英夫利西单抗联合小剂量甲氨蝶呤治疗10例重度银屑病临床观察

生物制剂能靶向性阻断T淋巴细胞活化,阻断特异的细胞因子参与免疫反应,在欧美国家已广泛应用于银屑病等免疫介导的炎症性疾病［１］,显示出显著的疗效及良好的安全性。我们采用英夫利西单抗（infliximab）联合甲氨蝶呤（MTX）治疗10例重度银屑病,取得良好效果,报道如下……     

英夫利西单抗治疗重度斑块状银屑病一例

患者女,28岁,因全身红色斑块、鳞屑10年就诊。10年前无明显诱因头皮、躯干、四肢出现红色斑块,表面覆着银白色鳞屑,伴瘙痒,冬重夏轻,无关节疼痛、脓疱,于外院诊断为寻常性银屑病。10年来先后口服过阿维A胶囊、雷公藤多苷、甲氨蝶呤及中成药等治疗,好转后逐渐停药,皮疹反复复发。半年前口服环孢素联合雷公藤多苷治疗,部分皮疹有所消退,但仍有新发皮疹。3个月前停药,皮疹渐泛发全身,1周前至外院住院治疗,行复方甘草酸苷80 mg/d、丹参40 ml/d静脉滴注,口服维A酸10 mg每日3次,皮疹无明显好转,为进一步诊治转入我科就诊……     

英夫利西单抗治疗斑块状银屑病一例

患者,女,23岁,因全身红斑鳞屑2年,加重7 d入院。患者诉2年前染发后头皮出现散在红斑,界清,伴脱屑、瘙痒,渐增多,就诊于第四军医大学第一附属医院西京医院皮肤科门诊,诊断为银屑病,给予口服转移因子胶囊,外用卡泊三醇软膏,皮疹可消退,但仍有反复,后就诊于多家医院,病情控制不理想。此次1年前皮疹泛发全身,先后于我科住院治疗,给予口服环孢素胶囊（125 mg,每天2次）,咪唑斯汀缓释片,外用卤米松乳膏、他卡西醇软膏、钙泊三醇倍他米松软膏、黑豆熘油封包、中药药浴、NB-UVB光疗等,病情明显好转,但出院后病情控制不佳,易复发,逐渐加重……     

英夫利西单抗治疗寻常性银屑病2例

<正>笔者于2015年收治寻常性银屑病2例,选用英夫利西单抗治疗,现报告如下。1临床资料例1.男,12岁。患儿于2014年1月无明显诱因下出现头皮散在粟粒至绿豆大的红色丘疹,部分扩大融合成棕红色斑块,上覆有少量片状薄层银白色鳞屑,鳞屑易刮脱,逐步蔓延至躯干及四肢,稍有瘙痒,遂于当地某医院就诊,诊断为寻常性银屑病,予口服、外用     

英夫利西单抗治疗寻常性银屑病七例

银屑病是一种由免疫介导的慢性炎症性疾病,常伴有代谢综合征、动脉粥样硬化和缺血性心脏病,与心血管危险因素密切相关［1］。治疗银屑病的传统系统性药物如阿维A和环孢素A对心血管均有一定程度的不良影响,不适宜伴有心血管异常的银屑病。肿瘤坏死因子α（TNF-α）抑制剂治疗中、重度银屑病不仅取得了较好疗效,而且能改善患者的生活质量［2］。我们用英夫利西单抗（infliximab,IFX）治疗7例重度银屑病患者,观察银屑病皮损面积及严重程度（PASI）评分的变化,并重点观察代谢综合征和动脉粥样硬化生化指标的变化,探讨英夫利西单抗对重度银屑病的疗效和对心血管疾病的防治作用……     

英夫利西单抗治疗脓疱性银屑病一例

患者女,25岁,9年前头皮出现红色斑块,伴鳞屑、瘙痒,外院诊断脂溢性皮炎,外用药物治疗效果欠佳。8年前全身出现点滴状红色丘疹,上覆银白色鳞屑,境界清楚,瘙痒明显,外院诊断为银屑病,予中药治疗3个月后皮疹基本消退。随后数年病情常反复,冬重夏轻。4年前病情再次加重,皮疹扩展至全身,至我院住院治疗,予强力宁针、白芍总苷片、甲氨蝶呤片（7.5 mg每周1次）治疗后,患者皮疹较前好转,瘙痒减轻……     

英夫利西单抗治疗寻常性银屑病一例

患者女,17岁。因全身反复红斑、丘疹、鳞屑8年,加重10 d,以寻常性银屑病收入院。患者8年前出现全身丘疹、斑丘疹,伴少量鳞屑,无瘙痒,于当地医院诊断为银屑病,给予外用及口服药物治疗（具体不详）,皮疹逐渐消退……     

英夫利西单抗治疗重度斑块状银屑病一例北大核心CSCD

患者女,28岁,因全身红色斑块、鳞屑10年就诊。10年前无明显诱因头皮、躯干、四肢出现红色斑块,表面覆着银白色鳞屑,伴瘙痒,冬重夏轻,无关节疼痛、脓疱,于外院诊断为寻常性银屑病。     

英夫利西单抗治疗17例中重度寻常性银屑病北大核心CSCD

银屑病是一种在多基因遗传因素与环境因素相互作用的基础上,由T淋巴细胞介导的免疫性慢性炎症性皮肤病,可并发多种系统性疾病,也可严重影响患者心理健康。目前认为肿瘤坏死因子（α（TNF-α）等前炎症因子在银屑病的发病机制中发挥了作用。英夫利西单抗是一种针对TNF—α的人鼠嵌合型单克隆抗体,可以阻断TNF—α与免疫活性细胞表面的TNF—α受体结合,抑制机体的炎症反应,达到控制病情的目的。我们观察英夫利西单抗治疗寻常性银屑病的疗效和安全性。     

甲银屑病与英夫利西单抗

指（趾）甲病变是银屑病最常见的临床表现之一。随着人们生活水平的提高和社会交往的增多,甲银屑病因为其凸显的发病部位而受到患者的重视,继而产生社会心理压力。甲银屑病的治疗也因其与银屑病性关节炎（psoriatic arthritis,PsA）关系密切而受到医生和患者的关注和重视……     

Infliximab for severe, treatment-resistant psoriasis: a prospective, open-label study

BACKGROUND: Infliximab, a mouse-human chimeric monoclonal antibody directed against tumour necrosis factor-alpha, has been shown to be effective for moderate to severe psoriasis, but there are few data published on its use in recalcitrant, treatment-resistant disease or in combination with other antipsoriatic therapies. OBJECTIVES: To report our experience with infliximab in the treatment of patients attending a tertiary referral service with severe recalcitrant disease. METHODS: All patients attending a tertiary referral service for severe psoriasis who were treated with infliximab between 2002 and July 2005 were entered into a prospective, open-label study. Details on disease phenotype, clinical course and adverse events were recorded together with measures of disease severity [Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index, clinical photography] at baseline, weeks 2 and 6, and then at 2-monthly intervals throughout the treatment period. RESULTS: Twenty-three patients were treated with infliximab during the study; one patient had pustular psoriasis and was therefore excluded from statistical analysis. All had severe disease (baseline PASI 26.5+/-6.7, mean+/-SD, n=22) and had received at least two systemic therapies for psoriasis in the past; 16 were taking one or more concomitant therapies at the time of treatment initiation. At week 10, 95% had achieved a 50% or greater improvement in baseline PASI (PASI 50), and 77% had achieved a 75% or greater improvement (PASI 75). Efficacy was sustained in the longer term, with eight of 10 patients on treatment for more than 11 months maintaining at least a PASI 50. Only one patient had treatment withdrawn due to lack of efficacy, two suffered severe systemic infections including extrapulmonary tuberculosis (splenic abscess) and cellulitis, and six have discontinued due to adverse effects including infusion reactions (two), severe thrombocytopenia (one), hepatitis (one) and malignancy (two). CONCLUSIONS: Data from this open-label study suggest that infliximab is a rapidly effective treatment for patients with severe, treatment-resistant disease, although approximately 25% of patients had to discontinue therapy due to the development of serious adverse effects. Long-term follow-up, continued pharmacovigilance, and further controlled comparative studies will be required to evaluate fully the risks associated with infliximab in the context of this already difficult to treat population.     

英夫利西单抗在银屑病中的应用进展

银屑病为多基因遗传背景的慢性炎症性皮肤病,遗传因素、环境因素及人体免疫等之间复杂多变的相互作用导致银屑病发生。大量研究表明,肿瘤坏死因子α（TNF-α）在角质形成细胞的过度增生、内皮细胞调节及记忆T细胞的募集及效应功能中起重要作用［1］。抗TNF-α制剂在银屑病治疗中显示出理想效果。在过去的十几年间,包括TNF-α抑制剂（依那西普、英夫利西单抗和阿达木单抗）的生物制剂等新的高选择性生物疗法已被批准用于治疗银屑病。英夫利西单抗（infliximab）为美国FDA批准应用于临床的肿瘤坏死因子人鼠嵌合IgG单克隆抗体,其适应证包括类风湿性关节炎、强直性脊柱炎、克罗恩病、银屑病等。本文就英夫利西单抗治疗银屑病的作用机制及临床应用做一介绍……     

Effectiveness of cyclosporine treatment in severe psoriasis: a clinical and immunologic study

The effectiveness of low doses of cyclosporine (3 to 5 mg/kg/day) for short-term treatment in 13 patients with severe psoriasis was studied. The psoriasis cleared in 12 of 13 patients within 3 to 4 weeks of treatment, and there was appreciable improvement in the thirteenth patient. No major side effects were observed: two patients showed biochemical evidence of slight transient renal dysfunction and three others had cutaneous infections (two viral and one mycotic). An immunohistologic study showed that the psoriatic plaques contained an infiltrate composed mainly of activated helper T lymphocytes. After 15 days of cyclosporine treatment, CD4+ cells were significantly fewer in the epidermis and dermis, and Langerhans cells were more regularly distributed in the epidermis. Our studies of neutrophil chemotaxis showed that it is not significantly influenced by cyclosporine in vitro but is decreased in vivo.     

英夫利西单抗治疗关节病性银屑病进展

关节病性银屑病（PsA）可累及四肢、脊柱等单个或多个关节,是一种慢性炎症过程。70% ~ 85%患者在关节症状出现前有过皮损。约25% ~ 34%银屑病患者并发关节症状［1］。PsA具有较大侵蚀性,严重时可使关节畸形,甚至使患者丧失基本活动能力,具有难治性特点［2-3］。在银屑病的进程中,肿瘤坏死因子α（TNF-α）是占主导作用的炎症细胞因子,可刺激巨噬细胞和T细胞分泌炎症因子如白介素1（IL-1）、IL-6、IL-8,从而导致T细胞活化及增殖;TNFα也促进了破骨细胞的分化和成熟,并刺激成纤维细胞、破骨细胞和软骨细胞释放酶蛋白,从而破坏关节软骨和骨组织［4］。英夫利西单抗是抗TNFα单克隆抗体,系鼠源性抗原结合可变区与人源性免疫球蛋白G 1恒定区组成的生物嵌合体,与体液中或细胞膜表面的TNF-α具有高亲和力,干扰其与受体结合,从而阻断TNF-α的作用［5］……     

Infliximab for the treatment of psoriasis in Greece: 4 years of clinical experience at a single centre

Background Infliximab, a chimeric monoclonal antibody, has been shown to be effective for moderate to severe psoriasis. Clinical experience with long‐term infliximab therapy for psoriasis is accumulating, and it is therefore important to share our experience with its use in real‐life clinical practice. Objectives To report our experience with infliximab (Remicade^®; Schering Plough, Kenilworth, NJ, U.S.A.) for the treatment of moderate to severe plaque psoriasis (and/or arthritis) from a single clinic in Greece. Patients and methods Between August 2004 and March 2008, 62 patients presenting to our clinic with moderate to severe psoriasis were treated with infliximab. Disease phenotype, clinical course, disease severity and adverse events were assessed throughout the treatment period. Results Infliximab resulted in a reduction of median Psoriasis Area and Severity Index (PASI) of 70% at week 6 and 84·4% at week 14. Nineteen patients who have completed 1 year on infliximab treatment experienced sustained efficacy with a median PASI improvement of 92·16% and a Physician’s Global Assessment (PGA) of ‘clear’ or ‘almost clear’, while nine patients have reached approximately 20 months of continuous therapy. All patients with psoriatic arthritis showed marked improvement in their clinical symptoms following the first infusion. Eight patients (12·9%) experienced adverse events that required discontinuation of treatment. There were no statistically significant differences in PASI and Dermatology Life Quality Index (DLQI) scores between patients with arthritis and those with only skin lesions, or between those who received methotrexate, either from the beginning or during infliximab therapy, and those who did not receive methotrexate at all. Selected patients of interest are discussed. Conclusions The above data confirm previous reports that treatment with infliximab is an efficacious and safe option for patients with moderate to severe plaque psoriasis (and/or arthritis). Long‐term follow‐up, continued pharmacovigilance, and controlled comparative studies will be required to fully evaluate its use in the treatment of psoriasis.