Hoi Alberta, Littlejohn Geoff
Department of Rheumatology, Monash Health , 246 Clayton Road, Clayton, Victoria 3168 , Australia
Expert Opin Biol Ther. 2014 Sep;14(9):1345-50. doi: 10.1517/14712598.2014.935329. Epub 2014 Jul 9.
The quest for safer and more effective treatments for systemic lupus erythematosus (SLE) has led to the development of many new biologic therapies. Abatacept is the first drug targeting co-stimulation between T cells and antigen presenting cells, with abundant pre-clinical evidence to support its use in SLE.
This review will present the relevant aspects of lupus pathophysiology pertaining to the mechanism of action of abatacept, a summary of murine studies and the latest human clinical trials.
Abatacept has demonstrated efficacy in both rheumatoid arthritis and psoriatic arthritis, and earlier studies have suggested tantalising evidence of efficacy in SLE. However, the latest randomised double-blinded study showed disappointingly negative results, much like the case of rituximab in SLE. Currently, abatacept remains a possible therapeutic option as an off-label therapy, and it is a part of our therapeutic armamentarium in difficult cases. The need to find appropriate definitions of response and optimal study design continues to be paramount in the field of lupus therapies.
对系统性红斑狼疮（SLE）更安全、更有效治疗方法的探索促使了许多新型生物疗法的发展。阿巴西普是首个靶向T细胞与抗原呈递细胞之间共刺激作用的药物，有大量临床前证据支持其在SLE中的应用。
本综述将介绍与阿巴西普作用机制相关的狼疮病理生理学的相关方面、小鼠研究总结及最新的人类临床试验情况。
阿巴西普已在类风湿关节炎和银屑病关节炎中显示出疗效，早期研究也提示了其在SLE中可能有效的诱人证据。然而，最新的随机双盲研究结果令人失望，呈阴性，这与利妥昔单抗在SLE中的情况类似。目前，阿巴西普作为一种超说明书用药仍是一种可能的治疗选择，且在疑难病例中是我们治疗手段的一部分。在狼疮治疗领域，找到合适的反应定义和优化研究设计的需求仍然至关重要。
