San Koo Bon, Kim Tae-Hwan
Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Korea.
Ther Adv Musculoskelet Dis. 2021 Jan 12;13:1759720X20986734. doi: 10.1177/1759720X20986734. eCollection 2021.
Among patients with axial spondyloarthritis (axSpA), non-radiographic axial spondyloarthritis (nr-axSpA) is distinguished from ankylosing spondylitis (AS) by a lack of obvious radiographic changes in the sacroiliac joint. Tumor necrosis factor inhibitor (TNFi) has been used as a highly effective treatment in patients with AS and has shown good efficacy and safety in clinical trials in patients with nr-axSpA. As the pathophysiological mechanism for axSpA has started to become better recognized, various drugs other than TNFi, all of which are related to the interleukin-17 (IL-17) axis, are being evaluated in patients with axSpA. IL-17 inhibitors, such as secukinumab and ixekizumab, are effective drugs for patients with AS. A recent clinical trial reported that ixekizumab, a monoclonal antibody against IL-17A, was also effective in patients with nr-axSpA. In a COAST-X study, ixekizumab was superior to a placebo for improving signs and symptoms in patients with nr-axSpA at weeks 16 and 52. The adverse events were no different from those found in previous ixekizumab studies, and no new safety signals were identified. However, when considering several IL-17 inhibitors, it is necessary to obtain sufficient data to identify the exacerbation of extra-articular manifestation. In terms of effectiveness and safety, ixekizumab may be an appropriate alternative to TNFi in nr-axSpA patients.
在轴性脊柱关节炎（axSpA）患者中，非放射学轴性脊柱关节炎（nr-axSpA）与强直性脊柱炎（AS）的区别在于骶髂关节缺乏明显的放射学改变。肿瘤坏死因子抑制剂（TNFi）已被用作AS患者的高效治疗药物，并且在nr-axSpA患者的临床试验中显示出良好的疗效和安全性。随着axSpA的病理生理机制开始得到更好的认识，除TNFi之外的各种药物（所有这些药物均与白细胞介素-17（IL-17）轴相关）正在axSpA患者中进行评估。IL-17抑制剂，如司库奇尤单抗和依奇珠单抗，是AS患者的有效药物。最近一项临床试验报告称，抗IL-17A单克隆抗体依奇珠单抗对nr-axSpA患者也有效。在一项COAST-X研究中，在第16周和第52周时，依奇珠单抗在改善nr-axSpA患者的体征和症状方面优于安慰剂。不良事件与之前依奇珠单抗研究中发现的无异，并且未发现新的安全信号。然而，在考虑几种IL-17抑制剂时，有必要获得足够的数据以确定关节外表现的加重情况。在有效性和安全性方面，依奇珠单抗可能是nr-axSpA患者TNFi的合适替代药物。
