目的:化脓性汗腺炎(HS)是一种具有挑战性的皮肤病,具有潜在的炎症过程。在过去的几年中,我们对HS的理解取得了重大进展,随着新型治疗方法的进步。目前的系统评价旨在评估Janus激酶(JAK)抑制剂和脾酪氨酸激酶(Syk)抑制剂治疗HS的安全性和有效性。
方法:在PubMed/Medline上进行了彻底的系统搜索,WebofScience,和OvidEmbase数据库截至9月23日,2023年。包括以英文发表的临床研究。
结果:我们的搜索产生了十篇文章,共165例接受四种JAK抑制剂治疗的患者(upadacitinib,波伏西替尼,托法替尼,和baricitinib)和一种Syk抑制剂(fostatatinib)。Upadacitinib,波伏西替尼,托法替尼改善了临床结果,在治疗期间,化脓性汗腺炎临床反应(HiSCR)以及脓肿和炎性结节计数(AN计数)显着降低。此外,这些药物在大多数HS患者中耐受性良好,不良事件(AE)发生率最低.此外,巴利替尼在一例病例报告中描述了HS的体征和症状的改善。此外,在中重度HS患者中,福司替尼在12周内表现出良好的耐受性.显著的临床改善,通过HiSCR和化脓性汗腺炎严重程度(IHS4)评估,与氟司他替尼给药后炎症的血清学指标密切相关。
结论:JAK和Syk抑制剂在控制中度至重度HS方面可能有效,因为促炎细胞因子是由JAK和Syk信号通路介导的。然而,为了评估此类药物的长期安全性和有效性,必须进行更严格的检查。
OBJECTIVE: Hidradenitis suppurativa (HS) is a challenging skin disease with an underlying inflammatory process. Substantial progress has been made in our understanding of HS over the last few years, with the advancement of novel treatment approaches. The current systematic
review aims to evaluate the safety and efficacy of Janus kinase (JAK) inhibitors and spleen tyrosine kinase (Syk) inhibitors in treating HS.
METHODS: A thorough systematic search was performed on PubMed/Medline, Web of Science, and Ovid Embase databases up to September 23th, 2023. Clinical studies published in English were included.
RESULTS: Our search yielded ten articles with a total of 165 patients treated with four types of JAK inhibitors (upadacitinib, povorcitinib, tofacitinib, and baricitinib) and one Syk inhibitor (fostamatinib). Upadacitinib, povorcitinib, and tofacitinib improved clinical outcomes, with a significant reduction in hidradenitis suppurativa clinical response (HiSCR) and abscess and inflammatory nodule count (AN count) during the treatment period. Also, these drugs are well tolerated in most HS patients with minimal adverse events (AEs). Moreover, baricitinib depicted an amelioration in signs and symptoms of HS in one case report. Also, fostamatinib exhibited favorable tolerability throughout a 12-week in moderate-to-severe HS patients. The remarkable clinical improvement, as assessed through HiSCR and hidradenitis suppurativa severity (IHS4), corresponded closely with serological indicators of inflammation following fostamatinib administration was achieved.
CONCLUSIONS: JAK and Syk inhibitors are potentially efficacious in managing moderate-to-severe HS since the proinflammatory cytokines are mediated by JAK and Syk signaling pathways. However, further research with a more rigorous examination is mandatory to evaluate such medication\'s long-term safety and efficacy.