment is injection site reactions, which are generally self-limiting. Reactivation of tuberculosis, reactivation of hepatitis B virus infection, congestive heart failure, demyelinating neurologic disorders, hematologic disorders like aplastic anemia and pancytopenia, vasculitis, immunogenicity, and exacerbation or induction of psoriasis are class effects of all the anti-TNF drugs, and have been seen in patients with ankylosing spondylitis. However, etanercept is less likely to induce reactivation of tuberculosis than the other anti-TNF drugs and it has been suggested that etanercept might be less immunogenic, especially in ankylosing spondylitis. Acute uveitis, Crohn's disease, and sarcoidosis are other adverse events that have been rarely associated with etanercept therapy in patients with ankylosing spondylitis.
迄今为止，抗肿瘤坏死因子α（抗TNF-α）疗法是治疗强直性脊柱炎的非甾体抗炎药之外的唯一选择。依那西普是一种可溶性TNF受体，其作用方式和药代动力学与抗体不同，且疗效和安全性独特。依那西普已证明对有或无放射学骶髂关节炎的强直性脊柱炎以及该疾病的其他表现，包括外周关节炎、附着点炎和银屑病有效。依那西普对炎性肠病无效，其治疗葡萄膜炎的疗效似乎低于其他抗TNF药物。依那西普的研究证实，脊柱和骶髂关节磁共振成像上的骨水肿有所消退，但未能像其他抗TNF药物那样减少放射学进展。当依那西普剂量降低或给药间隔延长时，似乎有一部分患者仍处于疾病缓解状态。在强直性脊柱炎的治疗中，依那西普总体耐受性良好，安全性可接受。依那西普治疗最常见的不良反应是注射部位反应，通常为自限性。结核病再激活、乙型肝炎病毒感染再激活、充血性心力衰竭、脱髓鞘性神经疾病、再生障碍性贫血和全血细胞减少等血液系统疾病、血管炎、免疫原性以及银屑病的加重或诱发是所有抗TNF药物的类效应，在强直性脊柱炎患者中也有出现。然而，依那西普诱发结核病再激活的可能性低于其他抗TNF药物，有人认为依那西普的免疫原性可能较低，尤其是在强直性脊柱炎患者中。急性葡萄膜炎、克罗恩病和结节病是强直性脊柱炎患者中很少与依那西普治疗相关的其他不良事件。
