Lutalo Pamela M K, D'Cruz David P
Louise Coote Lupus Unit, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, Great Maze Pond, London SE1 9RT, United Kingdom.
Int Immunopharmacol. 2015 Aug;27(2):209-12. doi: 10.1016/j.intimp.2015.04.023. Epub 2015 Apr 20.
The anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitides granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA) and microscopic polyangiitis (MPA) constitute a wide spectrum of clinical manifestations of systemic vasculitis which may range from limited disease to organ or life-threatening disease. The introduction of biologics for the management of severe ANCA-associated vasculitis and severe, relapsing disease refractory to conventional immunosuppressants, has significantly improved the clinical prognosis of these autoimmune disorders. Rituximab, an anti-CD20 monoclonal antibody is licenced for remission induction in severe GPA and MPA and the management of severe relapsing, refractory GPA and MPA. Belimumab, an anti-B lymphocyte stimulatory monoclonal antibody is in clinical trials for the management of the ANCA-associated vasculitis GPA. Mepolizumab and Omalizumab are biologics which have been reported to be efficacious in refractory asthma associated with EGPA. The role of anti-TNF therapy and T cell targeting drugs in ANCA-associated vasculitis is less clear due to limited study data. This review will summarise the clinical trials and clinical practice use of biologic treatment strategies for the management of ANCA-associated vasculitis.
抗中性粒细胞胞浆抗体（ANCA）相关血管炎包括肉芽肿性多血管炎（GPA）、嗜酸性肉芽肿性多血管炎（EGPA）和显微镜下多血管炎（MPA），构成了一系列广泛的系统性血管炎临床表现，范围从局限性疾病到器官或危及生命的疾病。用于治疗严重ANCA相关血管炎以及对传统免疫抑制剂难治的严重复发性疾病的生物制剂的引入，显著改善了这些自身免疫性疾病的临床预后。利妥昔单抗，一种抗CD20单克隆抗体，被批准用于严重GPA和MPA的诱导缓解以及严重复发性、难治性GPA和MPA的治疗。贝利尤单抗，一种抗B淋巴细胞刺激单克隆抗体，正在进行治疗ANCA相关血管炎GPA的临床试验。美泊利单抗和奥马珠单抗是据报道对与EGPA相关的难治性哮喘有效的生物制剂。由于研究数据有限，抗TNF治疗和T细胞靶向药物在ANCA相关血管炎中的作用尚不清楚。本综述将总结用于治疗ANCA相关血管炎的生物治疗策略的临床试验和临床实践应用。
