关注TNF-α抑制剂在葡萄膜炎治疗中存在的感染和肿瘤发生及进展风险  

Pay attention to the risk of infection and tumor progression during application of TNF-αinhibitors in uveitis

作　　者：池滢[1] 杨柳[1] Chi Ying;Yang Liu(Department of Ophthalmology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院眼科,100034

出　　处：《中华实验眼科杂志》2021年第11期929-932,共4页Chinese Journal Of Experimental Ophthalmology

摘　　要：随着生物制剂肿瘤坏死因子-α(TNF-α)抑制剂阿达木单抗经FDA获批用于非感染性中、后、全葡萄膜炎的治疗,TNF-α抑制剂在非感染性葡萄膜炎治疗中得到了广泛关注和应用。然而,基于该类生物制剂在炎症性肠病、类风湿性关节炎等免疫性疾病治疗中的应用观察,已有研究发现长期应用该类制剂的患者感染和肿瘤发生或发展的风险明显增加,应用过程中的主要安全性问题在于严重感染的发生、术后感染的发生、结核病和肝炎的发生或进展以及肿瘤发生或进展的风险增加。随着TNF-α抑制剂在难治性葡萄膜炎治疗中的广泛应用,眼科临床医生在聚焦其疗效的同时应认识和了解药物相关的不良反应及其发生机制,规范用药前后疾病的筛查或防控措施以及用药过程中的监测方法,做到合理选择用药方法及时机,尽量减少或避免药物不良反应,改善疗效和预后获益。Adalimumab,one of the tumor necrosis factor-α(TNF-α)inhibitors,has been approved as a therapeutic drug for non-infectious intermediate,posterior and pan-uveitis by FDA.Due to the good efficacy,TNF-αinhibitors are being applied widely in ophthalmology.However,some researches based on the application of TNF-αinhibitor in treating inflammatory bowel diseases and rheumatoid arthritis,etc.have showed that it can bring out some adverse effects such as infection and tumor occurrence and/or progression.The main safety problems in the application of TNF-αinhibitors lie in its increased risk of serious infection,postoperative infection,the occurrence or progression of tuberculosis and hepatitis,as well as the tumorigenesis and tumor progression.With the wider application of adalimumab in refractory uveitis,ophthalmologists should not only focus on its therapeutic effect,but also get to know the adverse effects of the drug,so as to standardize the examination,prevention and control of primary diseases before and after the administration of adalimumab and observe closely clinical manifestations of patients with administration of adalimumab,select the treating method and timing reasonably to reduce and avoid the adverse drug reactions,and improve the therapeutic outcome.

关 键 词：生物制剂 肿瘤坏死因子-α抑制剂 葡萄膜炎 阿达木单抗 疗效 安全性 

分 类 号：R773.9[医药卫生—眼科] R730.2[医药卫生—临床医学]