The Korean Journal of Medicine

  • 제93권5호
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  • Pages.424-429
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  • 2018
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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축형 척추관절염의 새로운 약물 치료

A New Medical Therapy for Axial Spondyloarthritis

  • 이소연 (경희대학교 의과대학 강동경희대학교병원 류마티스내과) ;
  • 이상훈 (경희대학교 의과대학 강동경희대학교병원 류마티스내과)
  • Lee, So Yun (Department of Rheumatology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University) ;
  • Lee, Sang-Hoon (Department of Rheumatology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University)
  • 발행 : 2018.10.01
⟨ 이전 논문 다음 논문 ⟩

초록

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been the first choice of treatment for axial spondyloarthritis (axSpA); cyclooxygenase (COX)-2 inhibitors reduce both inflammation and bone formation. When NSAID treatment fails, tumor necrosis factor inhibitors (TNFis) can be used to treat active axSpA, but, presently, TNFis cannot completely prevent radiographic progression. Theoretically, as TNF is a strong pro-inflammatory cytokine triggering bone resorption, TNFis should stimulate bone formation. Recently, it was discovered that the IL-23/-17 axis is associated with enthesitis development and bone formation in a mouse model. The anti-IL-23 monoclonal antibody ustekinumab has been approved as treatment for moderate-to-severe plaque psoriasis and psoriatic arthritis. However, in axSpA patients, ustekinumab effectiveness was low and a phase 3 clinical trial was terminated. The anti-IL-17A monoclonal antibody secukinumab has been approved as treatment for moderate-to-severe plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis. In a 3-year extension of the MEASURE 1 observational study, the mean change in modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) from baseline to week 104 was $0.30{\pm}2.53$ among patients with evaluable X-rays originally randomized to secukinumab (n = 168). Such patients exhibited less radiographic progression compared to other TNFi studies. Several new drugs are in clinical trials exploring their effects on axSpA; these include ixekizumab (an anti-IL-17A monoclonal antibody), brodalumab (an anti-IL-17 receptor monoclonal antibody), and the Janus kinase (JAK) inhibitors tofacitinib and upadacitinib. The IL-23/-17 axis is important in terms of axSpA inflammation and bone formation. However, to date, no drug has completely prevented radiographic progression in axSpA patients.

키워드

참고문헌

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