Lin Vincent W, Ringold Sarah, Devine Emily Beth
Arch Dermatol. 2012 Dec;148(12):1403-10. doi: 10.1001/2013.jamadermatol.238.
OBJECTIVE To compare the efficacy of ustekinumab with that of other biological agents using the Psoriasis Area and Severity Index (PASI) among adult patients with moderate to severe plaque psoriasis. DATA SOURCES We conducted a systematic search of the period January 31, 1992, to February 1, 2012, using MEDLINE (PubMed), Embase, the Cochrane Library, and clinicaltrials.gov. STUDY SELECTION We included randomized controlled trials of biological agents compared with placebo or other biological agents using the PASI in patients who had moderate to severe plaque psoriasis. DATA EXTRACTION Study data were extracted independently by 2 of us, with disagreement resolved by consensus. Data extracted included the size of the trial, follow-up period, age range of patients, disease duration, body surface area involvement, baseline PASI, PASI response, and previous treatment with biological agents. DATA SYNTHESIS A Bayesian network meta-analysis was performed by fitting 3 regression models: a fixed-effects model, a random-effects model, and a random-effects model with meta-regression coefficients. The random-effects model achieved the best fit for these data. In pairwise comparisons, ustekinumab use was associated with statistically significantly higher odds for achieving a 75% reduction in the PASI compared with adalimumab use (odds ratio [OR], 1.84; 95% credible interval [CrI], 1.01-3.54), alefacept use (OR, 10.38; CrI, 3.44-27.62), and etanercept use (OR, 2.07; 95% CrI, 1.42-3.06) but was associated with lower odds compared with infliximab use (OR, 0.36; 95% CrI, 0.14-0.82) . In the therapeutic class comparison, the interleukin-12/23 inhibitor had the highest odds for achieving a 75% reduction in the PASI compared with placebo (OR, 69.48; 95% CrI, 36.89-136.46), followed by tumor necrosis factor inhibitors (OR, 42.22; 95% CrI, 27.94-69.34) and the T-cell inhibitor (OR, 5.63; 95% CrI, 1.35-24.24). CONCLUSION For the treatment of moderate to severe plaque psoriasis, ustekinumab may be more efficacious than adalimumab, etanercept, and alefacept but not infliximab.
目的 使用银屑病面积和严重程度指数（PASI）比较优特克单抗与其他生物制剂在中度至重度斑块状银屑病成年患者中的疗效。 数据来源 我们使用MEDLINE（PubMed）、Embase、Cochrane图书馆和clinicaltrials.gov对1992年1月31日至2012年2月1日期间进行了系统检索。 研究选择 我们纳入了使用PASI比较生物制剂与安慰剂或其他生物制剂的随机对照试验，这些试验的患者为中度至重度斑块状银屑病患者。 数据提取 研究数据由我们两人独立提取，如有分歧通过协商解决。提取的数据包括试验规模、随访期、患者年龄范围、病程、体表面积受累情况、基线PASI、PASI反应以及既往生物制剂治疗情况。 数据合成 通过拟合3种回归模型进行贝叶斯网络荟萃分析：固定效应模型、随机效应模型和带有荟萃回归系数的随机效应模型。随机效应模型对这些数据的拟合效果最佳。在两两比较中，与使用阿达木单抗相比，使用优特克单抗实现PASI降低75%的几率在统计学上显著更高（优势比[OR]，1.84；95%可信区间[CrI]，1.01 - 3.54），与使用阿法赛特相比（OR，10.38；CrI，3.44 - 27.62），与使用依那西普相比（OR，2.07；95% CrI，1.42 - 3.06），但与使用英夫利昔单抗相比几率较低（OR，0.36；95% CrI，0.14 - 0.82）。在治疗类别比较中，与安慰剂相比，白细胞介素-12/23抑制剂实现PASI降低75%的几率最高（OR，69.48；95% CrI，36.89 - 136.46），其次是肿瘤坏死因子抑制剂（OR，42.22；95% CrI，27.94 - 69.34）和T细胞抑制剂（OR, 5.63；95% CrI，1.35 - 24.24）。 结论 对于中度至重度斑块状银屑病的治疗，优特克单抗可能比阿达木单抗、依那西普和阿法赛特更有效，但不比英夫利昔单抗有效。
