Innowacje w leczeniu AZS
Słowa kluczowe:
atopowe zapalenie skóry, leczenie biologiczne, inhibitory interleukin, inhibitory JAK-STATStreszczenie
Atopowe zapalenie skóry jest przewlekłą, nawrotową chorobą zapalną skóry, charakteryzującą się występowaniem nasilonego świądu i polimorficznych zmian skórnych, oraz przebiegająca z epizodami zaostrzeń i remisji. Jest najczęstszą dermatozą pojawiająca się w dzieciństwie. U większości pacjentów ustępuje w okresie dojrzewania, ale u około 40% trwa nadal w wieku dorosłym. Patogeneza AZS jest złożona, jednak główną rolę przypisuje się dysfunkcji bariery naskórkowej oraz zapaleniu skóry, wywołanego przez cytokiny, uwalniane przez pobudzone limfocyty i inne komórki immunokompetentne. Dotychczasowe leczenie AZS skupiało się na leczeniu objawowym choroby. Za podstawę terapii uważa się nawilżanie skóry preparatami emolientowymi oraz stosowanie miejscowych leków przeciwzapalnych. W ciężkich przypadkach konieczne jest użycie leków immunosupresyjnych takich jak azatiopryna, cyklosporyna czy metotreksat, jednak stosowanie ich wiąże się z występowaniem wielu działań niepożądanych. Dzięki poznaniu mechanizmów immunologicznych, biorących udział w patogenezie AZS, możliwe stało się stworzenie celowanych terapii z wykorzystaniem przeciwciał monoklonlanych skierowanych przeciwko cytokinom, takim jak IL-4, IL-5 IL-13, IL-15, IL-31, limfopoetynie zrębu grasicy (TSLP), cząsteczkom OX40, czy użycie małych cząsteczek prowadzących do inhibicji szlaku JAK-STAT. Stanowią one grupę nowatorskich preparatów, z których duża część jest aktualnie w trakcie badań klinicznych II i III fazy. Wydaje się, że niektóre z nich mogą stać się pomocne w przyszłym leczeniu chorych. Wciąż jednak potrzeba wielu badań w zakresie ich skuteczności działania oraz bezpieczeństwa, zarówno u pacjentów dorosłych, jak i pediatrycznych. Dupilumab jest pierwszym lekiem biologicznym dopuszczonym do leczenia pacjentów z AZS w stanie umiarkowanym do ciężkiego, zarówno u dorosłych, jak i dzieci od 6 roku życia, wymagających leczenia ogólnego. Praca ma na celu przegląd ostatnich odkryć w leczeniu biologicznym atopowego zapalenia skóry.
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Opublikowane
5 marca 2023
Prawa autorskie (c) 2023 Aleksandra Spychał; Karol Żmudka, Paulina Księżopolska, Maciej Smreczak
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Utwór dostępny jest na licencji Creative Commons Uznanie autorstwa – Użycie niekomercyjne – Bez utworów zależnych 4.0 Międzynarodowe.
