Efficacy of the anti-TNF-α antibody infliximab against refractory systemic vasculitides:: an open pilot study on 10 patients
Efficacy of the anti-TNF-α antibody infliximab against refractory systemic vasculitides:: an open pilot study on 10 patients
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DOI：
10.1093/rheumatology/41.10.1126
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发表时间：
2002-10-01
期刊：
影响因子：
5.5
通讯作者：
Guillevin, L
中科院分区：
文献类型：
--
作者：
Bartolucci, P;Ramanoelina, J;Guillevin, L
Objective.有证据表明，肿瘤坏死因子（TNF）是血管炎发病机制中的主要因子。我们研究了抗TNF-α抗体在类固醇和免疫抑制剂难治性系统性血管炎患者中的短期疗效。纳入了10例皮质类固醇和至少一种免疫抑制剂难治性患者，这些患者患有持续活动性疾病或新发发作。7例有韦格纳肉芽肿病，2例有类风湿性关节炎相关血管炎，1例有冷球蛋白血症，平均病程分别为9.1、21.5和17年。他们在第1、14、42天接受英夫利昔单抗（5 mg/kg），然后每8周一次。8名患者在0至42天之间停止使用免疫抑制剂，同时维持或降低类固醇剂量。采用伯明翰血管炎活动性评分2000（BVAS）评价治疗效果。所有患者均观察到完全或部分缓解。入组时的平均BVAS为9.1（范围4-15），到第42天降至1.9（范围0-4），6个月时降至1.3（范围0-4）; 4例患者在第42天记录的BVAS为0，5例患者在6个月时记录的BVAS为0。唯一的不良反应是2例患者出现皮疹。抗TNF-α成功诱导常规治疗无效的系统性血管炎患者迅速出现症状反应。英夫利西单抗在短期随访期间耐受良好。
Objective. Evidence indicates that tumour necrosis factor (TNF) is a major agent in the pathogenesis of vasculitis. We studied the short-term effect of anti-TNF-alpha antibody in systemic vasculitis patients refractory to steroids and immunosuppressive agents.Methods. Ten patients refractory to corticosteroids and at least one immunosuppressant and who had persistently active disease or a new flare were included. Seven had Wegener's granulomatosis, two had rheumatoid arthritis-associated vasculitis and one had cryoglobulinaemia with mean duration of 9.1, 21.5 and 17 yr. They received infliximab (5 mg/kg) on days 1, 14, 42 and then every 8 weeks. Immunosuppressants were stopped between days 0 and 42 for eight patients, while the steroid dose was maintained or lowered. The treatment response was evaluated clinically with the Birmingham Vasculitis Activity Score 2000 (BVAS).Results. Complete or partial remission was observed in all patients. The mean BVAS at entry was 9.1 (range 4-15) and had declined to 1.9 (range 0-4) by day 42 and 1.3 (range 0-4) at 6 months; BVAS of 0 was recorded for four patients on day 42 and for five at 6 months. The only adverse effect was cutaneous eruption in two patients.Conclusion. Anti-TNF-alpha successfully induced prompt symptomatic responses in patients with systemic vasculitis not responding to conventional treatment. Infliximab was well tolerated during the short-term follow-up.