Strehl Cindy, van der Goes Marlies C, Bijlsma Johannes W J, Jacobs Johannes W G, Buttgereit Frank
a Department of Rheumatology and Clinical Immunology , Charité - University Medicine Berlin , Berlin , Germany.
b German Rheumatism Research Centre (DRFZ) , Berlin , Germany.
Expert Opin Investig Drugs. 2017 Feb;26(2):187-195. doi: 10.1080/13543784.2017.1276562. Epub 2017 Jan 3.
The beneficial effects of glucocorticoids are highly regarded in the treatment of inflammatory diseases. In rheumatoid arthritis, these drugs are widely used because they effectively reduce signs and symptoms of the disease, and exert disease-modifying effects. However, both patients and physicians frequently associate glucocorticoids with a variety of adverse effects which hamper adherence. Due to this ambivalent nature of these drugs, several new glucocorticoids or glucocorticoid receptor ligands are being developed, aiming at improving their benefit-risk balance. Areas covered: Focussing on rheumatoid arthritis, we discuss current approaches to achieve this goal, including an optimized application of conventional glucocorticoids and the development of novel formulations aiming at minimizing adverse effects while keeping or even enhancing the anti-inflammatory efficacy. Expert opinion: Glucocorticoids - be it conventional or modified/delayed-release formulations - have so far been convincing in clinical practice, and their widespread use will therefore continue. They are not likely to be replaced by novel drugs in the near future although some investigational preparations are promising, and results obtained from currently ongoing clinical trials in humans are eagerly awaited. As a result of these developmental activities, a further improvement of the benefits-risk balance of glucocorticoids or glucocorticoid receptor ligands is expected.
糖皮质激素在炎症性疾病治疗中的有益作用备受认可。在类风湿关节炎中，这些药物被广泛使用，因为它们能有效减轻疾病的体征和症状，并发挥改善病情的作用。然而，患者和医生常常将糖皮质激素与多种阻碍依从性的不良反应联系在一起。由于这些药物的这种矛盾特性，几种新型糖皮质激素或糖皮质激素受体配体正在研发中，旨在改善其效益风险比。涵盖领域：聚焦于类风湿关节炎，我们讨论当前实现这一目标的方法，包括优化传统糖皮质激素的应用以及开发新型制剂，旨在在保持甚至增强抗炎疗效的同时将不良反应降至最低。专家观点：到目前为止，无论是传统的还是改良/缓释剂型的糖皮质激素在临床实践中都很有说服力，因此它们的广泛应用将会持续。尽管一些研究制剂很有前景，并且人们急切期待目前正在进行的人体临床试验结果，但在不久的将来它们不太可能被新药取代。由于这些研发活动，预计糖皮质激素或糖皮质激素受体配体的效益风险比将进一步改善。
