Adverse Reactions to Biologics in Psoriasis.
Adverse Reactions to Biologics in Psoriasis.
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DOI：
10.1159/000478072
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发表时间：
2018-01-01
期刊：
影响因子：
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通讯作者：
Kimball, Alexa B
中科院分区：
文献类型：
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作者：
Lockwood, Stephen J;Prens, Lisette M;Kimball, Alexa B
银屑病是一种慢性自身免疫性疾病，影响全世界数百万人。银屑病本身不仅可以使人衰弱并显著降低个体的生活质量，而且它也是其他全身性疾病的危险因素，如代谢综合征，心血管疾病和恶性肿瘤。在世纪中后期，银屑病的治疗取得了巨大的进步，包括局部皮质类固醇和维生素D类似物、甲氨蝶呤、全身性类维生素A和光疗的出现。然而，直到2004年，随着全身性生物制剂的出现，其精确靶向参与银屑病病理生理过程的免疫系统组分，主要治疗基准从银屑病面积和严重程度指数（PASI 50）改善50%增加到PASI 75，PASI 90，甚至PASI 100，或皮肤疾病完全消退。今天，许多接受生物治疗的患者常规皮肤疾病负担减少75%或90%以上，总体生活质量显著改善。这些生物制剂通常耐受性良好且安全，但与任何药物一样，具有相关的不良反应，其中一些是基于免疫调节、动物模型研究和已知细胞因子缺乏的人群的影响可预测的。展望未来，在临床试验和上市后监测登记研究中仔细监测这些药物的安全性特征以确保长期安全性将非常重要。令人放心的是，大型安全性登记研究一致证明了更新和新兴生物治疗的安全性特征改善。
Psoriasis is a chronic autoimmune disease which affects millions of people worldwide. Not only can psoriasis itself be debilitating and significantly reduce an individual's quality of life, but it is also a risk factor for other systemic disorders, such as metabolic syndrome, cardiovascular disease, and malignancy. Tremendous strides were made in the treatment of psoriasis during the mid-to-late-20th century, including the emergence of topical corticosteroids and vitamin D analogs, methotrexate, systemic retinoids, and phototherapy. However, it was not until 2004 with the advent of systemic biologic agents, which precisely target components of the immune system involved in the pathophysiological process of psoriasis, that the primary treatment benchmark increased from 50% improvement in the Psoriasis Area and Severity Index (PASI 50) to PASI 75, PASI 90, and even PASI 100, or complete resolution of cutaneous disease. Today, many patients receiving biologic therapy routinely experience greater than 75% or 90% reduction in cutaneous disease burden and a significant improvement in overall quality of life. These biologic agents are generally well-tolerated and safe but, like any medication, have associated adverse effects, some of which are predictable based on the effects of immune modulation, animal model studies, and human populations with known cytokine deficiencies. Going forward, it will be important to carefully monitor the safety profiles of these agents in both clinical trials and post-marketing surveillance registries to ensure long-term safety. It is reassuring that large safety registries are consistent in demonstrating an improved safety profile with newer and emerging biologic therapies.