研究动态
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免疫检查点抑制剂诱发的风湿性多肌痛和巨细胞动脉炎:系统文献综述,强调与特发性形式的差异。

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

发表日期:2024 Aug 06
作者: Elvis Hysa, Andrea Casabella, Emanuele Gotelli, Rosanna Campitiello, Carlotta Schenone, Carlo Genova, Enrica Teresa Tanda, Alberto Sulli, Vanessa Smith, Marco Amedeo Cimmino, Sabrina Paolino, Maurizio Cutolo
来源: AUTOIMMUNITY REVIEWS

摘要:

免疫检查点抑制剂(ICIs)干扰的免疫耐受改变可能导致新发风湿性多肌痛(PMR)和巨细胞动脉炎(GCA)。这篇系统文献综述 (SLR) 检查了 ICI 抗癌治疗后 PMR 和 GCA 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,以提供它们是否与特发性形式不同的见解。SLR 在 Medline 上进行和 EMBASE 数据库(从成立到 2024 年 7 月)以及 EULAR/ACR 摘要数据库(2021-2023 年)。使用将两组作为比较对象的研究数据,将 ICI 诱发的 PMR 和 GCA 综合征与疾病的主要形式进行比较。对于缺乏直接比较的手稿,我们总结了主要发现,并通过对主要形式的系统评价或大型观察性研究讨论了差异。从 1237 篇筛选的摘要中,46 篇符合纳入标准,涉及 358 名患者(314 名患有 ICI-PMR,44 名患有 ICI-PMR)。 ICI-GCA)。 ICI-PMR 在 ICI 接受者中的估计汇总患病率为 0.1% [95% CI: 0.07%, 0.14%],在经历风湿免疫相关不良事件的患者中为 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 阻滞剂有关 (87%)。临床特征包括腰带炎性疼痛(100%),尽管在某些病例中骨盆带受累的报道较少(3/28 研究)。 35%的患者存在周围关节炎。实验室检查显示 26% 的病例炎症标志物正常或轻微升高。糖皮质激素 (GC) 使 84% 的病例症状改善,但 20% 的病例需要免疫抑制治疗,14% 的病例出现复发。 ICI-GCA在ICI接受者中的患病率为0.06%,性别分布相等,平均年龄为71±5岁。大多数患者接受了抗 PD1/PDL1 阻滞剂(57%)。临床表现包括头部症状(75%)、永久性视力丧失(23%)和与大血管受累相关的症状(54%)。高剂量 GC 是有效的,96% 的患者获得缓解,但 17% 的患者出现复发。与特发性形式相比,ICI 诱导的 PMR 和 GCA 可能具有不同的临床特征,可能具有更轻微的症状和更好的治疗反应。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结果和病理生理学。版权所有 © 2024。由 Elsevier B.V. 出版。
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.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.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.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.Copyright © 2024. Published by Elsevier B.V.