更新系统文献综述和荟萃分析，以告知意大利风湿病学会关于类风湿关节炎相关间质性肺疾病治疗的建议

IF 8.3 1区医学 Q1 IMMUNOLOGY

Autoimmunity reviews Pub Date : 2025-08-26 DOI:10.1016/j.autrev.2025.103922

A. Fassio , M. Sebastiani , F. Pollastri , F. Cozzini , C. Crotti , N. Ughi , E. De Lorenzis , S. Mancuso , M. Radin , G. Carrara , G. Landolfi , D. Rozza , A. Manfredi

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引用次数: 0

摘要

背景：类风湿性关节炎相关间质性肺疾病（RA- ild）是类风湿性关节炎（RA）的一种严重的关节外表现。尽管最近制定了指南，但意大利尚未制定专门针对RA-ILD的治疗建议。本系统文献综述（SLR）和荟萃分析旨在为意大利风湿病学会（SIR）提供RA-ILD管理的国家建议。方法：我们对从开始到2023年10月评估RA-ILD药物干预措施的研究进行了系统回顾和荟萃分析，随后更新到2025年4月，采用预先定义的方案。符合条件的研究包括随机对照试验、队列研究和报告肺功能结局、放射学进展、不良事件和死亡率的病例系列。进行了荟萃分析，并对异质性和发表偏倚进行了全面评估。结果纳入69项研究，共7879例RA-ILD患者。使用传统的合成疾病调节抗风湿药物（csDMARDs）、利妥昔单抗（RTX）、霉酚酸酯（MMF）、阿巴肽（ABA）和Janus激酶抑制剂（JAKi）治疗与用力肺活量（FVC）的稳定或改善相关。甲氨蝶呤（MTX）与ILD进展和死亡率降低相关。抗纤维化药物，特别是尼达尼布，表现出不同的疗效，而吡非尼酮的疗效有限。在严重不良事件方面，抗纤维化药物的安全性优于csDMARDs/免疫抑制剂。本SLR提供了关于RA-ILD治疗的最新综合证据，支持即将发布的SIR建议。尽管观察性研究存在固有的局限性和异质性，但数据强调了MTX的安全性，特别是支持ABA， RTX和nintedanib作为有希望的选择，同时强调需要进一步的高质量试验，特别是在RA-ILD中。

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Updated systematic literature review and meta-analysis to inform the Italian Society of Rheumatology Recommendations on the treatment of rheumatoid arthritis-associated interstitial lung disease

Background

rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a severe extra-articular manifestation of rheumatoid arthritis (RA). Despite recent guideline initiatives, no treatment recommendations specifically tailored to RA-ILD have been developed in Italy. This systematic literature review (SLR) and meta-analysis was conducted to inform the Italian Society of Rheumatology (SIR) national recommendations for the management of RA-ILD.

Methods

we conducted a systematic review and meta-analysis of studies evaluating pharmacological interventions for RA-ILD from inception up to October 2023, followed by an update up to April 2025, with a pre-defined protocol. Eligible studies included randomized controlled trials, cohort studies, and case series reporting pulmonary function outcomes, radiological progression, adverse events, and mortality. Meta-analyses were performed, and heterogeneity and publication bias were thoroughly assessed.

Results

sixty-nine studies encompassing 7879 RA-ILD patients were included. Treatments with conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs), rituximab (RTX), mycophenolate mofetil (MMF), abatacept (ABA), and Janus kinase inhibitors (JAKi) were associated with stabilization or improvement of forced vital capacity (FVC). Methotrexate (MTX) was associated with reduced risk of ILD progression and mortality. Antifibrotics, particularly nintedanib, demonstrated variable efficacy, while pirfenidone showed limited benefit. Safety profiles favored antifibrotics over csDMARDs/immunosuppressants regarding serious adverse events.

Conclusions

this SLR provides an updated synthesis of evidence on RA-ILD treatments, supporting the forthcoming SIR recommendations. Despite inherent limitations of observational studies and heterogeneity, the data highlight the safety of MTX and particularly support ABA, RTX, and nintedanib as promising options, while underscoring the need for further high-quality trials specifically in RA-ILD.

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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.