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Vol. 4. Núm. S1.
Monográfico: Enfermedades sistémicas autoinmunitarias
Páginas 35-39 (Marzo 2008)
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Vol. 4. Núm. S1.
Monográfico: Enfermedades sistémicas autoinmunitarias
Páginas 35-39 (Marzo 2008)
Enfermedades sistémicas autoinmunitarias
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Nuevas dianas terapéuticas
New Therapeutic Targets
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Jaime Calvo Alén
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jcalvo@hsll.scsalud.es

Correspondencia: Dr. J. Calvo Alén. Sección de Reumatología. Hospital de Sierra Llana. B.o Gauzo, s/n. 39300. Torrelavega. Cantabria. España.
Sección de Reumatología. Hospital Sierrallana. Torrelavega. Cantabria. España
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El éxito obtenido con las terapias biológicas en la artritis reumatoide y en otras artropatías inflamatorias ha propiciado su desarrollo en otras enfermedades reumatológicas como el lupus eritematoso sistémico (LES) y, en menor grado, el síndrome de Sjögren (SS) y la esclerosis sistémica progresiva (ESP). La presente revisión resume las terapias biológicas que están en una fase de desarrollo relativamente avanzada de cara a su aplicación clínica en este tipo de patologías en un futuro cercano. En este sentido, es en el LES donde más estudios se están realizando con agentes como abetimus sódico (LJP 394), un análogo sintético del ADN; edratide (TV4710), un péptido del sitio de unión al antígeno de los anticuerpos anti-ADN bicatenario, o anticuerpos monoclonales con diversos efectos: depleción de linfocitos B (rituximab [anti-CD20] y epratuzumab [anti-CD22]), inhibición de factores de proliferación linfocitaria (belimumab [anti-BAFF]) o inhibición de la coestimulación (BG9588 [anti-CD40L] y abatacept [CTLA-4Ig]). En el SS el agente más prometedor es el rituximab, aunque también hay estudios con el efalizumab, un anticuerpo monoclonal dirigido contra la molécula LFA-1 (CD-11). Finalmente, en la ESS están en desarrollo anticuerpos monoclonales contra el TGFβ, citocina implicada en el reacción fibrótica que se produce en esta patología, así como un estudio sobre la utilización del abatacept. No obstante, en esta enfermedad los mayores avances terapéuticos se están viendo con agentes, como los inhibidores de la endotelina o de la tirosincinasa, que no entran dentro del grupo de las terapias biológicas.

Palabras clave:
Terapias biológicas
Conectivopatías
Lupus eritematoso sistémico

The success obtained with biologic therapies in rheumatoid arthritis and other inflammatory arthropathies has led to its use in other rheumatic diseases such as systemic lupus erythematosus (SLE) and, to a lesser degree, in Sjögren's syndrome (SS) and progressive systemic sclerosis (PSS). This review summarizes the biologic therapies that are still in a development phase, albeit a relatively advanced one, with the aim of applying them clinically in the near future. In this sense, SLE is the disease for which most trials are being carried out, including treatment with agents such as sodic abetimus (LJP 394) a synthetic analog of DNA, edratide (TV4710) a peptide from the antigen-binding site of anti-double stranded DNA, or monoclonal antibodies with different effects: B cell depletion (rituximab [anti-CD20+] and epratuzumab [anti-CD22]), lymphocyte proliferation inhibitors (belimumab [anti-BAFF]) or inhibition of costimulation (BG9588 [anti-CD40L] and abatacept [CTLA-4Ig]). In SS the agent that shows the most promise is rituximab though there are some studies with efalizumab, a monoclonal antibody directed against the LFA-1 (CD-11) molecule. Finally, in PSS there is development of monoclonal antibodies against TGFβ a cytokine implicated in the fibrotic reaction that is the result of this disease, as well as one trial that is employing abatacept. However, in this disease the most important advances are being seen with the use of agents such as endothelin inhibitors or tyrosin-kinases, which are not considered biologic therapies.

Key words:
Biologic therapies
Connectivopathy
Systemic lupus erythematosus
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Copyright © 2008. Elsevier España S.L. Barcelona
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