Gallegos Cesia, Oikonomou Evangelos K, Grimshaw Alyssa, Gulati Mridu, Young Bryan D, Miller Edward J
Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, CT, USA.
Yale University School of Medicine, Department of Internal Medicine, New Haven, CT, USA.
Int J Cardiol Heart Vasc. 2021 Apr 29;34:100782. doi: 10.1016/j.ijcha.2021.100782. eCollection 2021 Jun.
The treatment of active cardiac sarcoidosis (CS) usually involves immunosuppressive therapy, with the goal of preventing inflammation-induced scar formation. In most cases, steroids remain the first-line treatment for CS. However, given the side effect profile of their long-term use, steroid-sparing therapies are increasingly used. There are no published randomized trials of steroid-sparing agents in CS. We sought to do a systematic review to evaluate the current published data on the use of non-steroidal treatments in the management of CS. We searched the Cochrane Library, Ovid Medline, Ovid Embase, PubMed, and Web of Science Core Collection databases from inception of database to August 2020 to identify the effectiveness of biological or synthetic disease-modifying antirheumatic agents (s- and bDMARDs). Secondary objectives include safety profile as well as the change in the average corticosteroid dose after treatment initiation. Twenty-three studies were ultimately selected for inclusion which included a total of 480 cases of CS treated with a range of both s- and bDMARDs. In all included studies, sDMARDs and bDMARDs were studied in combination with steroids or as second or higher-line treatments after therapeutic failure or intolerance to corticosteroid use. Methotrexate (MTX) and infliximab (IFX) were the most common synthetic and biologic DMARDs studied respectively, reported in about 35% of the studies reviewed. The use of steroid-sparing agents was associated with a reduction in the maintenance steroid dose used. In conclusion, steroids will remain as the cornerstone of anti-inflammatory management in patients with CS until trials on the use and safety profile of other immunosuppressive agents are completed and published.
活动性心脏结节病（CS）的治疗通常包括免疫抑制治疗，目的是预防炎症诱导的瘢痕形成。在大多数情况下，类固醇仍然是CS的一线治疗药物。然而，鉴于其长期使用的副作用，越来越多地使用类固醇节省疗法。目前尚无关于CS中类固醇节省药物的随机试验发表。我们试图进行一项系统评价，以评估目前已发表的关于使用非甾体治疗CS的数据。我们检索了Cochrane图书馆、Ovid Medline、Ovid Embase、PubMed和Web of Science核心合集数据库，从数据库建立之初至2020年8月，以确定生物或合成的改善病情抗风湿药（s-和bDMARDs）的有效性。次要目标包括安全性以及治疗开始后平均皮质类固醇剂量的变化。最终选择了23项研究纳入，其中包括总共480例接受一系列s-和bDMARDs治疗的CS病例。在所有纳入的研究中，sDMARDs和bDMARDs与类固醇联合使用，或在治疗失败或对皮质类固醇使用不耐受后作为二线或更高线治疗。甲氨蝶呤（MTX）和英夫利昔单抗（IFX）分别是研究最常见的合成和生物DMARDs，在约35%的综述研究中有所报道。使用类固醇节省药物与维持使用的类固醇剂量减少有关。总之，在关于其他免疫抑制剂的使用和安全性的试验完成并发表之前，类固醇仍将是CS患者抗炎治疗的基石。
