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Sự Ức Chế IL12/IL23 Trong Điều Trị Viêm Khớp Psoriatic
Tóm tắt
Viêm khớp psoriatic (PsA) là một bệnh lý viêm khớp hệ thống có khả năng gây tàn phế, với biểu hiện lâm sàng đa dạng, có thể bao gồm viêm khớp, viêm gân bám, viêm ngón tay, chuyển hóa xương bất thường và psoriasis mảng. Cho đến rất gần đây, bệnh nhân mắc PsA có rất ít lựa chọn điều trị và phải chịu đựng gánh nặng thể chất và xã hội khổng lồ từ căn bệnh này. Việc sử dụng các tác nhân chống TNF đã mang lại hy vọng cho những bệnh nhân này, khi một tỷ lệ họ thấy cải thiện tình trạng psoriasis và viêm khớp psoriatic của mình. Tuy nhiên, theo thời gian, vấn đề lớn nhất với thuốc chống TNF đối với PsA là phát hiện rằng lên đến 50% bệnh nhân không đáp ứng hoặc không dung nạp các tác nhân này. Ustekinumab (UST) là một trong những tác nhân đầu tiên cung cấp một cơ chế thay thế cho việc điều trị psoriasis và PsA, bằng cách ức chế các cytokine IL12 và IL23. Việc sử dụng thuốc này liên quan trực tiếp đến sự hiểu biết tốt hơn của chúng ta về sinh lý bệnh của psoriasis và PsA, do ảnh hưởng của các tế bào Th1 và Th17. Trong nghiên cứu PSUMMIT II, những bệnh nhân chưa từng sử dụng thuốc chống TNF đã phản ứng tốt hơn với UST so với những bệnh nhân đã từng được điều trị bằng các loại thuốc đó. Những dữ liệu này chỉ ra rằng một nhóm bệnh nhân PsA thể hiện căn bệnh tiến triển liên tục kháng lại các tác nhân nhằm mục tiêu các con đường viêm miễn dịch thay thế không trực tiếp liên quan đến TNF. Những phát hiện này cũng đã được quan sát thấy ở viêm khớp dạng thấp (RA). Do đó, việc nhắm mục tiêu vào nhiều phân tử hơn bằng một kháng thể nhận ra hai mục tiêu khác nhau hoặc các liệu pháp sinh học phối hợp có thể là cần thiết để thúc đẩy phản ứng điều trị cao hơn hoặc thậm chí là hồi phục. Tất nhiên, một trở ngại lớn ngoài an toàn là chi phí; trung bình, UST với liều 90 mg có thể đắt hơn đáng kể so với tác nhân chống TNF. Tuy nhiên, khi các tác nhân mới an toàn và hiệu quả được cung cấp cho việc điều trị psoriasis và PsA, thuật toán điều trị của chúng ta cho việc điều trị PsA sẽ cần được đánh giá lại.
Từ khóa
Tài liệu tham khảo
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