Janus 激酶抑制剂在皮肌炎中的应用:系统文献综述。

Use of Janus kinase inhibitors in dermatomyositis: a systematic literature review.

机构信息

Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Priovant Therapeutics, New York, NY, USA.

出版信息

Clin Exp Rheumatol. 2023 Mar;41(2):348-358. doi: 10.55563/clinexprheumatol/hxin6o. Epub 2022 Jun 28.

Abstract

Dermatomyositis (DM) is an idiopathic inflammatory myopathy that commonly manifests with proximal muscle weakness and is associated with extramuscular pathology, including characteristic skin lesions such as Gottron's papules and heliotrope rash, as well as lung, gastrointestinal, joint, and cardiac involvement. Systemic corticosteroids are a cornerstone of therapy, and more recently intravenous immunoglobulin (IVIG; OCTAGAM®) has been approved by the US Food and Drug Administration for the treatment of adults with DM. Both steroids and IVIG represent nonspecific anti-inflammatory therapy, and more targeted approaches are lacking. Transcriptomics has identified upregulation of interferon (IFN)-regulated genes as key features of both adult DM and juvenile DM (JDM). Accordingly, blocking IFN signalling through inhibition of the Janus kinase (JAK) pathway represents a potential treatment option for DM. Placebo-controlled trial data assessing the use of JAK inhibitors for the treatment of DM are limited; as such, a systematic literature review was undertaken to assess the evidence of JAK inhibitors in the treatment of patients with DM. Terms related to DM and JAK inhibitors were searched using PubMed, Embase, Web of Science, Scopus, and Dimensions to identify peer-reviewed publications reporting patients with DM who were treated with a JAK inhibitor. Baseline demographics, clinical characteristics, and treatment outcome data were extracted. A total of 48 publications reporting 145 unique patients (adult DM, n=84; JDM, n=61) were identified. Among cases of adult DM, 61 of 84 (73%) had refractory skin disease at baseline, and all (61 of 61) reported improvement in cutaneous symptoms. Of patients with adult DM, 16 of 84 (19%) had refractory muscle disease at baseline, and all (16 of 16) reported improvement in muscle symptoms. In patients with adult DM complicated by interstitial lung disease (ILD; n=33), 31 (94%) patients improved with JAK inhibitor treatment. Among cases of JDM with refractory skin disease at baseline (60 of 61), most patients (57 of 60; 95%) showed improvements in skin symptoms after JAK inhibitor treatment. Of patients with JDM with refractory muscle disease at baseline (36 of 61), most (30 of 36; 83%) reported improvement in muscle symptoms. Four patients with JDM and ILD experienced improvement in lung disease activity following treatment with a JAK inhibitor. Among both DM and JDM cases, all patients (17 with DM and 16 with JDM) who had elevated serum IFN and/or IFN-stimulated gene expression at baseline showed reduction in IFN or IFN gene expression. Although the conclusions that can be drawn from this analysis are limited because of the differences in assessments used across publications, overall treatment of patients with DM or JDM with a JAK inhibitor was associated with significant improvement of a wide range of DM manifestations, including skin lesions, muscle weakness, and ILD. Our systematic literature review suggests that JAK inhibitors may be a viable treatment option for DM/JDM, and randomised controlled trials are necessary to confirm these findings.

摘要

皮肌炎(DM)是一种特发性炎症性肌病,通常表现为近端肌无力,并伴有肌肉外病理学,包括特征性皮肤损伤,如 Gottron 丘疹和向阳疹,以及肺、胃肠道、关节和心脏受累。系统性皮质类固醇是治疗的基石,最近美国食品和药物管理局已批准静脉注射免疫球蛋白(IVIG;OCTAGAM®)用于治疗成人 DM。皮质类固醇和 IVIG 均代表非特异性抗炎治疗,缺乏更具针对性的方法。转录组学已确定干扰素(IFN)调节基因的上调是成人 DM 和青少年 DM(JDM)的关键特征。因此,通过抑制 Janus 激酶(JAK)通路抑制 IFN 信号传导代表了 DM 的一种潜在治疗选择。评估 JAK 抑制剂治疗 DM 的安慰剂对照试验数据有限;因此,进行了系统文献综述,以评估 JAK 抑制剂在治疗 DM 患者中的证据。使用 PubMed、Embase、Web of Science、Scopus 和 Dimensions 搜索与 DM 和 JAK 抑制剂相关的术语,以确定报告接受 JAK 抑制剂治疗的 DM 患者的同行评审出版物。提取基线人口统计学、临床特征和治疗结果数据。确定了 48 篇报告了 145 例(成人 DM,n=84;JDM,n=61)独特患者的出版物。在成人 DM 病例中,84 例中有 61 例(73%)基线时有难治性皮肤疾病,所有(61 例中的 61 例)报告皮肤症状改善。在成人 DM 患者中,16 例(84 例中的 19%)基线时有难治性肌肉疾病,所有(16 例中的 16 例)报告肌肉症状改善。在伴有间质性肺病(ILD;n=33)的成人 DM 患者中,31 例(94%)患者接受 JAK 抑制剂治疗后病情改善。在基线时患有难治性皮肤疾病的 JDM 病例中(61 例中的 60 例),大多数患者(60 例中的 57 例;95%)在接受 JAK 抑制剂治疗后皮肤症状改善。在基线时有难治性肌肉疾病的 JDM 患者中(61 例中的 36 例),大多数(36 例中的 30 例;83%)报告肌肉症状改善。4 例 JDM 和 ILD 患者在接受 JAK 抑制剂治疗后肺部疾病活动度改善。在 DM 和 JDM 病例中,所有基线时血清 IFN 和/或 IFN 刺激基因表达升高的患者(17 例 DM 和 16 例 JDM)的 IFN 或 IFN 基因表达均减少。尽管由于出版物中使用的评估方法不同,从这项分析中得出的结论有限,但 DM 或 JDM 患者使用 JAK 抑制剂治疗与广泛的 DM 表现(包括皮肤损伤、肌肉无力和 ILD)的显著改善相关。我们的系统文献综述表明,JAK 抑制剂可能是 DM/JDM 的一种可行治疗选择,需要进行随机对照试验来证实这些发现。

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