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系统性红斑狼疮新型生物治疗靶点:希望与挑战

杨华夏 张奉春

杨华夏, 张奉春. 系统性红斑狼疮新型生物治疗靶点:希望与挑战[J]. 协和医学杂志, 2020, 11(3): 241-246. doi: 10.3969/j.issn.1674-9081.20200091
引用本文: 杨华夏, 张奉春. 系统性红斑狼疮新型生物治疗靶点:希望与挑战[J]. 协和医学杂志, 2020, 11(3): 241-246. doi: 10.3969/j.issn.1674-9081.20200091
Hua-xia YANG, Feng-chun ZHANG. New Biologic Targets for Systemic Lupus Erythematosus: Hope and Challenge[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(3): 241-246. doi: 10.3969/j.issn.1674-9081.20200091
Citation: Hua-xia YANG, Feng-chun ZHANG. New Biologic Targets for Systemic Lupus Erythematosus: Hope and Challenge[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(3): 241-246. doi: 10.3969/j.issn.1674-9081.20200091

系统性红斑狼疮新型生物治疗靶点:希望与挑战

doi: 10.3969/j.issn.1674-9081.20200091
基金项目: 

国家自然科学基金 81801633

详细信息
    通讯作者:

    张奉春  电话:010-69158792, E-mail:zhangfccra@aliyun.com

  • 中图分类号: R593.24

New Biologic Targets for Systemic Lupus Erythematosus: Hope and Challenge

More Information
  • 摘要: 随着贝利木单克隆抗体(肿瘤坏死因子家族B细胞活化因子拮抗剂)在中国用于治疗系统性红斑狼疮(systemic lupus erythematosus, SLE)适应证的获批, SLE的治疗逐渐迈向了生物制剂时代。SLE发病机制复杂, 包括B细胞和T细胞免疫耐受机制的破坏。本文关注SLE的新型生物治疗靶点, 以及正在进行的SLE临床试验, 围绕靶向B细胞特异性表面分子(CD20、CD19), 靶向B细胞信号通路和细胞因子(肿瘤坏死因子家族B细胞活化因子、增值诱导配体), 靶向共刺激因子减少B细胞抗原呈递(CD40及其配体、可诱导共刺激分子及其配体), 以及T细胞及信号通路(rigerimod、干扰素α、JAK-STAT)等SLE相关靶标展开讨论。总而言之, 生物靶向治疗SLE已获得一定进展, 未来前景可期。
    利益冲突  无
  • 表  1  系统性红斑狼疮有希望的治疗靶点及其临床试验

    靶点 药物 临床试验分期 入组人数(n) 主要研究终点 参考文献
    CD20 obinutuzumab 127 52周肾病完全缓解百分比 [4]
    CD20&BAFF rituximab+belimumab 200 SLEDAI-2000<2分患者百分比 [5]
    50 52周抗双链DNA滴度下降 [6]
    BAFF&APRIL telitacicept 318 52周SRI-4应答率 [7]
    BTK GDC 0853 240 48周SRI-4应答率 [10]
    CD40L dapirolizumab pegol 182 24周BICLA应答率 [11]
    IFNAR anifrolumab 150 尿蛋白肌酐比变化 [15]
    JAK1&JAK2 baricitinib 750 52周SRI-4应答率 [17-18]
    JAK1&JAK2 baricitinib 750 52周SRI-4应答率 [17-18]
    JAK1 & JAK3 tofacitinib 34 轻至中度活动患者的安全性 [16]
    IL-12 & IL-23 ustekinumab 500 52周SRI-4应答率 [20]
    BAFF:B细胞刺激因子; APRIL:增殖诱导配体; BTK:布鲁顿酪氨酸激酶; CD40L:CD40配体; IFNAR:Ⅰ型干扰素受体; IL:白细胞介素;SLEDAI:系统性红斑狼疮疾病活动度评分; SRI:系统性红斑狼疮反应者指数;BICLA:基于不列颠群岛狼疮评估小组的综合狼疮评估
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  • [1] Zhang F, Bae SC, Bass D, et al. A pivotal phase Ⅲ, randomised, placebo-controlled study of belimumab in patients with systemic lupus erythematosus located in China, Japan and South Korea[J]. Ann Rheum Dis, 2018, 77:355-363. doi:  10.1136/annrheumdis-2017-211631
    [2] 中华医学会风湿病学分会, 国家皮肤与免疫疾病临床医学研究中心, 中国系统性红斑狼疮研究协作组.2020中国系统性红斑狼疮诊疗指南[J].中华内科杂志, 2020, 59:172-185. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zhnk202003002
    [3] Fanouriakis A, Kostopoulou M, Alunno A, et al.2019 update of the EULAR recommendations for the management of systemic lupus erythematosus[J].Ann Rheum Dis, 2019, 78:736-745. doi:  10.1136/annrheumdis-2019-215089
    [4] US National Library of Medicine. A Study to Evaluate the Safety and Efficacy of Obinutuzumab Compared With Placebo in Participants With Lupus Nephritis (LN)[EB/OL].http://www.clinicaltrials.gov/ct2/show/NCT02550652.
    [5] Aranow C, DallEra M, Byron M, et al. Phase 2 trial of induction therapy with anti-CD20 (rituximab) followed by maintenance therapy with anti-BAFF (belimumab) in patients with active lupus nephritis[J]. Arthritis Rheumatol, 2018, 70:1870.
    [6] ISRCTN Registry. Belimumab after B cell depletion therapy as a new treatment for patients with systemic lupus erythematosus (SLE)[EB/OL].http://www.isrctn.com/ISRCTN47873003.
    [7] US National Library of Medicine. Study of Recombinant Human B Lymphocyte(RC18) Administered Subcutaneously to Subjects With Systemic Lupus Erythematosus(SLE)[EB/OL].https://www.clinicaltrials.gov/ct2/show/NCT04082416.
    [8] Merrill JT, June J, Koumpouras F, et al. Top-line results of a phase 2, double-blind, randomized, placebo-controlled study of a reversible B cell inhibitor, XmAb® 5871, in systemic lupus erythematous (SLE)[J]. Arthritis Rheumatol, 2018, 70:L19. doi:  10.1002/acr.23269
    [9] Hutcheson J, Vanarsa K, Bashmakov A, et al. Modulating proximal cell signaling by targeting Btk ameliorates humoral autoimmunity and end-organ disease in murine lupus[J]. Arthritis Res Ther, 2012, 14:R243. doi:  10.1186/ar4086
    [10] US National Library of Medicine. Study of the Safety and Efficacy of GDC-0853 in Participants With Moderate to Severe Active Systemic Lupus Erythematosus[EB/OL].http://www.clinicaltrials.gov/ct2/show/NCT02908100.
    [11] US National Library of Medicine. A Phase 2 Efficacy and Safety Study of Dapirolizumab Pegol (DZP) in Systemic Lupus Erythematosus[EB/OL].http://www.clinicaltrials.gov/ct2/show/NCT02804763.
    [12] Sullivan BA, Tsuji W, Kivitz A, et al. Inducible T cell co-stimulator ligand (ICOSL) blockade leads to selective inhibition of anti-KLH IgG responses in subjects with systemic lupus erythematosus[J]. Lupus Sci Med, 2016, 3:e000146. doi:  10.1136/lupus-2016-000146
    [13] Sascha T, Claudia K, David P, et al. SM101, a novel recombinant, soluble, human FcγⅡB receptor, in the treatment of systemic lupus erythematosus:results of a double- blind, placebo-controlled multicenter study[J]. Arthritis Rheum, 2014, 66:2833.
    [14] US National Library of Medicine. A 52-Week, Randomized, Double-Blind, Parallel-Group, Placebo-Controlled Study to Evaluate the Efficacy and Safety of a 200-mcg Dose of IPP-201101 Plus Standard of Care in Patients With Systemic Lupus Erythematosus (LUPUZOR)[EB/OL].http://www.clinicaltrials.gov/ct2/show/NCT02504645.
    [15] US National Library of Medicine. Safety and Efficacy of Two Doses of Anifrolumab Compared to Placebo in Adult Subjects With Active Proliferative Lupus Nephritis (TULIP-LN1)[EB/OL]. http://www.clinicaltrials.gov/ct2/show/NCT02547922.
    [16] US National Library of Medicine. Safety of Tofacitinib, an Oral Janus Kinase Inhibitor, in Systemic Lupus Erythematosus[EB/OL].http://www.clinicaltrials.gov/ct2/show/NCT02535689.
    [17] US National Library of Medicine. A Study of Baricitinib in Participants With Systemic Lupus Erythematosus (BRAVE Ⅱ)[EB/OL]. http://www.clinicaltrials.gov/ct2/show/NCT03616964.
    [18] US National Library of Medicine. A Study of Baricitinib (LY3009104) in Participants With Systemic Lupus Erythematosus (BRAVE I)[EB/OL]. http://www.clinical-trials.gov/ct2/show/NCT03616912.
    [19] van Vollenhoven RF, Hahn BH, Tsokos GC, et al. Efficacy and safety of ustekinumab an IL-12 and IL-23 inhibitor, in patients with active systemic lupus erythematosus:results of a multicenter, double-blind, phase 2, randomized, control-led study[J]. Lancet, 2018, 392:1330-1339. doi:  10.1016/S0140-6736(18)32167-6
    [20] National Library of Medicine. A Study of Ustekinumab in Participants With Active Systemic Lupus Erythematosus[EB/OL].http://www.clinicaltrials.gov/ct2/show/NCT03517722.
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出版历程
  • 收稿日期:  2020-03-31
  • 刊出日期:  2020-05-30

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