免疫检查点抑制剂诱发的多发性风湿痛和巨细胞动脉炎：系统性文献综述，强调与特发性的区别。

IF 9.2 1区医学 Q1 IMMUNOLOGY

Autoimmunity reviews Pub Date : 2024-07-01 DOI:10.1016/j.autrev.2024.103589

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引用次数: 0

摘要

导言：免疫检查点抑制剂（ICIs）扰乱的免疫耐受改变可能会导致新发多发性风湿痛（PMR）和巨细胞动脉炎（GCA）。本系统性文献综述（SLR）研究了使用 ICIs 抗癌治疗后的多发性风湿痛和巨细胞动脉炎样综合征的特征，总结了它们的人口统计学、临床和治疗相关特征，以深入了解它们是否有别于特发性综合征：方法：在 Medline 和 EMBASE 数据库（从开始到 2024 年 7 月）以及 EULAR/ACR 摘要数据库（2021-2023 年）中进行 SLR。将ICI诱发的PMR和GCA综合征与原发性疾病进行了比较，采用的数据来自将这两组疾病作为比较对象的研究。对于缺乏直接比较的稿件，我们总结了主要研究结果，并利用系统综述或有关原发性疾病的大型观察性研究讨论了两者之间的差异：从筛选出的 1237 篇摘要中，有 46 篇符合纳入标准，涉及 358 名患者（314 人使用 ICI-PMR，44 人使用 ICI-GCA）。据估计，ICI-PMR在ICI接受者中的总发病率为0.1% [95% CI：0.07%, 0.14%]，在发生风湿免疫相关不良事件的患者中的总发病率为15.9% [95% CI：12.6%, 19.9%]。ICI-PMR 患者的男女比例为 1.7:1，平均年龄为 71 ± 4 岁。大多数病例与PD1/PDL1受体阻滞剂有关（87%）。临床特征包括腰部炎症性疼痛（100%），但某些病例的骨盆腰部受累情况报告不足（3/28 项研究）。35%的患者出现外周关节炎。实验室检查显示，26%的病例炎症指标正常或轻微升高。糖皮质激素（GCs）使84%的病例症状得到改善，但20%的病例需要接受免疫抑制治疗，14%的病例复发。ICI-GCA在ICI受者中的发病率为0.06%，男女比例相当，平均年龄为（71±5）岁。大多数患者接受了抗PD1/PDL1阻断剂治疗（57%）。临床表现包括头颅症状（75%）、永久性视力丧失（23%）和大血管受累相关症状（54%）。大剂量GCs疗效显著，96%的患者病情得到缓解，但也有17%的患者复发：ICI诱发的PMR和GCA与特发性PMR和GCA相比，可能具有不同的临床特征，症状可能较轻，治疗反应较好。需要进一步的研究来证实这些发现，并更好地了解这些病症的长期疗效和病理生理学。

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Polymyalgia rheumatica and giant cell arteritis induced by immune checkpoint inhibitors: A systematic literature review highlighting differences from the idiopathic forms

Introduction

An altered immune tolerance disturbed by immune checkpoint inhibitors (ICIs) may contribute to new-onset polymyalgia rheumatica (PMR) and giant cell arteritis (GCA). This systematic literature review (SLR) examines the characteristics of PMR and GCA-like syndromes following anticancer treatment with ICIs, summarizing their demographic, clinical and treatment-related features to provide insights whether they differ from the idiopathic forms.

Methods

The SLR was conducted in Medline and EMBASE databases from inception to July 2024, and in the EULAR/ACR abstract database (2021−2023). ICI-induced PMR and GCA syndromes were compared to the primary forms of the diseases using data from studies that included both groups as comparators. For manuscripts lacking direct comparisons, we summarized the main findings and discussed the differences using systematic reviews or large observational studies on the primary forms.

Results

From 1237 screened abstracts, 46 met the inclusion criteria, involving 358 patients (314 with ICI-PMR and 44 with ICI-GCA). ICI-PMR had an estimated pooled prevalence of 0.1% [95% CI: 0.07%, 0.14%] among ICI recipients and 15.9% [95% CI: 12.6%, 19.9%] among patients experiencing rheumatic immune-related adverse events.

Patients with ICI-PMR had a male-to-female ratio of 1.7:1 and a mean age of 71 ± 4 years. Most cases were associated with PD1/PDL1 blockers (87%). Clinical features included inflammatory pain in the girdles (100%), though pelvic girdle involvement was under-reported in some cases (3/28 studies). Peripheral arthritis was present in 35% of patients. Laboratory tests showed normal or slightly elevated inflammatory markers in 26% of cases. Glucocorticoids (GCs) led to symptom improvement in 84% of cases although 20% required immunosuppressive treatment and 14% experienced relapses.

ICI-GCA had a prevalence of 0.06% among ICI recipients, with equal gender distribution and a mean age of 71 ± 5 years. Most patients received anti-PD1/PDL1 blockers (57%). Clinical manifestations included cephalic symptoms (75%), permanent visual loss (23%) and symptoms related to large-vessel involvement (54%). High-dose GCs were effective, with 96% achieving remission, though 17% experienced relapses.

Conclusions

ICI-induced PMR and GCA may have distinct clinical profiles compared to idiopathic forms, with potentially milder symptoms and better treatment responses. Further studies are needed to confirm these findings and better understand the long-term outcomes and pathophysiology of these conditions.

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来源期刊

Autoimmunity reviews 医学-免疫学

CiteScore

24.70

自引率

4.40%

发文量

164

审稿时长

21 days

期刊介绍： Autoimmunity Reviews is a publication that features up-to-date, structured reviews on various topics in the field of autoimmunity. These reviews are written by renowned experts and include demonstrative illustrations and tables. Each article will have a clear "take-home" message for readers. The selection of articles is primarily done by the Editors-in-Chief, based on recommendations from the international Editorial Board. The topics covered in the articles span all areas of autoimmunology, aiming to bridge the gap between basic and clinical sciences. In terms of content, the contributions in basic sciences delve into the pathophysiology and mechanisms of autoimmune disorders, as well as genomics and proteomics. On the other hand, clinical contributions focus on diseases related to autoimmunity, novel therapies, and clinical associations. Autoimmunity Reviews is internationally recognized, and its articles are indexed and abstracted in prestigious databases such as PubMed/Medline, Science Citation Index Expanded, Biosciences Information Services, and Chemical Abstracts.