Ungprasert Patompong, Thongprayoon Charat, Davis John M
Department of Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Semin Arthritis Rheum. 2016 Feb;45(4):428-38. doi: 10.1016/j.semarthrit.2015.09.004. Epub 2015 Oct 3.
While the efficacy of biologic agents for the treatment of psoriatic arthritis (PsA) has been well demonstrated in randomized controlled trials (RCTs), the data on their relative efficacy is limited. This meta-analysis is aimed at assessing the comparative efficacy of these agents in patients who had persistently active disease despite traditional non-steroidal anti-inflammatory drugs (NSAIDs)/disease-modifying anti-rheumatic drugs (DMARDs), or who could not tolerate NSAIDs/DMARDs.
RCTs examining the efficacy of biologic agents in patients with PsA who experienced inadequate response or intolerance of traditional DMARDs or NSAIDs were identified. If more than one RCT were available for a given biologic agent, the pooled risk ratio (RR) and 95% confidence interval (CI) of attaining a 20% improvement according to American College of Rheumatology criteria (ACR20) response across trials were calculated. The pooled risk ratios for each biologic agent were then compared using the indirect comparison technique.
A total of 12 RCTs were identified and included in the data analyses. We found that patients who received older TNF inhibitors (etanercept, infliximab, adalimumab, and golimumab) had a statistically significantly higher chance of achieving ACR20 response compared with apremilast, ustekinumab, and certolizumab. The likelihood of achieving ACR20 response among secukinumab users (at the dose of 150 mg and 300 mg weekly) was also higher compared with apremilast, ustekinumab, and certolizumab, though the relative risk did not always reach statistical significance.
Our study demonstrates that patients with PsA who experience inadequate response or intolerance of traditional DMARDs or NSAIDs have a higher probability of achieving the ACR20 response with older TNF inhibitors and secukinumab.
虽然生物制剂治疗银屑病关节炎（PsA）的疗效在随机对照试验（RCT）中已得到充分证实，但其相对疗效的数据有限。本荟萃分析旨在评估这些药物在尽管使用传统非甾体抗炎药（NSAIDs）/改善病情抗风湿药（DMARDs）但疾病仍持续活动，或无法耐受NSAIDs/DMARDs的患者中的比较疗效。
确定了研究生物制剂在对传统DMARDs或NSAIDs反应不足或不耐受的PsA患者中的疗效的RCT。如果一种特定生物制剂有多项RCT，计算各试验中根据美国风湿病学会标准（ACR20）反应达到20%改善的合并风险比（RR）和95%置信区间（CI）。然后使用间接比较技术比较每种生物制剂 的合并风险比。
共确定12项RCT并纳入数据分析。我们发现，与阿普斯特、乌司奴单抗和赛妥珠单抗相比，接受旧的肿瘤坏死因子抑制剂（依那西普、英夫利昔单抗、阿达木单抗和戈利木单抗）的患者达到ACR20反应的几率在统计学上显著更高。与阿普斯特、乌司奴单抗和赛妥珠单抗相比，司库奇尤单抗使用者（每周150毫克和300毫克剂量）达到ACR20反应的可能性也更高，尽管相对风险并不总是达到统计学显著性。
我们的研究表明，对传统DMARDs或NSAIDs反应不足或不耐受的PsA患者使用旧的肿瘤坏死因子抑制剂和司库奇尤单抗达到ACR20反应的概率更高。
