Hanberg Jennifer S, Miloslavsky Eli M
Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Rheumatology Unit, Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Best Pract Res Clin Rheumatol. 2023 Mar;37(1):101843. doi: 10.1016/j.berh.2023.101843. Epub 2023 Jun 22.
Glucocorticoids are the cornerstone of therapy for all forms of vasculitis. However, glucocorticoid treatment carries with it the risk of glucocorticoid toxicity. Recent research efforts in vasculitis have emphasized investigation into strategies that reduce glucocorticoid exposure. These strategies include the adoption of rapid-acting steroid-sparing agents, reduced-dose glucocorticoid induction regimens, the early introduction of steroid-sparing agents for maintenance therapy, and the extension of maintenance therapy to minimize glucocorticoid exposure associated with disease relapse. These are critical advances to move us toward the goal of glucocorticoid-free treatment of vasculitis. The evidence supporting each of these strategies and directions for future research are explored.
糖皮质激素是治疗所有类型血管炎的基石。然而，糖皮质激素治疗伴随着糖皮质激素毒性风险。血管炎领域最近的研究工作重点是对减少糖皮质激素暴露策略的研究。这些策略包括采用速效激素节省剂、降低剂量的糖皮质激素诱导方案、早期引入激素节省剂进行维持治疗，以及延长维持治疗以尽量减少与疾病复发相关的糖皮质激素暴露。这些都是朝着血管炎无糖皮质激素治疗目标迈进的关键进展。本文探讨了支持这些策略的证据以及未来的研究方向。
