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成人持续活动性类风湿性关节炎联合治疗的临床试验

Author
James R O'Dell, MD
Section Editor
Ravinder N Maini, BA, MB BChir, FRCP, FMedSci, FRS
Deputy Editor
Paul L Romain, MD
Translators
郁胜强, 副主任医师，副教授

引言

有类风湿关节炎(rheumatoid arthritis, RA)并且虽然采取了初始药物治疗但疾病仍为持续活动性的患者，需要调整治疗方案以有效控制疾病。持续活动性疾病患者通常需要联合采用缓解疾病的抗风湿药(disease-modifying antirheumatic drug, DMARD)治疗，持续活动性疾病定义为尽管已用一种或几种DMARD进行初始治疗，RA仍为活动性且持续至少6个月[1]。

DMARD可分为两大类(非生物型和生物型)，以及具有每种主要类型中某些特征的第三类。

●非生物型DMARD是传统的小分子或合成DMARD，如甲氨蝶呤(methotrexate, MTX)、来氟米特(leflunomide, LEF)、柳氮磺吡啶(sulfasalazine, SSZ)和羟氯喹(hydroxychloroquine, HCQ)。

●生物型DMARD通过脱氧核糖核酸(deoxyribonucleic acid, DNA) 重组技术产生，通常以特定细胞因子或其受体为目标，如肿瘤坏死因子(tumor necrosis factor, TNF)-α、白介素(interleukin, IL)-1或IL-6受体。其他类型的生物型DMARD包括B细胞消减剂及T细胞共刺激的阻滞剂。生物型DMARD的使用被称为“靶向治疗”。

●第三类DMARD包括药物托法替尼，该药与非生物型DMARD作为口服活性小分子药物共有某些特征，但该药是Janus激酶异构体的一种抑制剂，Janus激酶是对多种不同IL的细胞膜受体信号转导具有关键作用的胞质蛋白酪氨酸激酶。该药所致Janus激酶抑制作用的生物效应及临床效应与生物剂型相似。

                      

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Literature review current through: 2017-06 . | This topic last updated: 2016-01-02.
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