Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, Taiwan, ROC; Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan, ROC.
Department of Ophthalmology, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan, Taiwan, ROC.
Biochem Pharmacol. 2019 Jul;165:99-111. doi: 10.1016/j.bcp.2019.03.007. Epub 2019 Mar 13.
The introduction of biological disease-modifying antirheumatic drug (bDMARD) treatments for various types of autoimmune arthritis, such as rheumatoid arthritis, psoriatic arthropathy and ankylosing spondylitis, represents a new era of treatment for patients with a refractory response to conventional synthetic DMARDs (csDMARDs). Many new bDMARDs with different modalities or that target different pro-inflammatory molecules, likely cytokines, are rapidly emerging. Hence, physicians in the field may be confused about choosing appropriate bDMARDs for their patients. Considering the high cost of bDMARDs and the rapid destructive process of autoimmune arthritis in patients, the choice of optimal bDMARDs for patients who fail to respond or show an inadequate therapeutic response to csDMARDs designed to control the disease is very critical. Here, we summarize the strengths and weaknesses of bDMARDs and specifically focus on their uses in patients with comorbid conditions or with specific medical conditions, such as pregnancy. This commentary provides a solid up-to-date review on commercially available bDMARDs and very useful information for physicians to facilitate the choice of more appropriate bDMARDs to treat patients with autoimmune arthritis and for basic researchers to understand the current strategies of bDMARD usage and hopefully to develop more powerful bDMARDs with fewer safety concerns.
生物疾病修饰抗风湿药物（bDMARD）治疗各种类型的自身免疫性关节炎，如类风湿关节炎、银屑病关节炎和强直性脊柱炎，代表了对传统合成疾病修饰抗风湿药物（csDMARD）治疗反应不佳的患者的治疗新时代。许多具有不同作用机制或针对不同促炎分子（可能是细胞因子）的新型 bDMARD 药物迅速涌现。因此，该领域的医生可能会对为患者选择合适的 bDMARD 药物感到困惑。考虑到 bDMARD 药物的高成本和患者自身免疫性关节炎的快速破坏性过程，如果 csDMARD 药物设计用于控制疾病但未能达到预期治疗效果或反应不足，为患者选择最佳的 bDMARD 药物非常关键。在这里，我们总结了 bDMARD 的优缺点，并特别关注它们在合并症患者或特定医疗条件（如妊娠）患者中的应用。该评论提供了对商业上可用的 bDMARD 的全面最新综述，为医生提供了非常有用的信息，以帮助他们选择更合适的 bDMARD 药物来治疗自身免疫性关节炎患者，并为基础研究人员提供了了解当前 bDMARD 使用策略的机会，希望开发出更有效且安全性顾虑更少的 bDMARD 药物。
