Feldman S R, Gottlieb A B, Bala M, Wu Y, Eisenberg D, Guzzo C, Li S, Dooley L T, Menter A
Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
Br J Dermatol. 2008 Sep;159(3):704-10. doi: 10.1111/j.1365-2133.2008.08727.x. Epub 2008 Jul 9.
Psoriasis affects patients both physically and psychologically.
To investigate the effect of comorbidities on health-related quality of life (HRQoL) and to determine whether infliximab improved HRQoL in the presence of these conditions.
In this multicentre, double-blind study, 835 patients with moderate-to-severe plaque psoriasis were randomized to receive infliximab 3 or 5 mg kg(-1) or placebo at weeks 0, 2 and 6. Infliximab-treated patients were re-randomized at week 14 to receive the same treatment every 8 weeks or as needed through week 46; placebo patients crossed over to infliximab 5 mg kg(-1) at week 16. Disease severity (Psoriasis Area and Severity Index, PASI) and HRQoL (Dermatology Life Quality Index, DLQI; 36-item Short-Form Health Survey, SF-36) were measured at various time points. The effect of patient comorbidities on baseline HRQoL was assessed using multiple regression models. The impact of key comorbidities on infliximab treatment effect was also assessed.
Disease severity (PASI), depression and psoriatic arthritis (PsA) were predictors of poor baseline HRQoL. At week 10, infliximab 3 and 5 mg kg(-1) significantly improved physical and mental health dimensions of the SF-36 and the DLQI (all P < 0.001). Consistent improvement in HRQoL with infliximab treatment was observed regardless of baseline patient characteristics or comorbidities. Through week 50, HRQoL and PASI scores were most improved with infliximab 5 mg kg(-1) administered every 8 weeks.
Disease severity, depression and PsA were significant predictors of poor HRQoL. Infliximab significantly improved HRQoL, regardless of these characteristics.
银屑病对患者的身体和心理均有影响。
研究合并症对健康相关生活质量（HRQoL）的影响，并确定在存在这些情况时英夫利昔单抗是否能改善HRQoL。
在这项多中心、双盲研究中，835例中度至重度斑块状银屑病患者被随机分为在第0、2和6周接受3或5mg/kg英夫利昔单抗或安慰剂治疗。接受英夫利昔单抗治疗的患者在第14周重新随机分组，每8周接受相同治疗或至第46周按需治疗；安慰剂组患者在第16周改用5mg/kg英夫利昔单抗治疗。在不同时间点测量疾病严重程度（银屑病面积和严重程度指数，PASI）和HRQoL（皮肤病生活质量指数，DLQI；36项简明健康调查问卷，SF-36）。使用多元回归模型评估患者合并症对基线HRQoL的影响。还评估了关键合并症对英夫利昔单抗治疗效果的影响。
疾病严重程度（PASI）、抑郁和银屑病关节炎（PsA）是基线HRQoL较差的预测因素。在第10周，3和5mg/kg英夫利昔单抗显著改善了SF-36和DLQI的生理和心理健康维度（所有P<0.001）。无论患者的基线特征或合并症如何，均观察到英夫利昔单抗治疗使HRQoL持续改善。至第50周，每8周给予5mg/kg英夫利昔单抗时，HRQoL和PASI评分改善最为明显。
疾病严重程度、抑郁和PsA是HRQoL较差的重要预测因素。无论这些特征如何，英夫利昔单抗均能显著改善HRQoL。
