J Clin Rheumatol. 2018 Jan;24(1):6-13. doi: 10.1097/RHU.0000000000000583.
The aim of this study was to systemically review the efficacy and safety of inhibitors of interleukin 6 (IL-6): clazakizumab, IL-12/23: ustekinumab, and IL-17A: secukinumab, brodalumab, and ixekizumab in psoriatic arthritis (PsA).
The literature search was conducted using MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science. We included randomized controlled trials that assessed the efficacy of IL inhibitors and reported American College of Rheumatology 20 response at 24 weeks. Meta-analysis was done using random-effects model utilizing the DerSimonian and Laird method. Quality assessment was done using RobotReviewer Cochrane Risk-of-Bias Assessment Tool. Heterogeneity was assessed with Q statistic and quantified with I. Publication bias was assessed with a funnel plot.
Eight studies including 2722 subjects demonstrate the efficacy of IL inhibitors clazakizumab, secukinumab, ixekizumab, brodalumab, and ustekinumab in the treatment of PsA. The American College of Rheumatology 20/50/70 risk ratios were 2.02 (95% confidence interval [CI], 1.65-2.47; P = 0.000), 2.95 (95% CI, 2.32-3.73; P = 0.00), and 5.14 (95% CI, 3.28-8.06; P = 0.00), respectively, in favor of treatment versus placebo. There was no evidence of significant heterogeneity between trials. Subgroup analysis showed efficacy in patients who were tumor necrosis factor naive, as well as tumor necrosis factor nonresponders or inadequate responders. The number of adverse events was higher in the treatment groups versus placebo, the majority were mild and did not require treatment adjustment (risk ratio, 1.17; 95% CI, 1.06-1.28; P = 0.001). There was no significant difference in drug withdrawals.
Our meta-analysis shows that the inhibitors of IL-6 (clazakizumab), IL-12/23 (ustekinumab), and IL-17A (secukinumab, brodalumab, ixekizumab) are efficacious and generally well tolerated when used to treat patients with PsA.
本研究旨在系统评价白细胞介素 6（IL-6）抑制剂：克拉izumab、IL-12/23：乌司奴单抗和 IL-17A：司库珠单抗、布罗达umab 和依奇珠单抗治疗银屑病关节炎（PsA）的疗效和安全性。
使用 MEDLINE、EMBASE、Cochrane 图书馆、Scopus 和 Web of Science 进行文献检索。我们纳入了评估 IL 抑制剂疗效并报告 24 周美国风湿病学会 20 反应的随机对照试验。使用随机效应模型和 DerSimonian 和 Laird 方法进行荟萃分析。使用 RobotReviewer Cochrane 偏倚风险评估工具进行质量评估。使用 Q 统计量评估异质性，并用量化 I 表示。使用漏斗图评估发表偏倚。
八项研究共纳入 2722 例受试者，证明了 IL-6 抑制剂克拉izumab、司库珠单抗、依奇珠单抗、布罗达umab 和乌司奴单抗在治疗 PsA 中的疗效。美国风湿病学会 20/50/70 风险比分别为 2.02（95%置信区间[CI]，1.65-2.47；P=0.000）、2.95（95%CI，2.32-3.73；P=0.00）和 5.14（95%CI，3.28-8.06；P=0.00），均有利于治疗组与安慰剂组相比。各试验之间无明显异质性。亚组分析显示，在肿瘤坏死因子初治患者以及肿瘤坏死因子无应答或应答不足的患者中，疗效显著。与安慰剂组相比，治疗组不良反应发生率较高，但多数为轻度，无需调整治疗（风险比，1.17；95%CI，1.06-1.28；P=0.001）。药物停药率无显著差异。
我们的荟萃分析表明，白细胞介素 6（克拉izumab）、白细胞介素 12/23（乌司奴单抗）和白细胞介素 17A（司库珠单抗、布罗达umab、依奇珠单抗）抑制剂在治疗银屑病关节炎患者时具有疗效，且通常耐受性良好。
