社團法人臺灣臨床藥學會

已出刊文章

【綜述】Anti-IL-2R單株抗體於腎臟 移植之臨床應用與發展近況回顧
anti-IR-2R 單株抗體、anti-IL-2R monoclonal antibody、腎臟移植
林季伶Chi-Ling Lin* 、陳志碩Chih-Shou Chen 、江睿玲Ruey-Ling Jiang 、鄭奕帝Yih-Dih Cheng
1嘉義長庚醫院藥劑科 、2嘉義長庚醫院泌尿科
Anti-interleukin-2 receptor(anti-IL-2R)單株抗體提供一個嶄新的作用方式,用
來預防器官移植產生的急性排斥,其免疫抑制的機轉為選擇性抑制 IL-2  所引發的 T 淋巴球增生,即異體辨識(allorecognition)的關鍵路徑。臨床上以 anti-IL-2R 單株 抗體做為導引免疫抑制之誘導治療(induction therapy)來預防急性排斥的發生。 
Daclizuma(bhumanized monoclonal antibody)或 basilixima chimeric monoclonal antibody)加入免疫抑制劑 double therapy(環孢靈、類固醇)或 triple therapy(環 孢靈、類固醇與 azathioprine/mycophenolate mofetil)可降低急性排斥的發生率。第 三期臨床試驗顯示極佳的安全性,並不會增加伺機性感染與移植後淋巴增生疾病
(post-transplant lymphoproliferative disease)的發生率。然而在上市後的臨床監視 期,daclizumab 與 basiliximab 都有嚴重過敏性反應的報告。一個回溯性的比較研究 顯示,daclizumab 的安全性與預防急性排斥的成效優於 muromonab-CD3。與其他誘 導治療製 劑的相對 有效性與 安全性仍 待日後的 研究確立 。現有的 資料顯示 anti-IL-2R 單株抗體也許可減少 calcineurin 抑制劑與類固醇的使用量,從而改善它 們短期與長期的副作用。
Anti-IL-2R 單株抗體加入標準的免疫抑制劑療程可明顯降低移植後第一年急性 排斥的發生率,雖然移植腎與病人的存活率較高,但其差異並不顯著。此外, anti-IL-2R 單株抗體對於慢性移植腎的影響目前並不清楚。

The anti-interleukin-2 receptor (anti-IL-2R) antibody therapy is an exciting approach to the prevention of acute rejection whereby immunosuppression is exerted by a selective and competitive inhibition of IL-2-induced T cell proliferation, a critical pathway of allorecognition. The anti-IL-2R antibodies are used as induction therapy for prevention of acute rejection in adults and children.
Daclizumab (a humanized monoclonal antibody) or basiliximab (a chimeric monoclonal antibody) reduced the incidence of acute rejection when they were added to immunosuppressive regimens of double therapy (including cyclosporin and corticosteroids) or triple therapy (including cyclosporin and corticosteroids, and with or without azathioprine or mycophenolate mofetil). In phase III studies, they had excellent safety profiles. No increases were observed in the incidence of infectious or post-transplant lymphoproliferatve disease. However, severe hypersensitivity reactions have been observed both on exposure to daclizumab and basiliximab during postmarketing surveillance. In a retrospective study, daclizumab was safer and more effective for the prevention of acute rejection than muromonab-CD3. The relative efficacy and tolerability of anti-IL-2R monoclonal antibodies compared with other induction agents has yet to be defined. Available data suggest that anti-IL-2R monoclonal antibodies may allow minimizing exposure to the calcineurin inhibitors and corticosteroids thereby ameliorating their short and long-term side effects.
The use of an anti-IL-2R antibody in addition to standard double or triple therapy significantly reduces acute rejection within the first year post transplantation. Although use of an anti-IL-2R antibody favors graft and patient survival, the effect was not significant. The  effects of anti-IL-2R antibodies on chronic allograft nephropathy are still unknown.
操作進行中,請稍候~~~~
×
加载中...