Kondo Tsuneo, Amano Koichi
a Department of Rheumatology and Clinical Immunology , Saitama Medical Center, Saitama Medical University , Saitama , Japan.
Immunol Med. 2018 Mar;41(1):6-11. doi: 10.1080/09114300.2018.1451593. Epub 2018 Apr 9.
Glucocorticoids (GCs) have played a pivotal role in the treatment of immune-mediated inflammatory diseases (IMIDs) for a long time. However, GCs also incur a significant risk of undesirable adverse events such as Cushingoid changes, osteoporosis, glaucoma and metabolic abnormalities such as diabetes and hypercholesterolemia, which may lead to life-threatening cerebrovascular and cardiovascular events. High-dose GCs may also cause mental disorders and osteonecrosis. Recently, new therapeutic strategies have been developed to reduce the dose or even eliminate the need for GCs; multi-target drug therapies for systemic lupus erythematosus (SLE), biological agents such as tocilizumab and rituximab for systemic vasculitis, and anakinra and tocilizumab for adult-onset still's disease. Therefore, the era of GC-sparing or GC-free treatment for IMIDs is on the horizon.
长期以来，糖皮质激素（GCs）在免疫介导的炎症性疾病（IMIDs）治疗中发挥了关键作用。然而，GCs也会引发显著的不良事件风险，如库欣样改变、骨质疏松、青光眼以及糖尿病和高胆固醇血症等代谢异常，这些可能导致危及生命的脑血管和心血管事件。高剂量GCs还可能引起精神障碍和骨坏死。最近，已开发出新的治疗策略以降低GCs剂量甚至消除对其的需求；针对系统性红斑狼疮（SLE）的多靶点药物疗法、针对系统性血管炎的托珠单抗和利妥昔单抗等生物制剂，以及针对成人斯蒂尔病的阿那白滞素和托珠单抗。因此，IMIDs的无糖皮质激素或低糖皮质激素治疗时代即将到来。
