Low-Dose Sirolimus Immunoregulation Therapy in Patients with Active Rheumatoid Arthritis: A 24-Week Follow-Up of the...

Area of Science:

• Immunology
• Rheumatology
• Pharmacology

Background:

• Rheumatoid arthritis (RA) is characterized by insufficient regulatory T cells (Tregs), challenging traditional immunosuppressive therapies.
• Sirolimus, an mTOR inhibitor, promotes functional Treg growth.
• Investigating sirolimus as a targeted immunoregulation therapy for RA is warranted.

Purpose of the Study:

• To evaluate the efficacy of low-dose sirolimus combined with conventional immunosuppressants for RA treatment.
• To assess the impact of sirolimus on Treg levels and disease activity indicators.
• To determine the safety and tolerance profile of sirolimus immunoregulation therapy.

Main Methods:

• A nonblinded, parallel-group trial involving 62 RA patients.
• Patients received conventional therapy with or without low-dose sirolimus (0.5 mg on alternate days) for 24 weeks.
• Clinical manifestations and lymphocyte subsets were compared pre- and post-treatment.

Main Results:

• Sirolimus treatment significantly reduced RA disease activity indicators (DAS28, ESR, joint swelling/tenderness) (p < 0.001).
• Patients receiving sirolimus showed increased Treg levels compared to conventional therapy alone (p < 0.05).
• Sirolimus allowed for decreased use of other immunosuppressants without affecting blood counts or liver/renal function.

Conclusions:

• Low-dose sirolimus selectively upregulates Tregs in RA patients, partially replacing other immunosuppressants.
• Sirolimus immunoregulation therapy demonstrates efficacy and tolerability for RA treatment with minimal side effects.
• Further large-scale, long-term studies are needed to confirm these findings.