Prasse A, Bonella F, Müller-Ladner U, Witte T, Hunzelmann N, Distler J
Klinik für Pneumologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
Ruhrlandklinik, Klinik für Pneumologie, Universitätsmedizin Essen, Essen, Deutschland.
Z Rheumatol. 2020 Apr;79(3):294-303. doi: 10.1007/s00393-019-00724-y.
Systemic sclerosis (SSc) is a fibrosing autoimmune disease of the connective tissue. In addition to skin fibrosis, pulmonary involvement and interstitial lung disease (ILD) in particular are the most common and severe manifestations of SSc. The disease is associated with a substantial risk of morbidity and mortality, especially in progressive ILD. In the last 5 years new treatment concepts for SSc-ILD have been investigated in numerous clinical studies.
This review is based on a literature search in PubMed, focusing on the most relevant papers published up to the end of 2018 with the keywords "SSc" and "treatment".
The treatment of SSc-ILD has changed over the last few years due to the results of many clinical studies. The updated guidelines of the European League Against Rheumatism (EULAR) recommend the use of cyclophosphamide or hematopoietic stem cell transplantation. Data for a positive influence on SSc-ILD are also available for mycophenolate, tocilizumab and anabasum. Because of the pathophysiological similarities to idiopathic pulmonary fibrosis, the use of the antifibrotic agents nintedanib and pirfenidone is currently being investigated in randomized, multicenter clinical trials and could be a novel and promising therapeutic strategy.
Current drug studies may provide innovative therapeutic perspectives for SSc-ILD and could significantly improve the prognosis of affected patients in the future.
系统性硬化症(SSc)是一种结缔组织的纤维化自身免疫性疾病。除皮肤纤维化外,肺部受累尤其是间质性肺疾病(ILD)是SSc最常见和最严重的表现。该疾病与较高的发病和死亡风险相关,特别是在进行性ILD中。在过去5年中,针对SSc-ILD的新治疗理念已在众多临床研究中进行了调查。
本综述基于在PubMed上的文献检索,重点关注截至2018年底发表的最相关论文,关键词为“SSc”和“治疗”。
由于许多临床研究的结果,过去几年中SSc-ILD的治疗发生了变化。欧洲抗风湿病联盟(EULAR)的更新指南推荐使用环磷酰胺或造血干细胞移植。霉酚酸酯、托珠单抗和阿那巴生对SSc-ILD也有积极影响的数据。由于与特发性肺纤维化在病理生理学上有相似之处,目前正在随机、多中心临床试验中研究使用抗纤维化药物尼达尼布和吡非尼酮,这可能是一种新颖且有前景的治疗策略。
当前的药物研究可能为SSc-ILD提供创新的治疗前景,并可能在未来显著改善受影响患者的预后。