课件：中医中药与生物制剂在风湿病治疗中的应用.pptVIP

* Slide 27 Notes. Inhibition of Cytokines This figure illustrates the cytokine-based strategies being investigated for the treatment of inflammatory diseases. The upper left panel shows the normal interaction between an inflammatory cytokine and its receptor. When the cytokine binds to its receptor, inflammatory effector molecules are produced. Examples of such inflammatory cytokines include TNF?, IL-1, and IL-6. The upper right panel shows how a cytokine can be neutralized, either by a soluble receptor or by a monoclonal antibody, so that it cannot bind to its cell-surface receptor. Examples of this mode of inhibition are the soluble TNF-receptor fusion protein (eg, etanercept) and the IL-1 receptor, and the monoclonal antibodies against TNF? (infliximab, adalimumab [D2E7]) and IL-6. The lower left panel illustrates a second method of interrupting the cytokine pathway—blocking the cytokine from binding to its receptor. The receptor is blocked by a competitive receptor antagonist or by a monoclonal antibody against the cytokine receptor. Examples are the recombinant IL-1-receptor antagonists or the monoclonal antibody against the IL-6 receptor. Finally, the lower right panel shows how activation of anti-inflammatory cytokines also can counteract the activity of pro-inflammatory cytokines. Examples of anti-inflammatory cytokines are IL-4 and IL-10. Choy EHS, Panayi GS. Cytokine pathways and joint inflammation in rheumatoid arthritis. N Engl J Med. 2001;344:907-916. * * TNF抑制剂的疗效 依那西普 依那西普(益赛普)是目前全球应用最广泛的TNF-a抑制剂。单用或与甲氨喋吟( MTX)联合治疗RA的有效性和安全性在全球许多中心的临床试验中均已被肯定。依那西普治疗RA可快速、显著缓解病情活动性。在依那西普的长期疗效(随访2年)的试验中也证实，长期治疗，依那西普组达ACR20、骨侵蚀未增加以及健康问卷改善者均高于MTX治疗组。 THANK YOU SUCCESS * * 可编辑 英夫利西单抗 英夫利西单抗是第一个在美国获批准上市治疗RA的抗TNF-a单克隆抗体，是目前TNF抑制剂使用病例数最多的药物。试验证实，在第54周，英夫利昔治疗患者分别约66%，50%和34%达到ACR20，ACR50和ACR70反应，单用MTX治疗的患者反应率只有54%，32%和21%。关节影像学检查也证实，与MTX组患者的关节破坏相比，接受3 mg/kg或6mg/kg英夫利昔治疗的患者的关节破坏几乎没有进展。 阿达木单抗 阿达木单抗是第一个在欧洲获许用于RA的人单克隆抗体，是第一个获许与甲氨蝶呤联用或单用于RA的TNF-α拮抗剂。研究显