Multiple Sklerozda Monoklonal Antikorlar
Özet
Multiple sklerozis (MS),santral sinir sistemini tutan inflamatuar demyelinizan bir hastalıktır. MS’de hastalığın oluşumunda T ve B lenfosit aracılı otoimmün bir yanıt olduğuna inanılmaktadır. Son yıllarda hastalık aktivitesinin azaltan çok sayıda hastalık modifiye edici tedavi (DMT) ortaya çıkmıştır. Yüksek hastalık aktivitesi gösteren MS hastalarında DMT lere kıyasla etkinliği daha yüksek tedavi ajanlarına ihtiyaç vardır. Bu ilaçların büyük kısmını monoklonal antikor tedavileri oluşturmaktadır. B hücrelerinin MS patolojisinde aktif olarak rol alması,özellikle CD-20 olmak üzere B hücre spesifik yüzey antijenlerini hedef alarak B hücre sayısını azaltmaya yönelik monoklonal antikorların geliştirilmesine yol açmıştır. CD-20 monoklonal antikorlar,B hücrelerine seçici olarak bağlanmakta olup MS tedavisinde Amerika Birleşik Devletleri Gıda ve İlaç Dairesi (FDA) ve Avrupa İlaç Ajansı (EMA) tarafından onaylanmıştır. Başta okrelizumab olamak üzere rituksimab,ofatumumab ve ublituximab MS tedavisinde kullanılabilen CD-20 monoklonal antikorlardır. Diğer bir monoklonal antikor T ve B lenfosit hücre yüzeyinde bulunan CD-52 antijenine bağlanan Alemtuzumabdır. Ayrıca lenfosit hücrelerinde adezyon moleküllerine bağlanmayı sağlayan integrin denilen reseptörlere karşı geliştirilen Natalizumab gibi monoklonal antikorlar da geliştirilmiştir. Bu bölümde literatürde bulunan son çalışmalara uygun şekilde monoklonal antikorların MS tedavisinde klinik kullanımı,hastalık üzerine olan tedavi edici etkileri ve güvenilirlikleri detaylı bir şekilde incelenmiş ve değerlendirilmiş olup bu konuda literatüre katkı sağlanması amaçlanmıştır.
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