Effect of infliximab in progressive Neuro-Behcet's syndrome
Effect of infliximab in progressive Neuro-Behcet's syndrome
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DOI：
10.1016/j.jns.2008.05.002
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发表时间：
2008-09-15
影响因子：
4.4
通讯作者：
Hirohata, Shunsei
中科院分区：
文献类型：
--
作者：
Kikuchi, Hirotoshi;Aramaki, Kaori;Hirohata, Shunsei
最近的研究表明英夫利昔单抗对白塞病的眼部表现有有益的作用。目前的研究考察了英夫利昔单抗对甲氨蝶呤（MTX）难治性进行性神经-白塞综合征（NB）的疗效。5例进行性NB男性患者，尽管给予MTX和类固醇治疗，脑脊液IL-6持续升高（超过20 pg/ml），在第0、2、6和14周静脉滴注5 mg/kg英夫利昔单抗，同时给予MTX （10-17.5 mg/周）和强的松龙（< 10 mg/天）相同剂量。临床反应通过神经精神病学结果、修订的韦氏成人智力量表（WAIS-R）和24周时的脑磁共振成像（MRI）扫描来判断。5例患者在第一次输注的第二天，CSF IL-6明显降低1/2-1/37，在14周最后一次输注前保持在20 pg/ml以下，而CSF tnf - α在任何时间点均无显著变化。在第一次输注后24周，5例患者均未出现恶化（3例患者明显改善）。脑部核磁共振扫描显示，中脑、脑桥和髓质的萎缩也没有明显的进展。这些结果表明，英夫利昔单抗可能通过降低脑脊液IL-6水平而非TNF-a，对治疗进展性NB有有益作用。由于英夫利昔单抗已被证明对单核/巨噬细胞具有细胞毒性作用，因此输注后CSF IL-6的快速下降提示英夫利昔单抗可能直接作用于这些产生IL-6的炎症细胞。(C) 2008 Elsevier B.V.版权所有
Recent studies have shown the beneficial effect of infliximab in ocular manifestation of Behcet's disease. The current Studies examined the efficacy of infliximab in progressive neuro-Behcet's syndrome (NB) refractory to methotrexate (MTX). Five male patients with progressive NB with sustained elevation of cerebrospinal fluid (CSF) IL-6 (over 20 pg/ml) despite administration of MTX and steroid, were given intravenous infusion of 5 mg/kg infliximab at weeks 0, 2, 6, and 14 with MTX (10-17.5 mg/week) and prednisolone (< 10 mg/day) at the same doses. The clinical responses were judged by neuropsychiatric findings, revised Wechsler adult intelligence scale (WAIS-R), and brain magnetic resonance imaging (MRI) scans at 24 weeks. In all the 5 patients, CSF IL-6 were markedly decreased by 1/2-1/37 on the next day of the first infusion and remained below 20 pg/ml before the last infusion at 14 weeks, whereas CSF TNF-alpha were not significantly changed at any time point. At 24 weeks from the initial infusion, none of the 5 patients showed exacerbation (3 patients significantly improved). Nor did the atrophy in midbrain, pons and medulla on brain MRI scans show significant progression. These results suggest that infliximab might have a beneficial effect in the treatment of progressive NB by reducing CSF IL-6 levels but not TNF-a. Since infliximab has been shown to have cytotoxic effects on monocytes/macrophages, the rapid fall of CSF IL-6 after the infusion Suggest that infliximab might directly act on such inflammatory cells producing IL-6. (C) 2008 Elsevier B.V. All rights reserved.