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Drug insight: different mechanisms of action of tumor necrosis factor antagonists-passive-aggressive behavior?

机译:药物洞察力:肿瘤坏死因子拮抗剂-被动攻击行为的不同作用机制?

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摘要

Antagonists of tumor necrosis factor (TNF) have revolutionized the treatment of selected inflammatory diseases. In rheumatology, this has been most notable for ankylosing spondylitis, psoriatic arthritis and rheumatoid arthritis. Despite their specificity for TNF, these agents, which include the soluble p75 receptor etanercept and the anti-TNF antibodies adalimumab and infliximab, have demonstrated differential clinical efficacy in studies of rheumatoid arthritis; patients who do not respond to one antagonist often respond to another. Therapeutic disparity of these agents is also seen in specific diseases, most notably Crohn's disease. Differences in pharmacodynamics, pharmacokinetics and mechanisms of action, as well as disease heterogeneity, have been proposed to account for these effects. Reverse signaling by transmembrane TNF in response to anti-TNF antibodies, but not soluble receptor, might also influence the therapeutic response.
机译:肿瘤坏死因子(TNF)的拮抗剂彻底改变了某些炎性疾病的治疗方法。在风湿病学中,这对于强直性脊柱炎,银屑病关节炎和类风湿关节炎最为显着。尽管它们对TNF有特异性,但这些药物,包括可溶性p75受体依那西普和抗TNF抗体阿达木单抗和英夫利昔单抗,在类风湿关节炎的研究中已显示出不同的临床疗效。对一种拮抗剂无反应的患者通常对另一种拮抗剂有反应。这些药物的治疗差异也出现在特定疾病中,最著名的是克罗恩氏病。已提出药效学,药代动力学和作用机理以及疾病异质性方面的差异以解释这些影响。跨膜TNF响应抗TNF抗体而不是可溶性受体的反向信号也可能影响治疗反应。

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