巨细胞动脉炎及其并发症的治疗现状。

IF 5.2 2区 医学 Q1 RHEUMATOLOGY
Current opinion in rheumatology Pub Date : 2024-09-01 Epub Date: 2024-06-26 DOI:10.1097/BOR.0000000000001029
Elena Galli, Francesco Muratore, Kenneth J Warrington
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引用次数: 0

摘要

综述的目的:本综述介绍了巨细胞动脉炎(GCA)目前治疗策略的最新进展,强调需要采用替代疗法来减少疾病复发并降低与糖皮质激素(GC)相关的发病率:最近的研究结果:GCA的标准治疗方法历来包括长期使用糖皮质激素,而最近的研究正在探索更快的糖皮质激素减量方案,以期在维持疾病控制的同时减少不良反应。随机临床试验强调了白细胞介素-6受体抑制剂托西珠单抗(TCZ)在减少疾病复发和节省 GCs 方面的疗效。然而,TCZ的最佳治疗时间尚不明确,患者在停止治疗后仍有复发的风险。对于不适合使用 TCZ 的患者以及对这种生物制剂反应不佳的患者来说,治疗需求仍未得到满足。因此,针对白细胞介素-17A、阻断 T 细胞活化或抑制 Janus 激酶-信号转导和激活转录途径等替代疗法的研究,为量身定制的治疗提供了潜在的途径。针对与 GCA 发病机制有关的不同途径正在进行的研究取得了令人鼓舞的成果。然而,由于这些研究结果尚属初步性质,因此有必要进行更大规模的随机对照试验,以最终确定其疗效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Current management of giant cell arteritis and its complications.

Purpose of review: This review provides an update on current management strategies for giant cell arteritis (GCA), emphasizing the need for alternative therapies to reduce disease relapses and mitigate glucocorticoid (GC)-related morbidity.

Recent findings: The standard of care for GCA has traditionally involved prolonged use of GC, and recent studies are exploring faster GC tapering regimens in an effort to reduce adverse effects while maintaining disease control. Randomized clinical trials have highlighted the efficacy of tocilizumab (TCZ), an interleukin-6 receptor inhibitor, in reducing disease flares and sparing GCs. However, the optimal treatment duration with TCZ is unknown and patients remain at risk of relapse after treatment discontinuation. An unmet therapeutic need persists for patients who are not candidates for TCZ, and for those who have inadequate response to this biologic. Therefore, investigations into alternative therapies such as targeting interleukin-17A, blocking T-cell activation or inhibiting the Janus kinase-signal transducer and activator of transcription pathway, showcase potential avenues for tailored treatments.

Summary: While GCs remain the cornerstone of therapy, TCZ emerges as a promising GC-sparing agent. Ongoing research targeting different pathways implicated in GCA pathogenesis have led to encouraging results. However, the preliminary nature of these findings necessitates larger randomized controlled trials to establish their efficacy conclusively.

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来源期刊
Current opinion in rheumatology
Current opinion in rheumatology 医学-风湿病学
CiteScore
9.70
自引率
2.00%
发文量
89
审稿时长
6-12 weeks
期刊介绍: A high impact review journal which boasts an international readership, Current Opinion in Rheumatology offers a broad-based perspective on the most recent and exciting developments within the field of rheumatology. Published bimonthly, each issue features insightful editorials and high quality invited reviews covering two or three key disciplines which include vasculitis syndromes, medical physiology and rheumatic diseases, crystal deposition diseases and rheumatoid arthritis. Each discipline introduces world renowned guest editors to ensure the journal is at the forefront of knowledge development and delivers balanced, expert assessments of advances from the previous year.
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