Caravan Sahar, Lopez Christopher M, Yeh Jennifer E
Department of Dermatology, Stanford University School of Medicine, Redwood City, California.
JAMA Dermatol. 2024 Feb 1;160(2):210-217. doi: 10.1001/jamadermatol.2023.5418.
While several medications are known to induce dermatomyositis (DM), most existing studies are case reports or small case series from a single institution. There is also limited information on DM induced by immune checkpoint inhibitors, which are increasingly used in oncologic therapy.
To characterize causes and clinical presentation of drug-induced DM based on the current literature.
A systematic review was performed in PubMed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines, from inception to August 22, 2022. Articles meeting preestablished inclusion criteria (written in English and classified as original articles, case reports, literature reviews, and observation letters) were selected and data abstracted. Articles that met the scope of the review were also added from reference lists. When possible, study results were quantitatively combined.
In 134 studies (114 from the literature search and 20 additional studies pulled from reference lists) describing 165 cases, 88 patients (53.3%) were female, and the median (IQR) age was 61 (49-69) years. Among the cases of drug-induced DM, the most common associated medications were hydroxyurea (50 [30.3%]), immune checkpoint inhibitors (27 [16.4%]), statins (22 [13.3%]), penicillamine (10 [6.1%]), and tumor necrosis factor inhibitors (10 [6.1%]). Histopathologic testing, when undertaken, helped establish the diagnosis. There was a median (IQR) of 60 (21-288) days between drug initiation and drug-induced DM onset. History of cancer was reported in 85 cases (51.6%).
In this systematic review, drug-induced DM was associated with multiple types of medications, including chemotherapies and immunotherapies. It is essential that dermatologists promptly recognize and diagnose drug-induced DM so that they can guide management to minimize interruption of therapy when possible.
虽然已知有几种药物可诱发皮肌炎（DM），但大多数现有研究都是来自单一机构的病例报告或小型病例系列。关于免疫检查点抑制剂诱发的皮肌炎的信息也有限，而免疫检查点抑制剂在肿瘤治疗中的应用越来越广泛。
根据当前文献描述药物性皮肌炎的病因和临床表现。
根据系统评价和Meta分析的首选报告项目（PRISMA）报告指南，在PubMed中进行了一项系统评价，时间跨度从创刊到2022年8月22日。选择符合预先设定纳入标准（用英文撰写且分类为原创文章、病例报告、文献综述和观察信）的文章并提取数据。还从参考文献列表中添加了符合综述范围的文章。如有可能，对研究结果进行定量合并。
在描述165例病例的134项研究（114项来自文献检索，另外20项研究从参考文献列表中提取）中，88例患者（53.3%）为女性，年龄中位数（IQR）为61（49 - 69）岁。在药物性皮肌炎病例中，最常见的相关药物是羟基脲（50例[30.3%]）、免疫检查点抑制剂（27例[16.4%]）、他汀类药物（22例[13.3%]）、青霉胺（10例[6.1%]）和肿瘤坏死因子抑制剂（10例[6.1%]）。进行组织病理学检查有助于确诊。从开始用药到药物性皮肌炎发病的时间中位数（IQR）为60（21 - 288）天。85例（51.6%）报告有癌症病史。
在这项系统评价中，药物性皮肌炎与多种类型的药物有关，包括化疗药物和免疫治疗药物。皮肤科医生必须及时识别和诊断药物性皮肌炎，以便在可能的情况下指导管理，尽量减少治疗中断。
