生物制品治疗类风湿关节炎评价新视角

A New Perspective to Evaluate the Treatment of Rheumatoid Arthritis with Biological Products

类风湿关节炎(rheumatoid arthritis,RA)是一种广泛存在的系统性自身免疫性疾病,以关节免疫功能紊乱伴随严重滑膜炎和关节侵蚀为特征,进一步发展会导致进行性残疾。目前,临床上针对RA的治疗药物以缓解病情的抗类风湿药物(disease-modifying anti-rheumatic drugs,DMARDs)为主,包括传统合成DMARDs(traditional synthetic DMARDs,cs DMARDs)、生物类DMARDs(biological DMARDs,b DMARDs)和靶向合成DMARDs(targeted synthetic DMARDs,tsDMARDs),此外还包括非甾体类抗炎药(nonsteroidal antiinflammatory drugs,NSAIDs)及糖皮质激素类药物(glucocorticoids,GCs)。其中,bDMARDs和tsDMARDs已成为RA市场的绝对主力,但因其使用周期长且存在一定的安全性问题,无法达到有效的持续缓解状态,停药后往往会有复发可能,进一步限制了临床应用。综述了临床上主要RA治疗药物及停药后复发情况的研究进展,以期为临床用药周期及方式提供有效的理论依据和新思路。

Rheumatoid arthritis(RA)is a widespread systemic autoimmune disease characterized by joint immune dysfunction with severe synovitis and joint erosion,which can further lead to progressive disability.At present,the main therapeutic drugs for RA in clinical practice are disease modifying anti rheumatoid drugs(DMARDs)that alleviate the condition,including traditional synthetic DMARDs(csDMARDs),biological DMARDs(bDMARDs),and targeted synthetic DMARDs(tsDMARDs).In addition,non steroidal anti-inflammatory drugs(NSAIDs)and glucocorticoids(GCs)are also included.Among them,bDMARDs and tsD⁃MARDs have become the absolute mainstay of the RA market,but due to their long usage cycle and some safety issues,it is im⁃possible to achieve effective and sustained relief,and the phenomenon of relapse often occurs after drug withdrawal,which further limits the clinical application.The article reviewed the research progress on the recurrence of major RA treatment drugs after discon⁃tinuation in clinical practice,in order to provide an effective theoretical basis and new ideas for the clinical drug cycle and method.