背景:全身免疫调节剂用于治疗中度至重度斑块状银屑病和银屑病关节炎。围手术期使用这些药物可能会增加手术部位感染(SSI)和并发症的风险。
目的:评估接受免疫调节药物(肿瘤坏死因子-α[TNF-α]抑制剂,白细胞介素[IL]12/23抑制剂,IL-17抑制剂,IL-23抑制剂,细胞毒性T淋巴细胞相关抗原4共刺激因子,磷酸二酯酶-4抑制剂,Janus激酶抑制剂,酪氨酸激酶2抑制剂,环孢菌素(CsA),和甲氨蝶呤[MTX])接受手术。
方法:我们搜索了MEDLINEPubMed数据库中慢性自身免疫性炎症性疾病患者接受手术免疫治疗的数据。
结果:我们检查了48项新的或以前未审查的研究;大多数是类风湿关节炎和炎症性肠病患者的回顾性研究。
结论:对于低风险程序,TNF-α抑制剂,IL-17抑制剂,IL-23抑制剂,ustekinumab,abatacept,MTX,CsA,和apremilast可以安全地继续。对于中高风险手术,MTX,CsA,apremilast,abatacept,IL-17抑制剂,IL-23抑制剂,和ustekinumab可能是安全的继续;然而,建议采取个案处理的方法。阿维A可以继续进行任何手术。没有足够的证据对托法替尼提出坚定的建议,upadacitinib,和Deucravitinib.
BACKGROUND: Systemic immunomodulatory agents are indicated in the treatment of moderate-to-severe plaque psoriasis and psoriatic arthritis. Perioperative use of these medications may increase the risk of surgical site infection (SSI) and complication.
OBJECTIVE: To evaluate the risk of SSI and complication in patients with chronic autoimmune inflammatory disease receiving immunomodulatory agents (tumor necrosis factor-alfa [TNF-α] inhibitors, interleukin [IL] 12/23 inhibitor, IL-17 inhibitors, IL-23 inhibitors, cytotoxic T-lymphocyte-associated antigen-4 costimulator, phosphodiesterase-4 inhibitor, Janus kinase inhibitors, tyrosine kinase 2 inhibitor,
cyclosporine (CsA), and methotrexate [MTX]) undergoing surgery.
METHODS: We performed a search of the MEDLINE PubMed database of patients with chronic autoimmune inflammatory disease on immune therapy undergoing surgery.
RESULTS: We examined 48 new or previously unreviewed studies; the majority were retrospective studies in patients with rheumatoid arthritis and inflammatory bowel disease.
CONCLUSIONS: For low-risk procedures, TNF-α inhibitors, IL-17 inhibitors, IL-23 inhibitors, ustekinumab, abatacept, MTX, CsA, and apremilast can safely be continued. For intermediate- and high-risk surgery, MTX, CsA, apremilast, abatacept, IL-17 inhibitors, IL-23 inhibitors, and ustekinumab are likely safe to continue; however, a case-by-case approach is advised. Acitretin can be continued for any surgery. There is insufficient evidence to make firm recommendations on tofacitinib, upadacitinib, and deucravacitinib.