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依奇珠单抗治疗银屑病:三项双盲对照研究(UNCOVER-1、UNCOVER-2、UNCOVER-3)的综合疗效分析。

Ixekizumab treatment for psoriasis: integrated efficacy analysis of three double-blinded, controlled studies (UNCOVER-1, UNCOVER-2, UNCOVER-3).

机构信息

K Papp Clinical Research and Probity Medical Research Inc., Waterloo, ON, Canada.

Saint Louis University, St Louis, MO, U.S.A.

出版信息

Br J Dermatol. 2018 Mar;178(3):674-681. doi: 10.1111/bjd.16050. Epub 2018 Feb 23.

DOI:10.1111/bjd.16050
PMID:28991370
Abstract

BACKGROUND

Ixekizumab, a high-affinity monoclonal antibody that selectively targets interleukin (IL)-17A, is approved for the treatment of moderate-to-severe psoriasis.

OBJECTIVES

This analysis represents an overview of the efficacy outcomes from three phase III psoriasis studies.

METHODS

Data were integrated from the 12-week induction period of three studies in which patients received ixekizumab 80 mg every 2 weeks (IXE Q2W; n = 1169) or every 4 weeks (IXE Q4W; n = 1165) after an initial 160-mg dose for both; etanercept (50 mg biweekly; n = 740; two studies) or placebo (n = 792). The coprimary end points were the percentages of patients with response of static Physician's Global Assessment (sPGA; score 0 or 1) and ≥ 75% improvement in baseline Psoriasis Area and Severity Index (PASI 75) at week 12. Response rates were compared between treatments using the Cochran-Mantel-Haenszel test stratified by study. Treatment comparisons with placebo included data from three studies, whereas etanercept comparisons were based on two studies.

RESULTS

Ixekizumab treatment was superior to placebo (P < 0·001) and etanercept (P < 0·001) on sPGA (0, 1) and PASI 75, with significant differences in PASI improvement at week 1. With IXE Q2W, at week 12, the frequencies of patients achieving PASI 75, 90 and 100 were nearly 90%, 70% and 40%, respectively. Ixekizumab-treated patients showed significantly greater improvement vs. placebo and etanercept in percentage body surface area involvement and fingernail psoriasis. IXE Q2W was superior to IXE Q4W on all treatment outcomes.

CONCLUSIONS

Ixekizumab therapy at both dosing regimens demonstrated rapid onset and superior efficacy to placebo and etanercept, with IXE Q2W providing better outcomes than IXE Q4W during the first 12 weeks of treatment.

摘要

背景

依奇珠单抗是一种高亲和力的单克隆抗体,能选择性地靶向白细胞介素(IL)-17A,已被批准用于治疗中重度银屑病。

目的

本分析概述了三项 III 期银屑病研究的疗效结果。

方法

数据来自三项研究的 12 周诱导期,患者在初始给予 160mg 剂量后,分别接受依奇珠单抗 80mg 每 2 周(IXE Q2W;n=1169)或每 4 周(IXE Q4W;n=1165)一次治疗,以及依那西普(50mg 每两周一次;n=740;两项研究)或安慰剂(n=792)治疗。主要疗效终点为第 12 周时静态医师总体评估(sPGA;评分 0 或 1)应答的患者比例和基线银屑病面积和严重程度指数(PASI 75)改善≥75%。采用 Cochran-Mantel-Haenszel 检验比较治疗组间的应答率,按研究分层。与安慰剂的治疗比较包括了三项研究的数据,而依那西普的比较则基于两项研究。

结果

与安慰剂(P<0.001)和依那西普(P<0.001)相比,依奇珠单抗治疗在 sPGA(0,1)和 PASI 75 上均有优势,第 1 周时 PASI 改善的差异有统计学意义。接受 IXE Q2W 治疗的患者在第 12 周时达到 PASI 75、90 和 100 的频率分别接近 90%、70%和 40%。与安慰剂和依那西普相比,接受依奇珠单抗治疗的患者在体表面积受累百分比和指甲银屑病方面有显著更大的改善。IXE Q2W 在所有治疗结局上均优于 IXE Q4W。

结论

两种给药方案的依奇珠单抗治疗均表现出快速起效和优于安慰剂和依那西普的疗效,在治疗的前 12 周内,IXE Q2W 比 IXE Q4W 提供了更好的结果。

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