Ankilozan spondilitli hastalarda güncel tedavi yaklaşımları

Year 2015, Volume: 42 Issue: 1, 123 - 127, 09.05.2015

Bilal Elbey

https://doi.org/10.5798/diclemedj.0921.2015.01.0546

Cited By: 3

Abstract

Ankilozan spondilit (AS) başlıca sakroiliak eklemler ve omurgayı etkileyen kronik, inflamatuar bir romatizmal hastalık olarak, daha çok erkeklerde sıklıkla 2. ve 3. On yılda ortaya çıkan bir hastalıktır. AS’li hastalarda tedavinin temelini ağrı ve inflamasyonu azaltan nonsteroid anti-inflamatuar ilaçlar (NSAİİ) almaktadır. Modifiye edici antiromatizmal (DMARD) ilaçlar, AS hastalığın tedavisinde etkinliği kanıtlanamamıştır. DMARD’ların kullanımı semptomların iyileştirilmesinde yeterli bulunmamıştır. Son zamanlarda anti tümör nekrozis faktör (TNF) blokerleri olan Golimumab, Etanersept, Adalimumab, İnfliksimab gibi ajanlar AS tedavisinde umut verici sonuçlar vermektedir. TNF blokerleri AS hastalarının fiziksel işlevlerinde, yaşam kalitesinde ve semptomlarında iyileşme sağlamaktadır. Bu yazı AS’li hastaların güncel farmakolojik tedavisi üzerine odaklanmıştır. Anahtar kelimeler: Ankilozan spondilit, tedavi, tümör nekrozis faktör alfa inhibitörü, hastalık modifiye edici ilaç- lar

Keywords

Ankilozan spondilit, tedavi, tümör nekrozis faktör alfa inhibitörü, hastalık modifiye edici ilaçlar

Current treatment approaches in patients with ankylosing spondylitis

Abstract

Ankylosing spondylitis (AS) is a chronic, inflammatory, rheumatic disease that mainly affects sacroiliac joints and spine. AS predominantly occurs more often in males and typically begins in the second or third decade. The mainstay of therapy in AS are nonsteroidal anti-inflammatory drugs, which reduce inflammation and pain. Disease modifying antirheumatic drugs (DMARD) did not have enough evidence to prove their effect in AS treatment. The use of DMARD may not sufficient to improve the treatment and symptoms. Currently, TNF-blockers such as, Golimumab Etanersept Adalimumab İnfliksimab have promising results in the treatment of AS. TNF-blockers improve the clinical signs and symptoms, and improve the patients’ physical function and quality of life. This manuscript is focused that Current pharmacological treatments in patients with ankylosing spondylitis

Keywords

Ankylosing spondylitis, treatment, tumour necrosis factor alpha inhibitor, disease modifying antirheumatic drugs

References

• van der Linden S, van der Heijde D. Ankylosing spondylitis.
• Clinical features. Rheum Dis Clin North Am 1998;24:663-
• , vii.
• Weisman MH RJ, Heijde D. Ankilozan Spondilit ve Spondiloartropatiler.
• Ankara: Veri Medikal Yayıncılık; 2008.
• Dougados M, Dijkmans B, Khan M, et al. Conventional treatments
• for ankylosing spondylitis. Annals of the rheumatic diseases
• , 61 Suppl 3:iii 40-50.
• Lavie F, Pavy S, Dernis E, et al. Pharmacotherapy (excluding
• biotherapies) for ankylosing spondylitis: development of recommendations
• for clinical practice based on published evidence
• and expert opinion. Joint Bone Spine 2007;74:346-352.
• Kwan D, William R. Bartle, and Scott E. Walker. The effects of
• acetaminophen on pharmacokinetics and pharmacodynamics
• of warfarin. J Clin Pharmacol 1999;9: 68-75.
• Şahin E. Farmakolojik ajanlar. Fiziksel Tıp ve Rehabilitasyon
• Pratik El Kitabı. Tan CJ, editör. Şendur ÖF, Çeviri ed. 2.baskı
• İstanbul: Güneş Tıp Kitabevleri;2008. p.333-357.
• Melli M, Kayaalp SO. Non-Steroidal antiinflamatuar ilaçlar.
• Kayaalp SO (Editör). Rasyonel Tedavi Yönünden Tibbi Farmakoloji
• Baskı. Ankara: Hacettepe-Taş;2005 p.837-870.
• Maugars Y, Mathis C, Berthelot JM, et al: Assessment of
• the efficacy of sacroiliac corticosteroid injections in spondylarthropathies:
• a double-blind study. Brit J Rheumatol
• ;35:767-770.
• van den Berg R, Baraliakos X, Braun J, van der Heijde D. First
• update of the current evidence for the management of ankylosing
• spondylitis with non-pharmacological treatment and nonbiologic
• drugs: a systematic literature review for the ASAS/
• EULAR management recommendations in ankylosing spondylitis.
• Rheumatology 2012;51:1388-1396.
• Braun J, Pham T, Sieper J, et al: International ASAS consensus
• statement for the use of anti-tumour necrosis factor agents
• in patients with ankylosing spondylitis. Ann Rheum Dis
• ;62:817-824.
• Ozgocmen S, Akgul O, Altay Z, et al: Expert opinion and key
• recommendations for the physical therapy and rehabilitation
• of patients with ankylosing spondylitis. Int J Rheum Dis
• ;15:229-238.
• Brooks P. Slow acting anti rheumatic drugs and cytotoxic
• agents. In: Schumacher HR, ed. Primer on the Rheumatic Diseases.
• Atlanta: Arthritis Foundation; 1993. p303-6
• Zochling J, van der Heijde D, Dougados M, Braun J: Current
• evidence for the management of ankylosing spondylitis: a systematic
• literature review for the ASAS/EULAR management
• recommendations in ankylosing spondylitis. Ann Rheum Dis
• ;65:423-432.
• Rudwaleit M, Listing J, Brandt J, et al. Prediction of a major
• clinical response (BASDAI 50) to tumour necrosis factor
• α blockers in ankylosing spondylitis. Ann Rheum Dis,
• ;63:665-670.
• Braun J. V, Van Den Berg R, Baraliakos X, et al. 2010 update
• of the ASAS/EULAR recommendations for the management
• of ankylosing spondylitis. Ann Rheum dis 2011;70: 896-904.
• van der Heijde D, Sieper J, Maksymowych WP, et al. 2010
• Update of the international ASAS recommendations for the
• use of anti-TNF agents in patients with axial spondyloarthritis.
• Annals of the rheumatic diseases 2011;70:905-908.
• van der Heijde D, Dijkmans B, Geusens P, et al. Ankylosing
• Spondylitis Study for the Evaluation of Recombinant Infliximab
• Therapy Study G: Efficacy and safety of infliximab in
• patients with ankylosing spondylitis: results of a randomized,
• placebo-controlled trial (ASSERT). Arthrit Rheum
• ;52:582-591.
• Braun J, Brandt J, Listing J, et al. Treatment of active ankylosing
• spondylitis with infliximab: a randomised controlled multicentre
• trial. The Lancet 2002;359:1187-1193.
• Davis JC Jr, Van Der Heijde D, Braun J, et al. Recombinant
• human tumor necrosis factor receptor (etanercept) for treating
• ankylosing spondylitis: a randomized, controlled trial. Arthrit
• Rheum 2003; 48:3230-3236.
• Inman RD, Davis JC Jr, Heijde D, et al. Efficacy and safety
• of golimumab in patients with ankylosing spondylitis: results
• of a randomized, double-blind, placebo-controlled, phase III
• trial. Arthrit Rheum 2008; 58:3402-3412.
• Braun J, Davis J, Dougados M, et al. First update of the international
• ASAS consensus statement for the use of anti-TNF
• agents in patients with ankylosing spondylitis. Ann Rheum
• Dis 2006; 65:316-320.
• Saag KG, Teng GG, Patkar NM, et al. American College of
• Rheumatology 2008 recommendations for the use of nonbiologic
• and biologic disease-modifying antirheumatic drugs in
• rheumatoid arthritis. Arthrit Care Res 2008;59:762-784.
• Black R A, Rauch CT, Kozlosky CJ, et al. A metalloproteinase
• disintegrin that releases tumour necrosis factor-R from cells.
• Nature 1997;385:729-733.
• Pay S. Romatizmal Hastalıklarda Anti-TNF İlaç Kullanımı.
• Turkiye Klinikleri J Med Sci, 2006;26:430-440.
• Gorman JD, Sack, K E, Davis JC Jr. Treatment of ankylosing
• spondylitis by inhibition of tumor necrosis factor α. N Engl J
• Med 2002;346:1349-1356.
• Dvis JC, Webb A, Lund S, Sack K, Result from an open-label
• extension study of etanercept in ankylosing spondylitis. Art
• Rheum 2004;51:302-104
• Brandt J, Listing J, Haibel H, et al. Long-term efficacy and
• safety of etanercept after readministration in patients with active
• ankylosing spondylitis. Rheum 2005;44:342-348.
• Den Broeder AA, Saxne T, Heinegård D, et al. Long term antitumour
• necrosis factor α monotherapy in rheumatoid arthritis:
• effect on radiological course and prognostic value of markers
• of cartilage turnover and endothelial activation. Ann Rheum
• Dis 2002; 61:311-318.
• U.S Food and Drug administration, Full prescribing information,
• Adaliumab.2008. Available at:www.fda.gov.
• Tracey D, Klareskog L, Sasso EH, et al. Tumor necrosis factor
• antagonist mechanisms of action: a comprehensive review.
• Pharmacol Ther 2008;117:244-279.
• Callhoff J, Sieper J, Weiß A, et al. Efficacy of TNFα blockers
• in patients with ankylosing spondylitis and non-radiographic
• axial spondyloarthritis: a meta-analysis. Ann Rheum Dis
• doi:10.1136/ 2014-205322 [Epub ahead of print]
• Patel Aarat M, and Larry W. Moreland. “Certolizumab pegol:
• a new biologic targeting rheumatoid arthritis. Ann Rheum Dis
• ;6: 855-866.
• Nesbitt A, Fossati G, Bergin M, et al. Mechanism of action
• of certolizumab pegol (CDP870): In vitro comparison with
• other anti-tumor necrosis factor α agents. Inflamm Bowel Dis
• ;13:1323-1332.
• Evans Ashley T, Lee SD. “A review and expert opinion of the
• use of certolizumab for Crohn’s disease. Expert Opin Biol
• Ther 2012; 12:363-370.
• Landewé R, Braun, J, Deodhar A, et al . Efficacy of certolizumab
• pegol on signs and symptoms of axial spondyloarthritis
• including ankylosing spondylitis: 24-week results of a double-blind
• randomised placebo-controlled Phase 3 study. Ann
• Rheum Dis 2013;73:39-47.
• Dhillon S: Certolizumab pegol: a review of its use in patients
• with axial spondyloarthritis or psoriatic arthritis. Drugs
• ;74:999-1016.
• Braun J, Davis J, Dougados M, et al. First update of the international
• ASAS consensus statement for the use of anti-TNF
• agents in patients with ankylosing spondylitis. Ann Rheum
• Dis 2006;65:316-320.
• Davis JC. Ankylosing Spondylitis In: Koopman WJ, Moreland
• LW (eds). Arthritis and Allied Conditions. A Textbook
• of Rheumatology Lippincott Williams and Wilkins P. 2005
• p.1319-1333.
• Braun Jv, Van Den Berg R, Baraliakos X, et al. : 2010 update
• of the ASAS/EULAR recommendations for the management
• of ankylosing spondylitis. Ann Rheum Dis 2011;70:896-904.