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在幼年皮肌炎中使用 Janus 激酶抑制剂治疗:文献综述。

Treatment with Janus kinase inhibitors in juvenile dermatomyositis: A review of the literature.

机构信息

Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey.

Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey.

出版信息

Semin Arthritis Rheum. 2024 Jun;66:152426. doi: 10.1016/j.semarthrit.2024.152426. Epub 2024 Mar 1.

Abstract

BACKGROUND/OBJECTIVES: Janus kinase (JAK) inhibitors have been increasingly used in the treatment of juvenile dermatomyositis (JDM). This review aims to comprehensively analyze previous studies concerning the utilization of JAK inhibitors in JDM patients.

METHODS

We conducted a thorough review of MEDLINE and Scopus databases, spanning from their inception to September 1st, 2023, to identify articles involving JDM patients treated with JAK inhibitors.

RESULTS

Our literature search yielded 26 articles that encompassed 195 patients with JDM who received JAK inhibitors. The median (min-max) age of the patients was 4.9 (1-17) years (F/M:1.2). The most frequently used JAK inhibitor was tofacitinib (57.4 %), and improvement was achieved in 89.7 % of patients treated with tofacitinib. The improvement rate for ruxolitinib, which was the second most frequently used JAK inhibitor (27.2 %), was 69.2 %. For baricitinib (15.4 %), the improvement rate was 92.7 %. The most prevalent indication for JAK inhibitor use was resistant/recurrent skin involvement (34.7 %) followed by resistant/recurrent muscle involvement (28.6 %). Adverse events were reported in 72.1 % of the patients; an increase in infections (especially upper respiratory tract infections) was the most common side effect.

CONCLUSION

Our findings suggest that JAK inhibitors may be a good therapeutic option, particularly in the management of refractory JDM cases with an acceptable safety profile. However, further controlled studies are essential to establish a higher level of evidence for the optimal use of JAK inhibitors in JDM treatment.

摘要

背景/目的:Janus 激酶(JAK)抑制剂在治疗幼年特发性皮肌炎(JDM)中的应用日益增多。本综述旨在全面分析 JAK 抑制剂在 JDM 患者中的应用相关的既往研究。

方法

我们对 MEDLINE 和 Scopus 数据库进行了全面检索,检索时间从建库至 2023 年 9 月 1 日,以确定涉及 JAK 抑制剂治疗 JDM 患者的文章。

结果

我们的文献检索共获得 26 篇文章,其中包括 195 例接受 JAK 抑制剂治疗的 JDM 患者。患者的中位(最小-最大)年龄为 4.9(1-17)岁(F/M:1.2)。最常使用的 JAK 抑制剂是托法替尼(57.4%),接受托法替尼治疗的患者中有 89.7%病情改善。第二种最常使用的 JAK 抑制剂鲁索替尼(27.2%)的改善率为 69.2%。巴瑞替尼(15.4%)的改善率为 92.7%。使用 JAK 抑制剂的最常见指征是难治性/复发性皮肤受累(34.7%),其次是难治性/复发性肌肉受累(28.6%)。72.1%的患者报告有不良反应;感染(尤其是上呼吸道感染)增加是最常见的副作用。

结论

我们的研究结果表明,JAK 抑制剂可能是一种很好的治疗选择,特别是在管理难治性 JDM 病例方面,且安全性可接受。然而,为了在 JDM 治疗中确定 JAK 抑制剂的最佳使用,需要进一步开展对照研究以提供更高水平的证据。

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