National Institute of Arthritis Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA.
Expert Rev Clin Immunol. 2024 Jun;20(6):589-602. doi: 10.1080/1744666X.2024.2312819. Epub 2024 Feb 8.
Juvenile dermatomyositis (JDM) is a rare autoimmune disease most commonly with proximal weakness due to inflammation and characteristic skin rashes. Most patients have a chronic or polycyclic disease course on standard therapy so better treatments are needed. An interferon signature is well-established in key tissues of JDM. Janus kinase inhibitors (jakinibs), which can decrease IFN signaling, are therefore appealing as a targeted therapy.
Herein is a review of the growing literature on JDM patients in jakinibs, including specifics of their jakinib exposure, summary of efficacy, disease features, and characteristics of patients treated, and safety parameters.
The vast majority of refractory JDM patients respond to jakinib therapy, though they have varied features, doses, and previous/concurrent medications, and data is largely retrospective. Jakinibs are an exciting and promising treatment in JDM. Evaluation with larger prospective controlled studies is needed to answer remaining questions about jakinibs in JDM regarding dosing, which JDM patients to treat with jakinibs, potential biomarkers to use, and how best to monitor safety risks in JDM.
幼年特发性皮肌炎(JDM)是一种罕见的自身免疫性疾病,最常见的表现为炎症引起的近端肌无力和特征性皮疹。大多数患者在标准治疗下呈慢性或多周期性疾病过程,因此需要更好的治疗方法。干扰素特征在 JDM 的关键组织中已得到充分证实。因此,Janus 激酶抑制剂(jakinibs)作为一种靶向治疗具有吸引力,因为它们可以减少 IFN 信号传导。
本文综述了 jakinibs 在 JDM 患者中日益增多的文献,包括他们对 jakinib 的暴露情况、疗效总结、疾病特征以及接受治疗的患者特征和安全性参数的具体信息。
绝大多数难治性 JDM 患者对 jakinib 治疗有反应,但它们具有不同的特征、剂量和以前/同时使用的药物,而且数据主要是回顾性的。Jakinibs 是 JDM 中一种令人兴奋且有前途的治疗方法。需要进行更大规模的前瞻性对照研究,以回答关于 JDM 中 jakinibs 的剂量、用 jakinibs 治疗哪些 JDM 患者、潜在的生物标志物以及如何最好地监测 JDM 中的安全性风险等问题。