Murdaca Giuseppe, Negrini Simone, Magnani Ottavia, Penza Elena, Pellecchio Marco, Gulli Rossella, Mandich Paola, Puppo Francesco
a Department of Internal Medicine, Scleroderma Unit, Clinical Immunology Unit , University of Genova and IRCCS-Azienda Ospedaliera Universitaria San Martino , Genova , Italy.
b Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, Section of Medical Genetics , University of Genova and IRCCS-Azienda Ospedaliera Universitaria San Martino , Genova , Italy.
Mod Rheumatol. 2018 May;28(3):417-431. doi: 10.1080/14397595.2017.1366006. Epub 2017 Aug 24.
TNF-α inhibitors have demonstrated efficacy both as monotherapy and in combination with disease-modifying anti-rheumatic drugs (DMARDs) in the treatment of chronic inflammatory immune-mediated diseases such as rheumatoid arthritis, Crohn's disease, ulcerative colitis, ankylosing spondylitis (AS), psoriasis (Ps) and/or psoriatic arthritis (PsA) and may be administered off-label to treat disseminated granuloma annulare, systemic lupus erythematosus and systemic sclerosis. There are several TNF-α inhibitors available for clinical use including infliximab, adalimumab, golimumab, certolizumab pegol and etanercept. In this article, we discuss the efficacy and safety of etanercept in the treatment of spondyloarthritis and juvenile idiopathic arthritis (JIA). Etanercept is effective in the treatment of PsA, AS, JIA and uveitis. Independent predictors of achieving a sustained clinical improvement or MDA in children with JIA include shorter disease duration, no concurrent oral corticosteroid use, history of chronic anterior uveitis and age <9 years. IBD incidence was lower in patients receiving etanercept plus MTX. Intra-articular administration of etanercept seems to favor a prompt target joint improvement without serious adverse events. Etanercept improve endothelial function reducing the risk of acute cardiovascular and/or cerebrovascular events. The most commonly reported adverse events were nasopharyngitis, epidermal and dermal conditions, upper respiratory tract infection, cough, headache and fatigue.
肿瘤坏死因子-α（TNF-α）抑制剂已证明，无论是作为单一疗法还是与改善病情的抗风湿药物（DMARDs）联合使用，在治疗类风湿关节炎、克罗恩病、溃疡性结肠炎、强直性脊柱炎（AS）、银屑病（Ps）和/或银屑病关节炎（PsA）等慢性炎症性免疫介导疾病方面均有效，并且可在标签外使用以治疗播散性环状肉芽肿、系统性红斑狼疮和系统性硬化症。有几种TNF-α抑制剂可供临床使用，包括英夫利昔单抗、阿达木单抗、戈利木单抗、赛妥珠单抗和依那西普。在本文中，我们讨论依那西普在治疗脊柱关节炎和幼年特发性关节炎（JIA）方面的疗效和安全性。依那西普在治疗PsA、AS、JIA和葡萄膜炎方面有效。JIA患儿实现持续临床改善或最小疾病活动度（MDA）的独立预测因素包括病程较短、未同时使用口服糖皮质激素、有慢性前葡萄膜炎病史以及年龄<9岁。接受依那西普加甲氨蝶呤（MTX）治疗的患者中炎症性肠病（IBD）发病率较低。关节内注射依那西普似乎有利于靶关节迅速改善且无严重不良事件。依那西普可改善内皮功能，降低急性心血管和/或脑血管事件的风险。最常报告的不良事件为鼻咽炎、表皮和真皮疾病、上呼吸道感染、咳嗽、头痛和疲劳。
