生物制剂在自体免疫疾病临床实务探讨.pptVIP

生物製劑在自體免疫疾病臨床實務的探討 謝松洲 臺大醫院內科 Rheumatoid Arthritis About 0.5%-1% of adult population Characterized by pain, swelling, and destruction of joints, with resultant disability Untreated, 20% to 30% persons with Rheumatoid Arthritis become permanently work-disabled within 2 to 3 years of diagnosis Economic burden: direct costs of medial care, surgery and hospitalization; indirect costs of lost productivity and disability Significant numbers of RA refractory to both conventional therapy and newer biological agents such as TNF-a inhibitors Rheumatoid arthritis Major consequences in RA related to disease itself and its associated comorbidities Outcomes improved over past few decades with advent of new treatments and therapeutic approach Still having substantial functional disability and loss of ability to work Intensive but safe treatments having potential to improve long-term outcomes Rheumatoid arthritis Joint damage, ultimately disability, beginning early in the course of RA The longer active disease, the less likely respond to therapy Evidence currently available disease modifying antirheumatic drugs (DMARDs) and anticytokine agents can control synovitis and may slow, or even stop, radiographic progression supporting an early aggressive approach to treatment Therapies for Rheumatoid Arthritis Symptomatic medications, such as corticosteroids, NSAIDs, aspirin and analgesics Reducing joint pain, stiffness and swelling Disease-modifying antirheumatic drugs, such as low doses of methotrexate, leflunomide, D-Penicillamine, sulfasalazine, gold therapy, azathioprine, hydroxychloroquine, cyclosporine Could interfere with the disease process Biologic agents Especially inhibitors of TNF-a, for hitherto unseen therapeutic benefit, but frequency and degree of responses restricted New agents rituximab (anti-CD20), abatacept (CTLA-4Ig), tocilizumab (anti-IL6R) etc Rheumatoid arthritis A consistent trend of declining rates of progression of radiographic damage in three separate cohor