Continued from the previous article "
Interleukin 1 antagonists can also be used to treat gout attacks
2, and interleukin 17 antagonists
The interleukin 17 antagonists currently on the market include secukinumab (Secukinumab), ixekizumab ( Ixekizumab), brodalumab (Brodalumab).
secukinumab is an anti-IL-17A monoclonal antibody . Once a week initially for 4 weeks, it can be changed to once every 4 weeks.
Ixekizumab is a humanized anti-IL-17A monoclonal antibody. After the first dose of 2 times the dose, there is a single dose every 4 weeks thereafter.
Brolimumab is also an anti-IL-17 receptor A monoclonal antibody. Initially, it is once a week, and after 3 times, it can be changed to once every 2 weeks.
This type of drug is mainly used for moderate to severe psoriasis, psoriatic arthritis. Subsequent studies have confirmed that it also has a good effect on axial spondyloarthritis. There is more evidence that this type of drug seems to be better than other biological agents in treating psoriasis.
It is noteworthy that interleukin 17 antagonists do not induce the risk of relapse of latent tuberculosis. Although these drugs also increase the risk of infectious diseases. However, this type of disease carries the risk of inducing inflammatory bowel disease (especially Crohn's disease ). Patients with axial spondyloarthritis are often accompanied by inflammatory bowel disease, so doctors should be particularly careful in identifying and considering it.
Systemic treatment drugs for psoriasis
Three, interleukin 12/23 antagonists
The interleukin 12/23 antagonists currently on the market include Ustekinumab (Ustekinumab), Guselkumab (Guselkumab) , tildrakizumab, Risankizumab (Risankizumab)
ustekinumab human monoclonal antibodies targeting IL-12 and IL-23. It is once every 4 weeks for the first time, 2 times in a row; then every 12 weeks.
Guselkumab is a human immunoglobulin G1 (IgG1) lambda monoclonal antibody that binds to the p19 subunit of IL-23. First once every 4 weeks, 2 times in total; thereafter once every 8 weeks.
Tetrelizumab is a human IgG1 kappa monoclonal antibody that binds to the p19 subunit of IL-23. First once every 4 weeks, 2 times in total; thereafter once every 12 weeks.
Resalizumab is a humanized monoclonal antibody directed against the p19 subunit of IL-23 and IL-39. First once every 4 weeks, 2 times in total; thereafter once every 12 weeks.
These four drugs are mainly used to treat psoriasis and psoriatic arthritis. Ustekinumab is the earliest on the market, and its efficacy seems to be relatively poor among these drugs. Teclizumab was approved by the US FDA in 2018, and Resalizumab was approved in 2019.
It is worth noting that risankizumab (Risankizumab) can also be used for Crohn's disease. But more detailed information is needed.
4. Anti-leukocyte adhesion
The colchicine we are already using has anti-leukocyte adhesion effect. The drugs currently on the market include Efalizumab , Natalizumab (Natalizumab), Vedolizumab (Vedolizumab), Etrolizumab.
Efalizumab is a humanized monoclonal antibody against CD11a; CD11a is the alpha subunit of beta2 integrin LFA-1. The drug was withdrawn from the market after causing progressive multifocal leukoencephalopathy (PML) in a small number of people.
Natalizumab is an anti-α4 integrin humanized mAb. It can be used to treat Rohn's disease, multiple sclerosis , and rheumatoid arthritis. But there is also the risk of triggering PML.
Verdelizumab is a humanized IgG1 mAb against α4β7 integrin that only interferes with the α4β7/mucosal addressin cell adhesion molecule-1 (MAdCAM-1) interaction; it Its effect is limited to the gastrointestinal tract and has no effect on the transport of lymphocytes to other organs such as the central nervous system. So it can be used to treat inflammatory bowel disease. Because it has no effect on other organs, it is relatively safe. It is unclear whether it benefits joint pathology in inflammatory bowel disease.
etrolizumab is a humanized mAb that binds to the β7 subunit of α4β7 and αEβ7 integrin; it currently shows good promise in inflammatory bowel disease; more data are needed for in-depth research and judgment.
One of the mechanisms of action of colchicine is to inhibit leukocyte adhesion
5 and block costimulation
Abatacept (abatacept) is a soluble fusion protein; it contains cytotoxic T lymphocyte -related antigen 4 (cytotoxic T -lymphocyte-associated antigen 4, CTLA4) and the Fc segment of IgG1, so it is also called CTLA4-Ig.
CTLA4-Ig interferes with the binding of CD80 (B7-1) or CD86 (B7-2) to CD28 through its high affinity for CD28, thereby inhibiting the second signal transmission required for activation of T cells.
Abatacept is administered intravenously as follows: 3 initial doses (once every 2 weeks) and then every 4 weeks; it can also be administered subcutaneously once a week.
When treating rheumatoid arthritis, it is often used in combination with methotrexate . Abatacept is as effective as anti-tumor necrosis factor agents. It is a good alternative in cases of resistance to anti-TNF agents.
References:
1, Uptodate Clinical Advisor
2, "Firestein & Kelley’s Textbook of Rheumatology" (11th edition),
3, "Rheumatology" (7th edition)
