环胺是否仍然是早期严重迅速进展的全身性硬化症的黄金标准?
Corrado Campochiaro1, Yannick Allanore2, Yolanda Braun-Moscovici3
1IRCCS San Raffaele Hospital, Unit of Immunology, Rheumatology, Allergy and Rare Diseases; Vita-Salute San Raffaele University, Milan, Italy.
Autoimmunity reviews
|September 10, 2023
概括
环胺 (CYC) 是严重系统性硬化症 (SSc) 和SSc-ILD的标准. 新的药物提供了更好的安全性,而CYC现在是第二或第三线治疗选择.
科学领域:
- 类风湿病学 类风湿病学
- 免疫学 免疫学 免疫学
- 肺部病理学 肺部病理学
背景情况:
- 环胺 (CYC) 是严重系统性硬化症 (SSc) 的黄金标准,特别是在间歇性肺病 (ILD) 中.
- 它的使用受到重大不良事件和对生活质量,生存率和死亡率的有限影响的限制.
- 最近的进展引入了替代性免疫抑制剂和生物药物,其安全性更好.
研究的目的:
- 重新评估CYC在管理严重SSc和SSc-ILD方面的作用.
- 讨论关于CYC在治疗算法中的地位的专家意见的转变.
- 突出在SSc管理中需要个性化医疗方法.
主要方法:
- 对干预性研究的审查,包括随机对照试验,重点是SSc-ILD.
- 分析后期数据,系统审查和评估CYC有效性的元分析.
- 考虑专家意见和最近关于SSc治疗策略的辩论.
主要成果:
- 在SSc患者中,CYC对生活质量,无事件存活率和死亡率具有有限的益处.
- 其他替代疗法,如mycophenolate mofetil,tocilizumab和rituximab,具有相似的疗效,但安全性更好.
- 专家的共识已经发生了转变,将CYC定位为第二线或第三线治疗.
结论:
- 由于安全问题和优质替代品的可用性,CYC作为严重SSc的药物的作用正在减少.
- 以全面的患者分层为指导的个性化医学是优化SSc治疗的未来方向.
- 目前的证据和专家意见支持使用较新的药物而不是CYC作为SSc和SSc-ILD的第一线治疗.
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