Li L, Liu J J, Yu X, Wu D, Zhang S Z, Yang Y J, Zhou J X, Zeng X F, Zhang F C, Zheng W J
Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education,Peking Union Medical College Hospital Translational Medical Center, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing 100730, China.
Zhonghua Nei Ke Za Zhi. 2020 Apr 1;59(4):303-308. doi: 10.3760/cma.j.cn112138-20190730-00527.
To explore the efficacy and safety of anti-tumor necrosis factor alpha (TNFα) monoclonal antibodies (mAbs) for severe/refractory vasculo-Behcet's disease (BD). The clinical data of severe/refractory vasculo-BD patients treated with anti-TNFα mAbs were retrospectively analyzed. Response of anti TNFα mAbs was analyzed. The dosage changes of glucocorticoid, the level of erythrocyte sedimentation rate (ESR) and hypersensitive C-reactive protein (hsCRP) before and after treatment were recorded, as well as side effects. Sixteen patients were enrolled. Arterial lesions were reported in 12 patients, including 9 with arterial aneurysm, 6 with arterial dilation, 2 with stenosis and 2 with occlusion. Seven patients presented venous thrombosis, including lower extremity veins (=6), cerebral venous sinus (=2) and inferior vena cava system (=2). Two cases had both arterial and venous involvement. Before the application of TNFα mAbs, all 16 patients failed to response to prednisone or its equivalent dose of 40 (7.5-90) mg/d in combination with cyclophosphamide, methotrexate, thalidomide or azathioprine for median 4 (0-156) months. After a mean duration of treatment for (17.1±6.5) months, 15 patients achieved complete remission and 1 patient achieved partial remission. Three patients received surgery without any postoperative complications. After using anti TNFα mAbs, the dosage of prednisone [5(0-12.5)mg/d vs. 40(7.5-90)mg/d, <0.01], ESR [(7.3±4.6) mm/1h vs. (33.5±26.7) mm/1h, <0.01] and hsCRP [1.9(0.2-11.4) mg/L vs. 24.3(0.4-113.9) mg/L, <0.01] were significantly decreased. Side effects were observed in 2 patients. One developed pulmonary infection 12 months after adalimumab with conventional treatment. Another patient had allergy to infliximab then switched to adalimumab. In combination with corticosteroids and immunosuppressants, anti-TNF α mAbs are effective and well-tolerated in severe/refractory vasculo-BD, with a favorable steroid -sparing effect and rare postoperative complications.
探讨抗肿瘤坏死因子α（TNFα）单克隆抗体（mAbs）治疗重度/难治性血管型白塞病（BD）的疗效和安全性。回顾性分析接受抗TNFα mAbs治疗的重度/难治性血管型BD患者的临床资料。分析抗TNFα mAbs的反应。记录治疗前后糖皮质激素的剂量变化、红细胞沉降率（ESR）和超敏C反应蛋白（hsCRP）水平以及副作用。共纳入16例患者。12例患者有动脉病变，包括9例动脉瘤、6例动脉扩张、2例狭窄和2例闭塞。7例患者出现静脉血栓形成，包括下肢静脉（=6例）、脑静脉窦（=2例）和下腔静脉系统（=2例）。2例患者同时有动脉和静脉受累。在应用TNFα mAbs之前，所有16例患者对泼尼松或其等效剂量40（7.5 - 90）mg/d联合环磷酰胺、甲氨蝶呤、沙利度胺或硫唑嘌呤治疗均无反应，中位治疗时间为4（0 - 156）个月。经过平均（17.1±6.5）个月的治疗后，15例患者达到完全缓解，1例患者达到部分缓解。3例患者接受了手术，术后无任何并发症。使用抗TNFα mAbs后，泼尼松剂量[5（0 - 12.5）mg/d vs. 40（7.5 - 90）mg/d，<0.01]、ESR[（7.3±4.6）mm/1h vs.（33.5±26.7）mm/1h，<0.01]和hsCRP[1.9（0.2 - 11.4）mg/L vs. 24.3（0.4 - 113.9）mg/L，<0.01]均显著降低。2例患者观察到副作用。1例患者在使用阿达木单抗联合传统治疗12个月后发生肺部感染。另1例患者对英夫利昔单抗过敏，随后改用阿达木单抗。联合使用糖皮质激素和免疫抑制剂时，抗TNFα mAbs治疗重度/难治性血管型BD有效且耐受性良好，具有良好的激素节省作用且术后并发症少见。
