2016 12 12 Ankylosing Spondylitis AS human leukocyte antigen HLA- AS NSAIDs NSAIDs B27 100% NSAIDs NSAIDs 90% NSAID ~ AS 0.25% 2~3 1 100% 1 AS CFDA FDA EMA 14 AS NSAIDs 2 CFDA non-ster- AS 1 oidal anti-inflammatory drugs NSAIDs NSAIDs tumor necrosis factor TNF-α TNF-α AS AS Thomson Class Ⅰ Class Ⅱa Category B FDA TNF - AS Thomson Class Ⅱa Class Ⅱb Category A 3 1 AS China Food and Thomson Healthcare MICROMEDEX Drug Administration CFDA AS AS 1 AS AS CFDA AS 1 2 AS 2.1 NSAIDs NSAIDs 2 2 ~ AS 4 NSAIDs 2015 American College CFDA FDA EMA AS 2010 AS 2 1 NSAID 2 NSAIDs NSAID NSAIDs of Rheumatology ACR Spondylitis Association of America SAA Spondyloarthritis Research and Treatment 2 Network SPARTAN AS 2017 1 27 1 Pharmacy Today 2017 January Vol.27 No.1 1
1 AS AS AS 1. TNF-α TNF - 2. * 3. * ** ** -A ** 4. NSAIDs * AS ** 2 Pharmacy Today 2017 January Vol.27 No.1 2017 1 27 1
2 NSAIDs CFDA FDA EMA AS CFDA FDA EMA Thomson Healthcare MICROMEDEX Class I Class IIb Category B Class I Class I Category B - Class I Class I Category A Class I Class IIa Category B AS AS AS - Class I Class I Category A - AS - Class I Class IIa Category B Class IIa Class IIb Category A AS - AS - AS - AS CFDA FDA EMA AS AS - 2.2 CFDA 2015 ACR SAA SPARTAN AS 1 AS methotrexate MTX NSAIDs AS 2.2.1 TNF-α TNF-α TNF-α TNF-α 80% RNA TNF-α AS ~ 90% 3 2006 ASAS /EULAR AS TNF-α AS TNF-α 100% NSAIDs 4 2010 ASAS /EULAR AS TNF-α AS 5 2010 TNF-α AS ~ 100% AS C 2 AS 1 Thomson Healthcare MICROMEDEX Thomson Class Ⅱa Class Ⅱb C TNF-α TNF-α 3 2017 1 27 1 Pharmacy Today 2017 January Vol.27 No.1 3
3 AS * ** Thomson 60 mg / 120 mg / 60~ 120 mg /d FDA AS Thomson Class IIa Class IIb Category A 0.1 g / 0.2 g / 0.2 g / 1 FDA / AS Thomson Class I Class IIa Category B 25 mg / 25 ~ 50 FDA mg /d AS Thomson Class Ⅱa Class 50 ~ 100 mg /d Ⅱb Category C 2. 5mg / MICROMEDEX / 5mg / 5 mg /1 ml 10 mg / AS 1 ml 7. 5 ~ 10 mg / 5 mg / FDA AS MICROMEDEX AS 5 mg / FDA AS Thomson Class I Class IIa Category B 300 mg / 2~ 3 300 ~ 600 mg MICROMEDEX 20 mg / 30 ~ 60 mg /d3 MICROMEDEX 20 mg / 3 20~ 60 mg MICROMEDEX * CFDA FDA AS Thomson Healthcare MICROMEDEX AS ** Thomson Healthcare MICROMEDEX AS 150 mg /d 25~50mg /d 30 ASAS20 AS 50 ~ 100 mg /d 2013 3 4 Pharmacy Today 2017 January Vol.27 No.1 2017 1 27 1
2g /d n = 33 NSAIDs n = 37 2 MTX 10 mg 6 2.3 2.3.1 2015 ACR SAA SPARTAN AS AS 100% 1 2.2.2 MTX 2006 ASAS /EULAR AS MTX AS AS MTX AS FDA TNF-α AS AS 3 MTX 4 2.3.2 NSAIDs 2010 ASAS /EULAR AS AS MTX AS MTX 100% 5 2015 ACR SAA SPARTAN AS 3 1 MTX AS 2001 NSAIDs AS 51 AS 1000 mg /d MTX 7.5 mg 100% 7 2004 AS MTX 7.5 mg 24 8 2007 20 NSAIDs AS 1 MTX 15 mg4 MTX 20 mg12 25% ASAS20 10% ASAS40 ASAS70 9 MTX 10 AS Thomson Healthcare MICROMEDEX MTX AS TNF-α 1 ~ 2 1 AS TNF-α CFDA -A NSAIDs AS 2.4 2010 AS TNF-α AS MTX 2 1 MTX NSAIDs AS 100% NSAIDs 2017 1 27 1 Pharmacy Today 2017 January Vol.27 No.1 5
AS 2010 AS TNF-α NSAIDs AS AS 2 MTX Meta 2.5 11~ AS 13 CFDA Thomson Healthcare MICROMEDEX 2 ~ 3 300 ~ 600 mg 2 30 ~ 60 mg /d 3 3 Thomson 4 3 20 ~ 60 mg 3 NSAIDs TNF-α AS 5 4 CFDA AS A B C 4 NSAIDs TNF-α AS 5 6 4 Class I ClassII a Effective Evidence Favors Efficacy ClassII b Evidence is Inconclusive ClassIII Ineffective 5 Class I Recommended ClassII a Recommended In Most ClassII b ClassIII Class Indeterminate Recommended In Some Not Recommended 6 Category A Category B Category C No Evidence 6 Pharmacy Today 2017 January Vol.27 No.1 2017 1 27 1
1 Ward MM Deodhar A Akl EA et al. American College of Rheumatology / Spondylitis Association of America / Spondyloarthritis Research and Treatment Network 2015 recommendations for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis J. Arthritis Rheumatol 2016 68 2 282-298. 2 J. 2010 14 8 557-559. 3 Firestein GS Budd RC Gabriel SE et al. Kelley' s Textbook of Rheumatology 9th edition 1217. 4 Zochling J van der Heijde D Burgos-Vargas R et al. ASAS /EU- LAR recommendations for the management of ankylosing spondylitis J. Ann Rheum Dis 2006 65 4 442-452. 5 Braun J van den Berg R Baraliakos X et al. 2010 update of the ASAS / EULAR recommendations for the management of ankylosing spondylitis J. Ann Rheum Dis 2011 70 6 896-904. 6 Deng X Zhang J Zhang J et al. Thalidomide reduces recurrence of ankylosing spondylitis in patients following discontinuation of etanercept J. Rheumatol Int 2013 33 1409 1413 7 Altan L Bing l U Karako Y et al. Clinical investigation of methotrexate in the treatment of ankylosing spondylitis J. Scand J Rheumatol 2001 30 5 255-259. 8 Gonzalez-Lopez L1 Garcia-Gonzalez A Vazquez-Del-Mercado M et al. Efficacy of methotrexate in ankylosing spondylitis a randomized double blind placebo controlled trial J. J Rheumatol 2004 31 8 1568-1574. 9 Haibel H Brandt HC Song IH et al. No efficacy of subcutaneous methotrexate in active ankylosing spondylitis a 16-week open-label. trial J. Ann Rheum Dis 2007 66 3 419-421. 10 van den Berg R Baraliakos X Braun J et al. First update of the current evidence for the management of ankylosing spondylitis with non-pharmacological treatment and non-biologic drugs a systematic literature review for the ASAS / EULAR management recommendations in ankylosing spondylitis J. Rheumatology Oxford 2012 51 8 1388-1396. 11. Meta J. 2013 33 18 1542-1544. 12 Li H Guo F Luo YC et al. Efficacy of tripterygium glycosides tablet in treating ankylosing spondylitis a systematic review and meta-analysis of randomized controlled trials J. Clin Rheumatol 2015 34 11 1831-1838. 13. J. 2014 31 2 75-80. 1 wqw_sw@ 163.com liedai2004@ 163.com junewu@ tom.com 2017 1 27 1 Pharmacy Today 2017 January Vol.27 No.1 7
2 2016 112 2014 8 15 2014 48 753-2 510080 020 37886326 37886321 37886330 gdsyxh45@ 126.com http / /www.sinopharmacy.com.cn 2016 12 1 8 Pharmacy Today 2017 January Vol.27 No.1 2017 1 27 1