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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。Abstract: Belimumab is a human monoclonal antibody that inhibits B-cell activating factor of the tumor necrosis factor family(BAFF). With the approval of belimumab for treating patients with systemic lupus erythematosus (SLE), targeted biologics has generally ushered a new era in the treatment of SLE. The pathogenesis of SLE involves a general breakdown in both B cell and T cell tolerance. In this review, we focused on the new promising therapeutic targets and several ongoing clinical trials for SLE. The approaches of these biologic therapeutic agents included targeting B cell selective cell surface molecules (CD20 or CD19), inhibiting B cell survival by targeting cytokines and signaling molecules (BAFF or a proliferation-inducing ligand), interfering with B cell antigen presentation by targeting co-stimulatory molecules (CD40-CD40 ligand interactions or ICOS-ICOS ligand interactions), blocking the signal pathways (rigerimod, interferon-α, or JAK/STAT), et al. Biologic target therapies for SLE have made some progress and bringing successful new biologic therapies into the clinical practice for SLE remains challenging but promising in the future.
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Key words:
- systemic lupus erythematosus /
- biologics /
- therapeutic target /
- clinical trial
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 Ⅱ 127 52周肾病完全缓解百分比 [4] CD20&BAFF rituximab+belimumab Ⅱ 200 SLEDAI-2000<2分患者百分比 [5] Ⅱ 50 52周抗双链DNA滴度下降 [6] BAFF&APRIL telitacicept Ⅲ 318 52周SRI-4应答率 [7] BTK GDC 0853 Ⅱ 240 48周SRI-4应答率 [10] CD40L dapirolizumab pegol Ⅱ 182 24周BICLA应答率 [11] IFNAR anifrolumab Ⅱ 150 尿蛋白肌酐比变化 [15] JAK1&JAK2 baricitinib Ⅲ 750 52周SRI-4应答率 [17-18] JAK1&JAK2 baricitinib Ⅲ 750 52周SRI-4应答率 [17-18] JAK1 & JAK3 tofacitinib Ⅱ 34 轻至中度活动患者的安全性 [16] IL-12 & IL-23 ustekinumab Ⅲ 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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