How can new biologic IL-17A inhibitors benefit more patients? Experts say so.

Hope more biological agents into the medical insurance, let more patients benefit! Spinal arthritis (SPA) is a kind of chronic inflammatory rheumatism which mainly involves spine, joints, ligaments and tendons. Ankylosing spondylitis (as) is the most typical disease.according to statistics, the prevalence of as in China is 0.25% - 0.5% [1], about 3-6 million patients.with the increase of people's attention to their own health, more and more patients, especially young patients, hope to deepen their understanding of this disease. However, because as is a chronic disease and cannot be cured, many patients take a negative attitude towards the treatment of this disease.in view of this situation, the "medical community" media has the honor to invite Professor Leng Xiaomei from the Department of Rheumatology and immunology of Peking Union Medical College Hospital to take the time to participate in the online interview to answer the relevant questions of as diagnosis and treatment.interview video of Professor Leng Xiaomei 01: people with the following characteristics of early symptoms of as should seek medical treatment in time. As is a kind of disease mainly involving spine and joints, but in addition to joints, the disease may also be accompanied by other parts of the eye, gastrointestinal tract, cardiovascular and other parts.because of the occult onset and atypical early symptoms of as, many patients missed the best treatment opportunity, resulting in permanent irreversible damage, which seriously affected the quality of life of patients.therefore, early diagnosis and treatment are very important for as patients.Professor Leng Xiaomei pointed out that to understand as, we should first understand its three characteristics.first, AS is more common in young adults, and the incidence rate of male is higher than that of female, about 2 ~ 3:1. Second, at the early stage of onset of AS, patients mainly showed low back pain with unknown causes, mostly lumbosacral, and the pain was different from mechanical low back pain. AS was inflammatory low back pain. It was relieved after exercise and increased when resting. Third, AS onset was hidden, and early symptoms were not typical. If not intervened, it will cause permanent irreversible damage.according to statistics, 60% - 70% of as patients will form ligament osteophytes, and with the extension of the course of disease, the average number of ligament osteophytes gradually increases, resulting in the limitation of bone structure damage function [2].at present, the pathogenesis of as is not completely clear, but similar to most autoimmune or inflammatory diseases, the pathogenesis of as is a result of the interaction of genetics, environment and immune system. Br / >although there are some methods to predict the pathogenesis of as, it is not clear that there are some methods to predict the pathogenesis of as.for example, human leukocyte antigen (HLA) - B27 detection, previous studies have confirmed that the incidence of as is closely related to HLA-B27. The risk of as in patients with HLA-B27 positive is higher than that in patients with HLA-B27 negative. The positive rate of HLA-B27 in patients with as is as high as 90% in China [3].Professor Leng also pointed out that although HLA-B27 positive people have a higher incidence of as than HLA-B27 negative people, it does not mean that HLA-B27 positive people will definitely get as. HLA-B27 positive is not the gold standard for the diagnosis of as, and the specific situation needs to be comprehensively judged in combination with clinical practice.Professor Leng stressed that if there is a positive family history, unexplained low back pain, morning stiffness and other symptoms, and the HLA-B27 test is positive, people should go to the hospital in time for early diagnosis and treatment.02 traditional treatment can not fully meet the needs of patients. The world's first all human IL-17A inhibitor is on the stage. Currently, there is no radical cure method for as, but if patients can make timely diagnosis and reasonable treatment, the symptoms can be controlled and the prognosis can be improved.guidelines for the diagnosis and treatment of ankylosing spondylitis (2010) points out that the treatment objectives of as are as follows: ① relieve symptoms and signs - eliminate or minimize symptoms, such as back pain, morning stiffness and fatigue; ② functional recovery - maximize the recovery of physical functions, such as spinal range of motion, social activity / work ability; ③ Prevention of joint injury - prevent new bone formation, bone destruction, osteotonia and spinal deformation in patients with hip, shoulder, central axis and peripheral joints; prevent complications of spinal diseases - prevent spinal fracture, flexion contracture, especially the cervical spine; and improve the quality of life of patients. Professor Leng said that in the treatment of as, we should not only establish the awareness of achieving short-term goals, that is, to control symptoms and inflammation, but also to realize long-term goals, that is, to prevent joint deformity and ensure the functional status of patients. at present, the main treatment methods of as include non drug treatment, drug treatment and surgical treatment. drug therapy includes non steroidal anti-inflammatory drugs (NSAIDs), traditional synthetic anti rheumatic drugs (csdmards) and biological agents. 1. NSAIDs can control acute pain, morning stiffness and other symptoms of patients. Even a small number of patients can achieve the reduction of disease activity under the condition of using NSAIDs only. Some studies believe that NSAIDs can alleviate the formation of spinal osteophyte to a certain extent. 2. Csdmardscsdmads are effective only for as patients with peripheral joint involvement (such as knee, hip, ankle joint), and have poor curative effect on axial disease. At present, there is no evidence-based medical evidence that csdmards can alleviate the inflammation of axial joint. Biological agents: tumor necrosis factor inhibitor (tnfi) and interleukin-17 inhibitor (IL-17 inhibitor) are the most commonly used biological agents in as. Professor Leng pointed out that in recent years, tnfi has emerged in an endless stream, which has indeed improved the prognosis of most as patients, and even has revolutionary significance. however, it is worth noting that most studies believe that tnfi can alleviate as symptoms and reduce disease activity [4-6], but long-term observation shows that new ligament osteophytes will still form after treatment. at present, the new biological agents IL-17A inhibitors, such as the newly marketed sikuqiyoumab, can not only control the acute inflammation of as, but also reduce the formation of osteophytes of ligament. Previous studies have shown that after 2 years of treatment, 80% of as patients have no new osteophytes, and 80% of patients have no deterioration of spinal injury after 4 years of treatment [7-15]. at present, scuziumab has been approved for marketing in more than 80 countries and regions, including European Union countries and the United States [16]. It has been recommended as an ankylosing spondylitis treatment drug by several international authoritative guidelines such as the United States, Europe, France and the United Kingdom [16-23]. On April 23, 2020, it was approved for marketing in China for the treatment of as. 03 I hope more biological agents will be included in the medical insurance system to benefit more patients! Professor Leng said that the emergence of scuziumab is undoubtedly a great boon for patients with as, but such biological agents are expensive and affect the accessibility of patients. in order to make more patients can afford good medicine, we hope that our medical insurance system can play a greater role. as is a chronic disease, which needs long-term medication treatment, and the drug cost of patients is very heavy. at present, national and regional health institutions such as the United Kingdom [16], Italy [24], Finland [25], South Korea [26], Canada [27] and Taiwan [17] have included sikuqiumab in the reimbursement list. with the development of China's economy and the construction of the national medical security system, especially through the negotiation mechanism of medical insurance drugs, many good drugs for the treatment of patients' diseases have entered the medical insurance system, which greatly reduces the price of drugs and brings great benefits to patients. it is hoped that in the near future, the state will also consider including scuquizumab into the medical insurance, so that more patients have the opportunity to use good drugs and better improve the prognosis of patients. 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