10가지 자가 면역 질환을 일으키는 6가지 Cytokine 과 15가지 치료 약의 약효 비교 평가 > 임상 응용 정보

10가지 자가 면역 질환을 일으키는 6가지 Cytokine 과 15가지 치료 약의 약효 비교 평가

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10가지 자가 면역 질환을 일으키는<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
 
6가지 Cytokine 과 15가지 치료 약의 약효 비교 평가 
 
류머티스 관절 염 같은 자가 면역 질환들을 일으키는 것은 
T-림프구 같은 면역 세포가 만드러내는 Cytokine 이라는 
면역 인자 들이다 
 
Cytokine은 정상인들에게서는 여러가지 병을 고쳐 주는 
이른바 생리적 자가 치유 인자들이다
 
그러나 자가 면역 질환을 지닌 자들에게는 
병을 유발하는 이른바 미쳐버린 Cytokine 들이다
 
해서 이러한 Cytokine 의 작용을 억제하는 Cytokine 억제제가
약으로 개발되어 사용되고 있다
 
독일 뉴렌베르그 Erlangen 의대 연구팀은 
10가지 자가면역 질환을 유발하고 있는 
6가지 Cytokine에 대하여 15가지 Cytokine억제 제들이 
어느 정도의 약효를 발휘하는가를 보여 주는 
약효 비교 평가 표를 만들었다
 
 
 
약효 비교 평가 표 
 
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최신 신약 약효 ) 비교 평가 표</TD></TR>
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자가면역 질환</TD>
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TNF-α</TD>
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IL-6R</TD>
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IL-1</TD>
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IL-2/23</TD>
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IL-17A</TD></TR>
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류머티스 관절염 </TD>
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Giant cell 관절염</TD>
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유년형관절염,Still’s 병등 </TD>
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통풍</TD>
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크론씨 병</TD>
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궤양 성 대장염</TD>
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건선</TD>
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건성 성 관절염 </TD>
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강직성 척추 염</TD>
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다발 성 경화증</TD>
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치료 약 (치험 약 포함)</TD>
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Adalimumab
(휴미라 주)
Etanercept
(앰브렐주)
Infriximab
(레미케이드_
Certolizumab
Golimumab</TD>
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 64.05pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #fde9d9; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid; " width=85>
Toclizumab
Sanilumab</TD>
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 75.55pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #fde9d9; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid; " width=101>
Anakinra
Canakinumab
Rilonacept</TD>
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 70.75pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #fde9d9; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid; " width=94>
Ustekinmab
Briakinumab</TD>
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 73.65pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #fde9d9; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid; " width=98>
Brodalumab
Ixekizumab
Secucinumab</TD></TR>
<TR >
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 147.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #1f497d; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid; mso-background-themecolor: text2" rowSpan=4 width=196>
약효 판정 </TD>
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 77.5pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #66ff66; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid; " width=103>
 </TD>
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 284pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #dbe5f1; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid; " width=379 colSpan=4>
무작위 비교 임상으로 약효 입증 </TD></TR>
<TR >
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 77.5pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ff99ff; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid; " width=103>
 </TD>
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 284pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #dbe5f1; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid; " width=379 colSpan=4>
아직은 기초 예비 임상으로 약효가 인정되어 있음</TD></TR>
<TR >
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 77.5pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #eeece1; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid; mso-background-themecolor: background2" width=103>
 </TD>
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 284pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #dbe5f1; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid; " width=379 colSpan=4>
약효가 매우 약하거나 없거나 자료 불충분 상태</TD></TR>
<TR style="mso-yfti-irow: 16; mso-yfti-lastrow: yes">
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 77.5pt; PADDING-RIGHT: 5.4pt; BACKGROUND: red; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid; " width=103>
 </TD>
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 284pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #dbe5f1; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid; " width=379 colSpan=4>
오히려 증상을 악화시킴 </TD></TR></TBODY></TABLE>
 
 
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<IMG src="/_dimg/4-1%2020150514_105643.png"> 
[그림] 관절 을 파괴하는 Cytokine 인 TNF-α 를  
작용못하도록 묶어 벟리는 항체 Etanercept 
 
 
 
부신 피질 호르몬 제 Methotrexate 등과 
 
Cytokine 억제 제 와의 차이 점 
 
현재 사용 중이거나 연구 단계에 있는 
Cytokine 억제 제 는 모두가 Cytokine 하나 하나를
항원으로 하여 개발된 항체들이다
 
이러한 모노 항체가 개발괴기 전에는 
주로 부신 피질 호르몬 제와 
Methotrexate 
Azathioprine 등과 같은 약을 사용했다 
 
이러한 기존 약들은 한 개의 Cytokine 만을 억제하는 것이 아니라
광범위.하게 여러 가지 Cytokine 들을 억제하는 약들이다
 
그러나 TNF-α 만을 억제하는 Etanercept 같은 
Cytokine 억제 제를 사용해보니 
Methotrexate 제 같은  광범위 cytokine 억제제를 
사용하는 경우 보다 
치료 효과가 우수한 경우가 많다는 사실이 밝혀 진 것이다 
 
그러나 Cytokine 억제 제 와 Methotrexate 을 병용하면 
더 잘 들으므로 최근에는 처음부터 병용 요법을 실시한다
 
이는 자가 면역 질환을 유발하는 새로운 Cytokine 은
아직도 계속해서 밝혀 질것임을 의미 하고 있는 것이다
 
 
[근거{ <A title="Nature medicine." href="http://www.ncbi.nlm.nih.gov/pubmed/23836224">Nat Med.</A> 2013 Jul;19(7):822-4. doi: 10.1038/nm.3260.
   How Cytokine Networks Fuel Inflammation: Toward a cytokine-based disease taxonomy <A href="http://www.ncbi.nlm.nih.gov/pubmed?term=Schett%20G%5BAuthor%5D&cauthor=true&cauthor_uid=23836224">Schett G</A>, <A href="http://www.ncbi.nlm.nih.gov/pubmed?term=Elewaut%20D%5BAuthor%5D&cauthor=true&cauthor_uid=23836224">Elewaut D</A>, <A href="http://www.ncbi.nlm.nih.gov/pubmed?term=McInnes%20IB%5BAuthor%5D&cauthor=true&cauthor_uid=23836224">McInnes IB</A>, <A href="http://www.ncbi.nlm.nih.gov/pubmed?term=Dayer%20JM%5BAuthor%5D&cauthor=true&cauthor_uid=23836224">Dayer JM</A>, <A href="http://www.ncbi.nlm.nih.gov/pubmed?term=Neurath%20MF%5BAuthor%5D&cauthor=true&cauthor_uid=23836224">Neurath MF</A>.; 
Department of Internal Medicine  University of Erlangen-Nuremberg, Erlangen, Germany.