New therapies for psoriasis and psoriatic arthritis.
New therapies for psoriasis and psoriatic arthritis.
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DOI：
10.1097/bor.0000000000000274
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发表时间：
2016-05
影响因子：
5.1
通讯作者：
Krueger JG
中科院分区：
文献类型：
--
作者：
Ritchlin CT;Krueger JG
在过去的几年中，新的免疫途径在银屑病和银屑病关节炎的病理生物学发展的关键已经被揭示。这些发现促进了对新治疗靶点的探索，从而产生了许多新的治疗方法，这些方法现在可用于银屑病患者。沿着分泌IL-17（TH 17）的辅助性T细胞与CD 8+细胞、先天性淋巴细胞和γ δ T细胞在银屑病和银屑病关节炎（PsA）的发病机制中是重要的。最近，靶向IL-17、IL-17受体和IL-23（抗p19）的药物已被批准或正在进行临床试验。阿普斯特是一种新的口服药物，已被批准用于治疗银屑病和PsA。苏金单抗是一种IL-17 A抗体，在美国已被批准用于治疗银屑病和PsA。它是有效的，具有良好的安全性。另一种抗IL-17 A抗体Ixekizumab目前正在临床试验中，而IL-17受体拮抗剂brodalumab由于安全性问题而从临床试验中删除，尽管在银屑病和PsA中证明了疗效。用p19抗体靶向IL-23是另一种在银屑病中具有令人鼓舞的结果的方法。阿普斯特是一种被批准用于治疗银屑病和PsA的口服药物，具有良好的安全性记录。托法替尼在银屑病疾病中的作用仍有待确定，有待银屑病的安全性审查和PsA试验的完成。
Over the last several years, novel immunologic pathways pivotal in the development of the pathobiology of psoriasis and psoriatic arthritis have been revealed. These discoveries catalyzed a search for new treatment targets resulting in many new therapies that are now available for patients with psoriatic disease. Helper T cells that secrete IL-17 (TH17) along with CD8+ cells, innate lymphocyte cells and gamma delta T cells are important in the pathogenesis of psoriasis and psoriatic arthritis (PsA). Recently, agents that target IL-17, the IL-17 receptor, and IL-23 (anti-p19) have been approved or are in clinical trials. Apremilast, a new oral agent, was approved for treatment of psoriasis and PsA. Secukinumab, an IL-17A antibody has been approved for treatment of psoriasis and PsA in the US. It is effective with a good safety profile. Ixekizumab, another anti-IL-17A antibody is currently in clinical trials and brodalumab, an IL-17 receptor antagonist, was removed from clinical trials due to safety concerns despite demonstrated efficacy in psoriasis and PsA. Targeting IL-23 with antibodies to p19 is another approach with encouraging results in psoriasis. Apremilast, an oral agent approved to treat psoriasis and PsA demonstrates moderate efficacy with an excellent safety record. The role of tofacitinib in psoriatic disease remains to be determined pending a safety review in psoriasis and completion of PsA trials.