Department of Rheumatology, Royal Free London NHS Trust, London, UK.
Department of Rheumatology, East Suffolk and North Essex Foundation Trust, Colchester, UK.
Expert Opin Emerg Drugs. 2024 Mar;29(1):5-17. doi: 10.1080/14728214.2024.2303093. Epub 2024 Jan 13.
GCA (giant cell arteritis) and PMR (polymyalgia rheumatica) are two overlapping inflammatory rheumatic conditions that are seen exclusively in older adults, sharing some common features. GCA is a clinical syndrome characterized by inflammation of the medium and large arteries, with both cranial and extracranial symptoms. PMR is a clinical syndrome characterized by stiffness in the neck, shoulder, and pelvic girdle muscles. Both are associated with constitutional symptoms.
In this review, we assess the established and upcoming treatments for GCA and PMR. We review the current treatment landscape, completed trials, and upcoming trials in these conditions, to identify new and promising therapies.
Early use of glucocorticoids (GC) remains integral to the immediate management of PMR and GCA but being aware of patient co-morbidities that may influence treatment toxicity is paramount. As such GC sparing agents are required in the treatment of PMR. Currently there are limited treatment options available for PMR and GCA, and significant unmet needs remain. Newer mechanisms of action, and hence therapeutic options being studied include CD4 T cell co-stimulation blockade, IL-17 inhibition, IL-12/23 inhibition, GM-CSF inhibition, IL-1β inhibition, TNF-α antagonist and Jak inhibition, among others, which will be discussed in this review.
巨细胞动脉炎（GCA）和多发性肌炎（PMR）是两种仅在老年人中发生的重叠性炎症性风湿性疾病，具有一些共同特征。GCA 是一种临床综合征，其特征为中等和大动脉炎症，伴有颅内外症状。PMR 是一种以颈部、肩部和骨盆带肌肉僵硬为特征的临床综合征。两者均伴有全身症状。
在这篇综述中，我们评估了 GCA 和 PMR 的既定和新兴治疗方法。我们回顾了这些疾病的当前治疗现状、已完成的试验和即将进行的试验，以确定新的、有前途的治疗方法。
糖皮质激素（GC）的早期使用仍然是 PMR 和 GCA 即刻治疗的重要组成部分，但要注意可能影响治疗毒性的患者合并症至关重要。因此，PMR 的治疗需要 GC 保留剂。目前，PMR 和 GCA 的治疗选择有限，仍存在显著的未满足需求。正在研究新的作用机制和治疗选择，包括 CD4 T 细胞共刺激阻断、IL-17 抑制、IL-12/23 抑制、GM-CSF 抑制、IL-1β 抑制、TNF-α 拮抗剂和 Jak 抑制等，本文将对此进行讨论。
