ABSTRACT
Los tratamientos disponibles para la esclerosis sistémica (ES) tienen una efectividad limitada. Recientemente se ha propuesto el tratamiento con tocilizumab (TCZ), un fármaco biológico que inhibe la interleucina 6 (IL6). En este trabajo se realiza una revisión de la literatura para evaluar la eficacia y seguridad de TCZ en ES. Se han encontrado 52 artículos, de los que, tras su evaluación, se han seleccionado solo 10. En un ensayo clínico aleatorizado TCZ demostró una mejoría no significativa del grado de induración cutánea, mientras que en un estudio observacional los resultados fueron neutros. En dicho ensayo clínico, los parámetros funcionales respiratorios mostraron cierto grado de estabilización. El perfil de seguridad de TCZ es aceptable. La evidencia actual en cuanto al tratamiento de la ES con TCZ es muy limitada, aunque el fármaco podría tener un efecto beneficioso en la afectación cutánea. Se requieren nuevos ensayos clínicos para comprobar su utilidad en ES
The available treatments for systemic sclerosis (SS) have limited effectiveness. Treatment with tocilizumab (TCZ), a biological drug that inhibits interleukin 6 (IL-6), has recently been proposed. In this study, we conducted a literature review to assess the safety and efficacy of TCZ in SS. We found 52 articles, 10 of which we selected after evaluating the articles. In a randomised clinical trial, TCZ showed a nonsignificant improvement in the degree of skin induration, while another observational study showed neutral results. In this same clinical trial, the functional respiratory parameters showed a certain degree of stabilization. The safety profile of TCZ is acceptable; however, the current evidence regarding treatment of SS with TCZ is highly limited, although the drug could have a beneficial effect in skin disorder. New clinical trials are needed to determine the usefulness of TCZ in SS
Subject(s)
Humans , Scleroderma, Systemic/drug therapy , Antibodies, Monoclonal, Humanized/therapeutic use , Biological Therapy , Interleukin-6/antagonists & inhibitors , Treatment OutcomeABSTRACT
BACKGROUND AND OBJECTIVES: Recently published population-based cohort studies have shown a high prevalence of cardiovascular disease in Systemic Sclerosis (SSc) patients. The aim of this study is to compare three different methods to measure cardiovascular risk in patients with scleroderma. METHODS: Forty-three SSc patients were included. A prospective study was performed for evaluation of cardiovascular risk and subclinical atheromatosis using 3 non-invasive methods: cardiovascular risk tables, carotid Doppler ultrasonography and quantification of coronary calcium by computerized tomography (CT). RESULTS: The cardiovascular risk charts for the Spanish population did not identify patients at high cardiovascular risk. Framingham-REGICOR identified 13 intermediate-risk patients. Twenty-two patients (51.2%) had plaques on carotid ultrasonography. We performed a ROC curve to identify the best cutoff point for the quantification of coronary artery calcium (CACscore), the value of CACscoreâ¯>â¯28â¯AU (Agatston Units) had the highest sensitivity (73%) and specificity (81%) for the diagnosis of subclinical atheromatosis. In the multiple regression study, age and decreased HDL cholesterol levels were identified as independent factors for subclinical atherosclerotic disease. No disease-related factors were associated with increased subclinical arteriosclerosis. CONCLUSION: Carotid ultrasound and CACscore are useful for identifying subclinical atheromatosis in patients with SSc and are superior compared to risk charts used for general population. HDL cholesterol and age were independent factors for the presence of subclinical atherosclerotic disease. A carotid ultrasound or CT should be performed for early detection of subclinical atheromatosis if these factors are present.
Subject(s)
Calcium/metabolism , Cardiovascular Diseases/complications , Coronary Vessels/pathology , Scleroderma, Systemic/etiology , Ultrasonography/methods , Adult , Aged , Aged, 80 and over , Calcium/analysis , Female , Humans , Male , Middle Aged , Prospective Studies , Risk FactorsABSTRACT
The available treatments for systemic sclerosis (SS) have limited effectiveness. Treatment with tocilizumab (TCZ), a biological drug that inhibits interleukin 6 (IL-6), has recently been proposed. In this study, we conducted a literature review to assess the safety and efficacy of TCZ in SS. We found 52 articles, 10 of which we selected after evaluating the articles. In a randomised clinical trial, TCZ showed a nonsignificant improvement in the degree of skin induration, while another observational study showed neutral results. In this same clinical trial, the functional respiratory parameters showed a certain degree of stabilization. The safety profile of TCZ is acceptable; however, the current evidence regarding treatment of SS with TCZ is highly limited, although the drug could have a beneficial effect in skin disorder. New clinical trials are needed to determine the usefulness of TCZ in SS.
Subject(s)
Humans , Male , Middle Aged , Retroperitoneal Fibrosis/complications , Retroperitoneal Fibrosis/diagnosis , Hypergammaglobulinemia/complications , Hypergammaglobulinemia/diagnosis , Prednisone/therapeutic use , Retroperitoneal Fibrosis/physiopathology , Retroperitoneal Fibrosis , Biopsy, Needle , Mycophenolic Acid/therapeutic use , Positron-Emission Tomography/methods , Positron-Emission Tomography , Fluorodeoxyglucose F18/therapeutic useABSTRACT
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