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Advances in the use of biologic agents for the treatment of systemic vasculitis.

机译:使用生物制剂治疗系统性血管炎的进展。

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PURPOSE OF REVIEW: Due to the well known toxicities of cyclophosphamide, substantial interest exists in finding other therapies to treat primary systemic vasculitis. Biologic agents have been proposed as an alternative to cyclophosphamide for these disorders because of their recent success in treating other rheumatic diseases. This article reviews the current state-of-the-art therapy with regards to the use of biologic agents as treatments for systemic vasculitis. RECENT FINDINGS: The greatest amount of experience with these agents for the treatment of systemic vasculitis is with antitumor necrosis factor agents, pooled intravenous immunoglobulin, and anti-B-cell therapies such as rituximab. Intravenous immunoglobulin is already a standard therapy for Kawasaki's disease, but should also be considered for the treatment of vasculitis associated with antineutrophil cytoplasmic antibodies when standard therapies are either ineffective or contraindicated. Early experience with tumor necrosis factor inhibitors indicates that they may be effective for the treatment of Takayasu's arteritis, but their role in the treatment of other forms of vasculitis remains controversial. Early experience with rituximab for the treatment of several forms of vasculitis has been quite promising, but must be confirmed by ongoing randomized clinical trials. SUMMARY: Biologic agents represent the next evolution in treatment for the primary systemic vasculitides. Greater understanding of these diseases has allowed us to move further away from nonspecific, highly toxic therapies toward a more directed approach. As our experience with these agents increases, they will likely form the keystone of treatment in the near future.
机译:审查目的:由于环磷酰胺具有众所周知的毒性,因此人们对寻找其他治疗原发性系统性血管炎的疗法有着浓厚的兴趣。由于最近在治疗其他风湿病方面的成功,已经提出了生物剂作为环磷酰胺的替代物。本文就使用生物制剂作为系统性血管炎的治疗方法,综述了当前的最新技术。最近的发现:这些药物治疗系统性血管炎的最大经验是使用抗肿瘤坏死因子药物,合并的静脉内免疫球蛋白和抗B细胞疗法,如利妥昔单抗。静脉内免疫球蛋白已经是川崎病的标准疗法,但当标准疗法无效或禁忌时,也应考虑治疗与抗中性粒细胞胞浆抗体相关的血管炎。肿瘤坏死因子抑制剂的早期经验表明,它们可能对Takayasu的动脉炎有效,但在治疗其他形式的血管炎中的作用仍存在争议。利妥昔单抗用于治疗多种形式的血管炎的早期经验是非常有希望的,但是必须通过正在进行的随机临床试验来证实。总结:生物制剂代表了原发性全身性血管炎治疗的下一步发展。对这些疾病的深入了解使我们能够从非特异性,剧毒疗法进一步转向更具针对性的方法。随着我们对这些药物经验的增加,它们可能会在不久的将来成为治疗的基石。

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