非向的免疫抑制和免疫调节疗法用于异常性炎症性肌肉病变
Joost Raaphorst1, Nicola J Gullick2,3,4, Farhad Shokraneh5,6,7,8,9
1Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
The Cochrane database of systematic reviews
|August 11, 2025
概括
异形性炎症性肌肉病 (IIM) 治疗仍然是一个未满足的需求. 静脉注射免疫球蛋白 (IVIg) 可能会改善耐火IIM患者的残疾和肌肉强度,但对其他治疗方法的证据有限.
科学领域:
- 风湿病学和免疫学:专注于影响骨肌肉的自身免疫性疾病.
背景情况:
- 异形性炎症性肌肉病变 (IIM) 是一种具有显著发病率和死亡率的自身免疫性肌肉疾病.
- 目前对IIM的治疗方法代表了一个尚未满足的需求领域.
- 这次审查更新了以前的发现,并纳入了关于非向治疗的新数据.
研究的目的:
- 评估各种IIM亚型的非向免疫抑制剂和免疫调节治疗的益处和危害.
- 评估治疗对功能,肌肉力量,皮肤症状和不良事件的影响.
主要方法:
- 随机对照试验 (RCT) 和准RCT的系统审查和元分析.
- 搜索了多个数据库,包括Cochrane,MEDLINE和Embase,直到2023年2月.
- 使用Cochrane RoB 1工具评估偏差风险和使用GRADE的证据确定性.
主要成果:
- 静脉注射免疫球蛋白 (IVIg) 可能会改善耐火性IIM的残疾,肌肉强度和皮肤症状 (中度确定性证据).
- 有限的证据表明IVIg可能会增加严重不良事件,但撤销与安慰剂类似.
- 对阿扎西奥普林和甲索特酸的证据显示,在大多数IIM亚型中,除了青少年DM中的甲索特酸,疗效的确定性非常低 (低确定性证据).
结论:
- IVIg显示了对耐火性DM的潜在益处,改善了关键的临床结果.
- 目前对IIM中其他非向治疗的证据不足以确定疗效.
- 改善临床试验的进行,报告,和建立最小临床重要差异 (MCIDs) 是需要的IIM研究.
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