Oussedik Elias, Patel Nupur U, Cash Devin R, Gupta Angela S, Feldman Steven R
Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA -
G Ital Dermatol Venereol. 2017 Dec;152(6):586-596. doi: 10.23736/S0392-0488.17.05750-9. Epub 2017 Sep 12.
Biologic therapies have revolutionized the approach to immune-mediated diseases such as psoriasis. Due to their favorable safety profiles and excellent efficacy, biologic agents are considered the gold standard for moderate-to-severe psoriasis. The aim of this paper is to saliently review the severe and acute complications of the Food and Drug Administration (FDA) approved biologic agents for psoriasis. Reviewed agents include tumor necrosis factor alpha inhibitors (etanercept, infliximab, and adalimumab), interleukin 12/23 inhibitors (ustekinumab), and interleukin 17 (IL-17) inhibitors (secukinumab and ixekizumab). While malignancies, serious infections, and major adverse cardiovascular events have been reported, their association with biologic therapy are not hypothesized as causal. However, IL-17 inhibitors appear to cause exacerbations and new cases of inflammatory bowel disease. While more long-term studies are warranted in understanding the biologic's long-term side effect profile, short-term studies have confirmed that the biologics are some of the safest treatment options for psoriasis. Nevertheless, certain populations yield higher risk to acute complications with the biologics than others - physicians must use their judgement and vigilance when monitoring and treating patients undergoing therapy with biological agents.
生物疗法彻底改变了诸如银屑病等免疫介导疾病的治疗方法。由于其良好的安全性和卓越的疗效，生物制剂被视为中重度银屑病的金标准。本文旨在着重综述美国食品药品监督管理局（FDA）批准用于治疗银屑病的生物制剂的严重及急性并发症。所综述的制剂包括肿瘤坏死因子α抑制剂（依那西普、英夫利昔单抗和阿达木单抗）、白细胞介素12/23抑制剂（乌司奴单抗）以及白细胞介素17（IL-17）抑制剂（司库奇尤单抗和伊塞克单抗）。虽然已有恶性肿瘤、严重感染及主要不良心血管事件的报道，但它们与生物治疗之间的关联并未被假定为因果关系。然而，IL-17抑制剂似乎会导致炎症性肠病的病情加重及新发病例。虽然需要更多长期研究来了解生物制剂的长期副作用情况，但短期研究已证实，生物制剂是银屑病最安全的治疗选择之一。尽管如此，某些人群使用生物制剂发生急性并发症的风险高于其他人群——医生在监测和治疗接受生物制剂治疗的患者时必须运用自己的判断力并保持警惕。
