Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida.
J Am Acad Dermatol. 2024 Aug;91(2):251.e1-251.e11. doi: 10.1016/j.jaad.2024.03.008. Epub 2024 Mar 17.
Systemic immunomodulatory agents are indicated in the treatment of moderate-to-severe plaque psoriasis and psoriatic arthritis. Perioperative use of these medications may increase the risk of surgical site infection (SSI) and complication.
To evaluate the risk of SSI and complication in patients with chronic autoimmune inflammatory disease receiving immunomodulatory agents (tumor necrosis factor-alfa [TNF-α] inhibitors, interleukin [IL] 12/23 inhibitor, IL-17 inhibitors, IL-23 inhibitors, cytotoxic T-lymphocyte-associated antigen-4 costimulator, phosphodiesterase-4 inhibitor, Janus kinase inhibitors, tyrosine kinase 2 inhibitor, cyclosporine (CsA), and methotrexate [MTX]) undergoing surgery.
We performed a search of the MEDLINE PubMed database of patients with chronic autoimmune inflammatory disease on immune therapy undergoing surgery.
We examined 48 new or previously unreviewed studies; the majority were retrospective studies in patients with rheumatoid arthritis and inflammatory bowel disease.
For low-risk procedures, TNF-α inhibitors, IL-17 inhibitors, IL-23 inhibitors, ustekinumab, abatacept, MTX, CsA, and apremilast can safely be continued. For intermediate- and high-risk surgery, MTX, CsA, apremilast, abatacept, IL-17 inhibitors, IL-23 inhibitors, and ustekinumab are likely safe to continue; however, a case-by-case approach is advised. Acitretin can be continued for any surgery. There is insufficient evidence to make firm recommendations on tofacitinib, upadacitinib, and deucravacitinib.
系统性免疫调节剂用于治疗中重度斑块状银屑病和银屑病关节炎。这些药物的围手术期使用可能会增加手术部位感染（SSI）和并发症的风险。
评估接受免疫调节剂（肿瘤坏死因子-α[TNF-α]抑制剂、白细胞介素[IL]12/23 抑制剂、IL-17 抑制剂、IL-23 抑制剂、细胞毒性 T 淋巴细胞相关抗原 4 共刺激因子、磷酸二酯酶-4 抑制剂、Janus 激酶抑制剂、酪氨酸激酶 2 抑制剂、环孢素[CsA]和甲氨蝶呤[MTX]）治疗的慢性自身免疫性炎症性疾病患者发生 SSI 和并发症的风险。
我们对接受免疫治疗行手术的慢性自身免疫性炎症性疾病患者进行了 MEDLINE PubMed 数据库检索。
我们检查了 48 项新的或以前未审查的研究；其中大多数是类风湿关节炎和炎症性肠病患者的回顾性研究。
对于低风险手术，TNF-α 抑制剂、IL-17 抑制剂、IL-23 抑制剂、乌司奴单抗、阿巴西普、MTX、CsA 和阿普米司特可以安全继续使用。对于中高危手术，MTX、CsA、阿普米司特、阿巴西普、IL-17 抑制剂、IL-23 抑制剂和乌司奴单抗可能可以安全继续使用，但应根据具体情况进行处理。阿维 A 酯可用于任何手术。对于托法替布、巴瑞替尼和德瓦鲁单抗，尚无足够证据做出明确的推荐。
