免疫调节剂
作为一种新型生物疗法,针对免疫/炎症过程的单克隆抗体已被运用于阿弗他溃疡的治疗。[51]O'Neill ID, Scully C. Biologics in oral medicine: principles of use and practical considerations. Oral Dis. 2012;18:525-536.http://onlinelibrary.wiley.com/doi/10.1111/j.1601-0825.2012.01919.x/fullhttp://www.ncbi.nlm.nih.gov/pubmed/22420757?tool=bestpractice.com[52]O'Neill ID, Scully C. Biologics in oral medicine: ulcerative disorders. Oral Dis. 2013;19:37-45.http://www.ncbi.nlm.nih.gov/pubmed/22471882?tool=bestpractice.com这些单克隆抗体包括肿瘤坏死因子-α(TNF-α) 拮抗剂,例如依那西普[53]Robinson ND, Guitart J. Recalcitrant, recurrent aphthous stomatitis treated with etanercept. Arch Dermatol. 2003;139:1259-1262.http://archderm.jamanetwork.com/article.aspx?articleid=479506http://www.ncbi.nlm.nih.gov/pubmed/14568829?tool=bestpractice.com和阿达木单抗。[54]Vujevich J, Zirwas M. Treatment of severe, recalcitrant, major aphthous stomatitis with adalimumab. Cutis. 2005;76:129-132.http://www.ncbi.nlm.nih.gov/pubmed/16209159?tool=bestpractice.com然而,这些药物用于 RAU 的治疗尚缺乏足够的证据支持,[55]O'Neill ID. Off-label use of biologicals in the management of inflammatory oral mucosal disease. J Oral Pathol Med. 2008;37:575-581.http://www.ncbi.nlm.nih.gov/pubmed/18764859?tool=bestpractice.com在使用时需特别谨慎。[56]Leao JC, Duarte A, Gueiros LA, et al. Severe oral epithelial dysplasia in a patient receiving adalimumab therapy. J Oral Pathol Med. 2005;34:447-448.http://www.ncbi.nlm.nih.gov/pubmed/16011616?tool=bestpractice.com此外,使用这些药物引发的不良反应越来越多地被报道,其中最著名的就是依法利珠单抗导致的进行性多灶性白质脑病 (PML)。 [57]Kuehn BM. Rare neurological condition linked to newer monoclonal antibody biologics. JAMA. 2009;301:1423-1424.http://www.ncbi.nlm.nih.gov/pubmed/19351930?tool=bestpractice.com因此,目前不建议对 RAU 患者使用这些药物。