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【medical-news】抗TNF 治疗可能对类风湿性恶液质有
Michelle Rizzo
NEW YORK (Reuters Health) Jan 03 - Although a clinical response was observed, anti-tumor necrosis factor (TNF) therapy with etanercept did not appear to be superior to methotrexate for the treatment of rheumatoid cachexia, according to findings published in the December issue of the American Journal of Clinical Nutrition. However, in a subgroup of rheumatoid arthritis (RA) patients, etanercept normalizes an anabolic response to overfeeding.
Blockade of tumor necrosis factor has been shown to prevent catabolism in animal models. Little evidence exists showing that anti-TNF therapy effectively treats cachexia in humans.
In the current study, Dr. Samuele M. Marcora, of the University of Wales, Bangor, and colleagues examined the effect of etanercept, a synthetic soluble TNF receptor, on body composition in patients with early RA. They compared etanercept with methotrexate, the most common anti-rheumatic drug.
Twenty-six patients were randomized to 24 weeks of etanercept or methotrexate. The team measured body composition, physical function, disease activity, systemic inflammation, and the circulating insulin-like growth factor (IGF) system at baseline and at 12 and 24 weeks. Twelve patients in each treatment group completed the study.
No significant changes in body composition were observed, according to the investigators. There was a transient increase in IGF-I at week 12 (p < 0.01), which returned to baseline values by week 24.
The secondary analysis of the six patients in each treatment group who gained weight during follow-up demonstrated a significant effect of etanercept on the composition of the weight gained. In the etanercept group, 44% of weight gained was fat-free mass, compared with 14% in the methotrexate group (p = 0.04). Both treatments were equally effective in controlling the disease and improving physical function.
"Anti-TNF therapy seems to have a specific effect on skeletal muscles only in those RA patients who are on positive energy balance, not on the overall RA population," Dr. Marcora said in an interview with Reuters Health. "The results of our subgroup analysis of RA patients on positive energy balance suggest the possibility of using anti-TNF therapy in conjunction with hypercaloric feeding when the aim is to increase body weight in catabolic patients," he said. However, muscle wasting in RA is "usually accompanied by a concomitant increase in body fat, the so-called 'cachetic obesity.'"
The author noted that the problem of cachexia is seriously overlooked in rheumatology. "What is clear from this and other studies is that RA patients have significant muscle atrophy," Dr. Marcora said. "Although effective anti-rheumatic treatment reduces further muscle wasting, it is necessary to include an adjunct anabolic treatment such as intense resistance training to recover the muscle tissue lost even before starting medical therapy," he added. "Anti-rheumatic drugs are not enough."]
Am J Clin Nutr 2006;84:1463-1472.
http://www.medscape.com/viewarticle/550227 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 NEW YORK (Reuters Health) Jan 03 - Although a clinical response was observed, anti-tumor necrosis factor (TNF) therapy with etanercept did not appear to be superior to methotrexate for the treatment of rheumatoid cachexia, according to findings published in the December issue of the American Journal of Clinical Nutrition. However, in a subgroup of rheumatoid arthritis (RA) patients, etanercept normalizes an anabolic response to overfeeding.
纽约（路透社健康）1.03- 根据美国临床营养杂志11月刊的报道，在观察了临床表现后发现，用依那西普进行抗肿瘤坏死因子（TNF）治疗并不比甲氨喋呤治疗类风湿性恶病质更具优势。然而，在类风湿性关节炎(RA)患者的一组中，服用依那西普可使因吃的过量引起的合成代谢反应正常化。
Blockade of tumor necrosis factor has been shown to prevent catabolism in animal models. Little evidence exists showing that anti-TNF therapy effectively treats cachexia in humans.
在动物模型中证实，TNF的阻塞可防止分解代谢。但抗TNF治疗人类恶病质是否有效几乎毫无证据。
In the current study, Dr. Samuele M. Marcora, of the University of Wales, Bangor, and colleagues examined the effect of etanercept, a synthetic soluble TNF receptor, on body composition in patients with early RA. They compared etanercept with methotrexate, the most common anti-rheumatic drug.
在目前的研究中，威尔士班戈大学的Samuele M. Marcora博士和其同事检验了依那西普的疗效，依那西普是一个合成可溶性TNF受体，作用于早期类风湿关节炎患者的人体成分中。他们将依那西普与最常用的抗类风湿药物甲氨喋呤进行比较。
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作者:admin@医学,生命科学 2011-04-07 17:17
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