Krulig Eliana, Gordon Kenneth B
NorthShore University HealthSystem, University of Chicago, Pritzker School of Medicine, Skokie, IL, USA.
Core Evid. 2010 Jul 27;5:11-22. doi: 10.2147/ce.s5994.
Psoriasis is a chronic inflammatory skin disease affecting approximately 2% to 3% of the population worldwide. Discoveries over the past 3 to 5 years have significantly altered our view of psoriasis as primarily a T-cell mediated condition. The most recent research has demonstrated the essential role of specific cytokines in the development of this complex disease, including TNF-alpha, interleukin-23 (IL-23), and potentially, IL-22. These are all part of a newly defined autoimmune pathway directed by specialized T cells called Th17 helper T cells. Ustekinumab is a fully human monoclonal antibody that targets IL-12 and IL-23, thus targeting both Th1 and Th17 arms of immunity. It has a promising efficacy and safety profile that not only represents a valuable treatment alternative, but also a continuation in our constantly evolving understanding of this disorder.
To review the emerging evidence supporting the use of ustekinumab in the management of moderate to severe plaque psoriasis.
There is clear evidence that ustekinumab is effective in the treatment of moderate to severe psoriasis. Phase III trials (PHOENIX 1 and 2) demonstrated a statistically significant difference between Psoriasis Area and Severity Index (PASI) 75 responses achieved by patients receiving ustekinumab, given as a 45 mg or 90 mg subcutaneous injection every 12 weeks, than their placebo counterparts. Treatment with this novel agent resulted in a rapid onset of action, with over 60% of treated patients attaining Physician's Global Assessment (PGA) scores of "cleared" or "minimal" by week 12. Quality of life assessments paralleled clinical improvements.
Ustekinumab is an effective and efficient therapeutic option for patients with moderate to severe psoriasis. Although further studies are required to establish ustekinumab's place in the therapy of psoriasis, with its convenient dosing schedule and rapid onset of action, this drug could provide a great addition to the current therapeutic armamentarium available for psoriatic patients.
银屑病是一种慢性炎症性皮肤病，全球约2%至3%的人口受其影响。过去3至5年的研究发现显著改变了我们对银屑病的看法，即银屑病主要是一种由T细胞介导的疾病。最新研究表明，特定细胞因子在这种复杂疾病的发展中起着至关重要的作用，包括肿瘤坏死因子-α（TNF-α）、白细胞介素-23（IL-23），以及可能的白细胞介素-22（IL-22）。这些都是由一种名为辅助性Th17 T细胞的特殊T细胞所引导的新定义自身免疫途径的一部分。优特克单抗是一种全人单克隆抗体，靶向IL-12和IL-23，从而针对免疫的Th1和Th17两条途径。它具有令人期待的疗效和安全性，不仅是一种有价值的治疗选择，也代表着我们对这种疾病不断发展的认识的延续。
综述支持优特克单抗用于治疗中度至重度斑块状银屑病的新证据。
有明确证据表明优特克单抗对治疗中度至重度银屑病有效。III期试验（PHOENIX 1和2）显示，接受优特克单抗治疗（每12周皮下注射45毫克或90毫克）的患者达到银屑病面积和严重程度指数（PASI）改善75%的比例与接受安慰剂的患者相比，在统计学上有显著差异。使用这种新药治疗起效迅速，超过60%的接受治疗患者在第12周时达到医生整体评估（PGA）“清除”或“轻微”评分。生活质量评估与临床改善情况相符。
优特克单抗对中度至重度银屑病患者是一种有效且高效的治疗选择。尽管需要进一步研究以确定优特克单抗在银屑病治疗中的地位，但因其给药方案方便且起效迅速，这种药物可为目前可供银屑病患者使用的治疗手段增添有力补充。
