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首页> 外文期刊>Prescrire international >Tocilizumab: new drug. Rheumatoid arthritis: another 'mab', no therapeutic advantage.
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Tocilizumab: new drug. Rheumatoid arthritis: another 'mab', no therapeutic advantage.

机译：托珠单抗：新药。类风湿关节炎：另一种“单克隆抗体”，无治疗优势。

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(1) First-line disease-modifying treatment for rheumatoid arthritis is based on slow-acting include a TNF-alpha antagonist, followed by rituximab or possibly abatacept; (2) Tocilizumab, a monoclonal antibody, inhibits interleukin-6 receptors. It is licensed in the European Union for patients with rheumatoid arthritis in whom other drugs have failed; (3) Clinical evaluation includes 4 placebo-controlled trials of the methotrexate-tocilizumab combination, after failure of a slow-acting antirheumatic drug (3 trials) or failure of a slow-acting antirheumatic drug and a TNF-alpha antagonist (1 trial). An indirect comparison suggests that tocilizumab is no more effective than rituximab in patients with multiple treatment failure; (4) Tocilizumab, like TNF-alpha antagonists, is an immunosuppressant. It carries a risk of serious infections, haematological disorders (neutropenia, thrombocytopenia), gastrointestinal bleeding, hepatic disorders, and systemic and local reactions during the infusion; (5) the adverse effects of long-term tocilizumab therapy are unknown, particularly the risk of cancer; (6) Tocilizumab carries a risk of interactions with drugs that are metabolised by cytochrome P450 isoenzymes. Clinical consequences cannot be ruled out when co-administered drugs have a narrow therapeutic margin; (7) Tocilizumab is administered intravenously every 4 weeks, making it slightly more convenient that rituximab at the beginning of treatment; (8) In patients with rheumatoid arthritis and multiple treatment failure, it remains to be shown whether tocilizumab has a better risk-benefit balance than rituximab, a drug with which we have more experience. It is therefore better to continue to use rituximab, or possibly abatacept.
机译：（1）类风湿关节炎的一线缓解疾病的治疗方法是基于缓慢作用的药物，包括TNF-α拮抗剂，然后是利妥昔单抗或可能的abatacept; （2）单克隆抗体Tocilizumab抑制白介素6受体。在欧洲联盟中，它已被许可用于风湿性关节炎患者，但其他药物均无效; （3）临床评估包括甲氨蝶呤-妥珠单抗组合的4项安慰剂对照试验，其中慢效抗风湿药失败（3次试验）或慢效抗风湿药和TNF-α拮抗剂失败（1次试验） 。间接比较表明，在多次治疗失败的患者中，托珠单抗不比利妥昔单抗更有效。 （4）Tocilizumab与TNF-α拮抗剂一样，是一种免疫抑制剂。在输注过程中，它具有严重感染，血液系统疾病（中性粒细胞减少症，血小板减少症），胃肠道出血，肝病以及全身和局部反应的风险; （5）长期使用Tocilizumab的不良反应尚不清楚，尤其是罹患癌症的风险; （6）托珠单抗可能与细胞色素P450同工酶代谢的药物发生相互作用。当合并用药的治疗范围狭窄时，不能排除临床后果。 （7）Tocilizumab每4周静脉注射一次，比起开始使用rituximab更加方便; （8）对于类风湿性关节炎和多次治疗失败的患者，托珠单抗是否比利妥昔单抗具有更好的风险收益平衡尚待证实，利妥昔单抗是我们拥有更多经验的药物。因此，最好继续使用利妥昔单抗或可能的abatacept。

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    《Prescrire international》 |2009年第103期|共4页
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