Kim Byungsoo, Maverakis Emanual, Raychaudhuri Siba P
Department of Dermatology, Pusan National University School of Medicine, Yangsan, Korea.
Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
Ann Dermatol. 2019 Oct;31(5):495-501. doi: 10.5021/ad.2019.31.5.495. Epub 2019 Aug 30.
Tumor necrosis factor (TNF) antagonists are highly effective treatments for psoriasis. These agents provide the opportunity to improve disease activity and achieve clinical remission. Despite its efficacy, long-term use of biologics is associated with high financial costs and possibly life-threatening adverse events. Recently, there has been an increasing interest in discontinuing TNF antagonists in patients with psoriasis who have achieved a positive clinical response. However, there is a paucity of data and clinical guidelines concerning the cessation TNF antagonists in psoriasis treatment. Several factors, including cost, subsequent treatment efficacy, relative risks, and tolerability, should be considered before the decision is made to discontinue TNF antagonists. Well-designed clinical trials are necessary to identify factors that may trigger disease exacerbation after medication discontinuation in order to recognize the potential disadvantages of discontinuing treatment in patients who are previously successfully managed on TNF antagonists.
肿瘤坏死因子（TNF）拮抗剂是治疗银屑病的高效药物。这些药物为改善疾病活动度和实现临床缓解提供了契机。尽管其疗效显著，但长期使用生物制剂会带来高昂的经济成本，且可能引发危及生命的不良事件。最近，对于已取得积极临床反应的银屑病患者停用TNF拮抗剂的兴趣日益浓厚。然而，关于银屑病治疗中停用TNF拮抗剂的数据和临床指南较为匮乏。在决定停用TNF拮抗剂之前，应考虑包括成本、后续治疗疗效、相对风险和耐受性在内的多个因素。有必要开展精心设计的临床试验，以确定停药后可能引发疾病加重的因素，从而认识到在先前使用TNF拮抗剂治疗成功的患者中停药的潜在弊端。
