Lopalco Giuseppe, Rigante Donato, Giannini Margherita, Galeazzi Mauro, Lapadula Giovanni, Iannone Florenzo, Cantarini Luca
Interdisciplinary Department of Medicine, University of Bari, Italy.
Institute of Paediatrics, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
Clin Exp Rheumatol. 2016 May-Jun;34(3):531-8. Epub 2016 Feb 26.
Anakinra is a biologic response modifier that competitively antagonises the biologic effects of interleukin-1, the ancestor pleiotropic proinflammatory cytokine produced by numerous cell types, found in excess in the serum, synovial fluid and any involved tissues of patients with many inflammatory diseases. The magnitude of the risk of different infections, including Mycobacterium tuberculosis (Mtb) infection, associated with the large use of anakinra in many rheumatologic, metabolic or autoinflammatory disorders is still unknown. In addition, it is unclear whether this effect is modified by the concomitant use of antirheumatic drugs and corticosteroids. The rates of development of Mtb disease in patients treated with anakinra due to rheumatoid arthritis, systemic autoinflammatory diseases, Schnitzler's syndrome, Behçet's disease, adult-onset Still disease, systemic juvenile idiopathic arthritis, gout and diabetes mellitus have been usually very low. However, clinicians must carefully weigh the benefits of biological drugs against their risks, particularly in patients prone to infections. Additional data are needed to understand whether this risk of Mtb infection and reactivation are representative of a class effect related to biologics or whether anakinra bears specifically an intrinsic lower risk in comparison with other biologic drugs.
阿那白滞素是一种生物反应调节剂，它能竞争性拮抗白细胞介素-1的生物学效应。白细胞介素-1是由多种细胞类型产生的多效性促炎细胞因子鼻祖，在许多炎症性疾病患者的血清、滑液及任何受累组织中均过量存在。在许多风湿性、代谢性或自身炎症性疾病中大量使用阿那白滞素后，包括结核分枝杆菌（Mtb）感染在内的不同感染风险程度仍不清楚。此外，尚不清楚抗风湿药物和皮质类固醇的联合使用是否会改变这种效应。因类风湿关节炎、系统性自身炎症性疾病、施尼茨勒综合征、白塞病、成人斯蒂尔病、系统性幼年特发性关节炎、痛风和糖尿病而接受阿那白滞素治疗的患者中，Mtb病的发生率通常非常低。然而，临床医生必须仔细权衡生物药物的益处与风险，尤其是在易感染患者中。需要更多数据来了解Mtb感染和再激活的这种风险是与生物制剂相关的类效应的体现，还是与其他生物药物相比，阿那白滞素本身具有更低的固有风险。
