Department of Medicine, Rochester General Hospital, Rochester, NY, USA.
, Rochester, USA.
Clin Rev Allergy Immunol. 2020 Oct;59(2):220-230. doi: 10.1007/s12016-019-08739-8.
The use of biologic agents as therapies for atopic diseases such as asthma and atopic dermatitis has increased greatly in recent years. The biological agents used to treat atopic diseases are for the most part monoclonal antibodies that suppress the immune response and reduce inflammation by targeting particular cytokines or other molecules involved in Th1, Th2, or Th17 immune reactions. Various side effects and rare complications have been reported from these agents. In this review, we discuss mechanisms of various adverse effects for the biologic agents currently in use or in development for atopic and inflammatory diseases. Monoclonal antibodies targeting the Th1 and Th17 pathways have been associated with significant side effects, partially due to their ability to cause significant impairment in immune responses to pathogens because of the immunologic alterations that they produce. Biologicals targeting Th2-mediated inflammation have had fewer reported side effects, though many are new and emerging drugs whose adverse effects may remain to be fully elucidated with more use. Therefore, continued long-term safety monitoring is required. As with all therapies, the risks associated with side effects of biologics must be balanced against the benefits these drugs offer for treating atopic diseases. One of the most apparent benefits is the steroid-sparing effect of well-chosen biologic therapy used to treat severe atopic disease. In contrast with the quite favorable safety profile of currently available biologics that target the Th2-mediated immune response, chronic systemic corticosteroid use is associated with significant side effects, many of which impact the majority of patients who are placed on long-term steroid therapy.
近年来，生物制剂作为治疗哮喘和特应性皮炎等特应性疾病的疗法的应用大大增加。用于治疗特应性疾病的生物制剂大多数是单克隆抗体，通过针对特定细胞因子或其他参与 Th1、Th2 或 Th17 免疫反应的分子来抑制免疫反应和减少炎症。这些药物已报告有各种副作用和罕见并发症。在这篇综述中，我们讨论了目前用于治疗特应性和炎症性疾病的生物制剂的各种不良反应机制。针对 Th1 和 Th17 途径的单克隆抗体与显著的副作用有关，部分原因是它们能够因产生的免疫改变而导致对病原体的免疫反应显著受损。针对 Th2 介导的炎症的生物制剂报告的副作用较少，但许多是新出现的药物，其不良反应可能随着更多的使用而尚未完全阐明。因此，需要持续进行长期安全性监测。与所有治疗方法一样，必须权衡生物制剂副作用的风险与这些药物治疗特应性疾病的益处。一个最明显的好处是，选择合适的生物治疗用于治疗严重的特应性疾病，具有类固醇节省效应。与目前针对 Th2 介导的免疫反应的生物制剂相当有利的安全性概况形成对比的是，慢性全身皮质类固醇的使用与显著的副作用相关，其中许多副作用影响大多数接受长期类固醇治疗的患者。
