背景:糖皮质激素(GC)是风湿性多肌痛(PMR)治疗的基石,但它们的长期使用(通常是PMR患者所必需的)可引起许多不良事件.长期以来一直在寻求替代方案。我们的叙述回顾的主要目的是提供有关PMR患者使用抗肿瘤坏死因子α(TNF-α)药物的概述。并讨论优点和缺点。
方法:我们在PubMed和Medline(OVID接口)上进行了非系统文献检索(未遵循PRISMA方案)。
结论:仅两种抗TNF-α药物已被用于PMR患者:英夫利昔单抗62例,依那西普28例。当存在明显的合并症和/或复发性PMR时,这些药物通常用于GCs;不太常见,它们被用作一线治疗。总的来说,他们在PMR患者中几乎没有成功。的确,随机对照试验未证实病例报告和/或病例系列中报告的阳性结果.然而,与过去提出的不同的给药方案和研究设计可能有利于PMR患者的新方案.
BACKGROUND: Glucocorticoids (GCs) are the cornerstone of polymyalgia rheumatica (PMR) therapy, but their long-term use (as is usually necessary in PMR patients) can induce many adverse events. Alternatives have long been sought. The primary aim of our narrative review is to provide an overview about the use of anti-tumor necrosis factor alpha (TNF-α) drugs in patients with PMR, and discuss advantages and disadvantages.
METHODS: we performed a non-systematic literature search (PRISMA protocol not followed) on PubMed and Medline (OVID interface).
CONCLUSIONS: only two anti TNF-α drugs have been prescribed to PMR patients: infliximab in 62 patients and etanercept in 28 patients. These drugs were normally used in addition to GCs when significant comorbidities and/or relapsing PMR were present; less commonly, they were used as first-line therapy. In general, they have been scarcely successful in patients with PMR. Indeed, randomized controlled trials did not confirm the positive results reported in case reports and/or case series. However, an administration schedule and study design different from those proposed in the past could favour new scenarios in the interest of PMR patients.