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The TNF/IL-23/IL-17 axis - head-to-head trials comparing different biologics in psoriasis treatment.
Scandinavian Journal of Immunology ( IF 4.1 ) Pub Date : 2020-07-22 , DOI: 10.1111/sji.12946
Lisa Lynn Ten Bergen 1, 2 , Aleksandra Petrovic 1 , Anders Krogh Aarebrot 1 , Silke Appel 1
Affiliation  

Psoriasis is a T cell–mediated disease with autoimmune characteristics modulated by genetic susceptibility along with environmental triggers. Inflammatory pathways marked with excessive production of cytokines IL‐12 and IL‐23, drive differentiation of pathogenic T cell responses resulting in TNF and IL‐17 production. These cytokines are an integral part of the TNF/IL‐23/IL‐17 axis, which is responsible for maintaining inflammation in psoriatic skin. Our improved understanding of the immunopathogenesis led to the development of biological drugs in the treatment of moderate‐to‐severe disease. Biologics have revolutionized the management of psoriasis, highlighting the central role of TNF/IL‐23/IL‐17 axis in the physiopathology of the disease. Still, psoriasis usually requires long‐term treatment, aiming to fully remove psoriatic lesions without experiencing adverse events. In this review, we discuss the recent findings of all 27 available head‐to‐head trials investigating the efficacy and safety of systemic and biologic therapies in moderate‐to‐severe psoriasis vulgaris, as it is thought to provide more useful knowledge than placebo intervention alone. According to our evaluation, inhibitors that specifically target IL‐23 or IL‐17 are clinically more beneficial than inhibitors of IL‐12/IL‐23 and TNF. More informative results might be obtained by comparing these more efficient biological agents to each other. In addition, newer therapies for psoriasis using small‐molecule drugs may represent important advances compared to well‐established biologics as these are less expensive and orally administered.

中文翻译:

TNF / IL-23 / IL-17轴-头对头试验比较了牛皮癣治疗中不同生物制剂的情况。

牛皮癣是一种T细胞介导的疾病,其自身免疫特征受遗传易感性和环境触发因素调节。以细胞因子IL-12和IL-23过量产生为标志的炎性途径驱动致病性T细胞反应的分化,导致TNF和IL-17产生。这些细胞因子是TNF / IL-23 / IL-17轴必不可少的部分,负责维持牛皮癣皮肤的炎症。我们对免疫发病机制的深入了解导致了用于治疗中重度疾病的生物药物的开发。生物制剂彻底改变了牛皮癣的治疗方法,突显了TNF / IL-23 / IL-17轴在疾病的生理病理学中的核心作用。不过,牛皮癣通常需要长期治疗,旨在完全清除牛皮癣病变而不会发生不良事件。在这篇综述中,我们讨论了所有27项头对头试验的最新发现,这些试验研究了中度至重度寻常型牛皮癣的全身和生物疗法的疗效和安全性,因为它被认为比安慰剂干预提供了更多有用的知识。单独。根据我们的评估,在临床上,特异性针对IL-23或IL-17的抑制剂比IL-12 / IL-23和TNF的抑制剂更有益。通过将这些更有效的生物制剂相互比较,可以获得更有益的结果。此外,与行之有效的生物制剂相比,使用小分子药物治疗牛皮癣的新疗法可能代表着重要的进展,因为这些生物制剂价格便宜且可以口服。我们讨论了所有27项头对头试验的最新研究结果,这些试验研究了中度至重度寻常型牛皮癣的全身和生物疗法的疗效和安全性,因为据认为它比单纯的安慰剂干预提供了更多有用的知识。根据我们的评估,在临床上,特异性针对IL-23或IL-17的抑制剂比IL-12 / IL-23和TNF的抑制剂更有益。通过将这些更有效的生物制剂相互比较,可以获得更有益的结果。此外,与行之有效的生物制剂相比,使用小分子药物治疗牛皮癣的新疗法可能代表着重要的进展,因为这些生物制剂价格便宜且可以口服。我们讨论了所有27项头对头试验的最新研究结果,这些试验研究了中度至重度寻常型牛皮癣的全身和生物疗法的疗效和安全性,因为据认为它比单纯的安慰剂干预提供了更多有用的知识。根据我们的评估,在临床上,特异性针对IL-23或IL-17的抑制剂比IL-12 / IL-23和TNF的抑制剂更有益。通过将这些更有效的生物制剂相互比较,可以获得更有益的结果。此外,与行之有效的生物制剂相比,使用小分子药物治疗牛皮癣的新疗法可能代表着重要的进步,因为这些生物制剂价格便宜并且可以口服。
更新日期:2020-09-30
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