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原発性シーグレン症候群の治療:体系的なレビュー
Manuel Ramos-Casals1, Athanasios G Tzioufas, John H Stone
1Sjögren Syndrome Research Group (AGAUR), Josep Font Laboratory of Autoimmune Diseases, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, C/Villarroel, 170, 08036 Barcelona, Spain. mramos@clinic.ub.es
JAMA
|July 29, 2010
まとめ
主要なシェーグレン症候群の治療のための証拠に基づいたガイドラインは不足しています. ピロカルピンとセビメリンはシッカの症状に効果を示し,局所用サイクロスポリンは中等から重度の乾燥眼を助けます.
科学分野:
- 病理学・リウマチ学・免疫学について
- オフタルモロジック (眼科)
- 薬理学 薬理学とは
背景:
- プライマリ・ショーグレン症候群 (pSS) は,外分泌腺に影響を及ぼし,乾燥につながる慢性的な自己免疫疾患です.
- pSSの現在の治療法は,包括的なエビデンスに基づいたガイドラインが欠けている.
- pSSの症状,特にシッカ症状の管理は,依然として臨床的な課題です.
研究 の 目的:
- 主要性シーグレン症候群の薬物療法に関する証拠を体系的に検討し,要約する.
- ランダム化対照試験 (RCT) に基づく様々な局所および全身薬剤の有効性を評価する.
- pSS管理のための将来の治療ガイドラインの開発に情報を提供するために.
主な方法:
- 1986年1月から2010年4月まで,MEDLINEとEMBASEのデータベースの体系的な文献検索を行った.
- ランダム化対照試験 (RCT) が含まれており,プライマリー・シューグレン症候群の成人患者における局所および全身の薬物治療を評価した.
- シッカ症候群およびその他の関連するアウトカムに対する有効性を評価する試験に焦点を当てた.
主要な成果:
- 局所用オキュラー0.05%サイクロスポリンは,乾燥眼のパラメータの有意な改善を示しました.
- ピロカルピンとセビメリンは,プラセボと比較して,乾燥口と乾燥眼の両方の症状を改善する上で有意な有効性を示しました.
- 経口用プレドニゾン,ヒドロキシクロロキン,アザチオプリン,サイクロスポリンは,小規模な試験でシッカ症候群に限定的または有意な効果を示さなかった.
結論:
- ピロカルピンとセビメリンは,シッカの特徴の管理に有効である.
- 局所用サイクロスポリンは,pSSで中度から重度の乾燥眼に対する有益な治療オプションを提供します.
- 現在の証拠は,抗腫瘍死滅因子剤の有効性を支持していません; リトゥキシマブについては,より大きな試験が必要です.
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