Department of Biomedicine, Aarhus University, Aarhus, Denmark; Department of Neurology, Sygehus Lillebælt, Kolding, Denmark.
Department of Medicine Solna, Karolinska Institutet, Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden.
Biomed Pharmacother. 2022 Apr;148:112687. doi: 10.1016/j.biopha.2022.112687. Epub 2022 Feb 25.
Immune checkpoint inhibitor-induced inflammatory arthritis (ICI-IA) is a relatively new disease entity caused by ICI agents during cancer therapy. Reactive arthritis (ReA) is a well-known disease entity caused by urogenital or gastrointestinal bacterial infection or pneumonia. In this sense, ICI-IA and ReA are both defined by a reaction to a well-specified causal event. As a result, comparing these diseases may help to determine therapeutic strategies.
We compared ICI-IA and ReA with special focus on pharmacological management. Specifically regarding treatment, we conducted a literature search of studies published in the PubMed database. Inclusion criteria were studies on treatment with non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (GC), or disease modifying antirheumatic drugs (DMARDs) in ICI-IA or ReA. During systematic selection, 21 studies evaluating ICI-IA and 14 studies evaluating ReA were included.
In ICI-IA, prospective and retrospective studies have shown effects of non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoid (GC), sulfasalazine (SSZ), methotrexate (MTX), hydroxychloroquine (HCQ) and TNFi. In ReA, retrospective studies evaluated NSAIDs and GC. A randomized controlled trial reported the effect of SSZ, and a retrospective study reported the effect of MTX and SSZ in combination with tumor necrosis factor alpha inhibition (TNFi). For both entities, small case reports show treatment effects of interleukin 6 receptor inhibition (IL-6Ri).
This literature review identified both similarities and differences regarding the pathogenesis and clinical features of ReA and ICI-IA. Studies on treatment reported effectiveness of NSAIDs, GC, MTX, SSZ and TNFi in both diseases. Further, small case reports showed effects of IL-6Ri.
免疫检查点抑制剂诱导的炎症性关节炎（ICI-IA）是一种相对较新的疾病实体，由癌症治疗期间的ICI 药物引起。反应性关节炎（ReA）是一种由泌尿生殖或胃肠道细菌感染或肺炎引起的已知疾病实体。从这个意义上说，ICI-IA 和 ReA 都是由对特定病因事件的反应定义的。因此，比较这些疾病可能有助于确定治疗策略。
我们比较了 ICI-IA 和 ReA，特别关注药物治疗。具体来说，在治疗方面，我们对发表在 PubMed 数据库中的研究进行了文献检索。纳入标准为关于 ICI-IA 或 ReA 中使用非甾体抗炎药（NSAIDs）、糖皮质激素（GC）或改善病情的抗风湿药（DMARDs）治疗的研究。在系统选择过程中，纳入了 21 项评估 ICI-IA 的研究和 14 项评估 ReA 的研究。
在 ICI-IA 中，前瞻性和回顾性研究表明 NSAIDs、GC、柳氮磺胺吡啶（SSZ）、甲氨蝶呤（MTX）、羟氯喹（HCQ）和 TNFi 有效。在 ReA 中，回顾性研究评估了 NSAIDs 和 GC。一项随机对照试验报告了 SSZ 的疗效，一项回顾性研究报告了 MTX 和 SSZ 联合肿瘤坏死因子-α 抑制（TNFi）的疗效。对于这两种疾病，小病例报告显示白细胞介素 6 受体抑制（IL-6Ri）的治疗效果。
本文献综述确定了 ReA 和 ICI-IA 的发病机制和临床特征既有相似之处，也有不同之处。关于治疗的研究报告了 NSAIDs、GC、MTX、SSZ 和 TNFi 在这两种疾病中的疗效。此外，小病例报告显示了 IL-6Ri 的疗效。
