MD Program, Faculty of Medicine, University of Toronto, Toronto, Canada.
Division of Dermatology, University of Toronto, Toronto, Canada.
Br J Dermatol. 2018 Aug;179(2):290-295. doi: 10.1111/bjd.16485. Epub 2018 Jun 6.
Pyoderma gangrenosum (PG) is a neutrophilic dermatosis with substantial morbidity. There is no consensus on gold-standard treatments.
To review the effectiveness of systemic therapy for PG.
We searched six databases for 24 systemic therapies for PG. Primary outcomes were complete healing and clinical improvement; secondary outcomes were time to healing and adverse effects.
We found 3326 citations and 375 articles underwent full-text review; 41 studies met the inclusion criteria. There were 704 participants in 26 retrospective cohort studies, three prospective cohort studies, seven case series, one case-control study, two open-label trials and two randomized controlled trials (RCTs). Systemic corticosteroids were the most studied (32 studies), followed by ciclosporin (21 studies), biologics (16 studies) and oral dapsone (11 studies). One RCT (STOP-GAP, n = 121) showed that prednisolone and ciclosporin were similar: 15-20% of patients showed complete healing at 6 weeks and 47% at 6 months. Another RCT (n = 30) found that infliximab was superior to placebo at 2 weeks (46% vs. 6% response), with a 21% complete healing rate at 6 weeks. Two uncontrolled trials showed 60% and 37% healing within 4 months for canakinumab and infliximab, respectively; other data suggest that patients with concurrent inflammatory bowel disease may benefit from biologics. The remaining studies were poor quality and had small sample sizes but supported the use of corticosteroids, ciclosporin and biologics.
Systemic corticosteroids, ciclosporin, infliximab and canakinumab had the most evidence in treating PG. However, current literature is limited to small and lower-quality studies with substantial heterogeneity.
坏疽性脓皮病（PG）是一种中性粒细胞性皮肤病，发病率较高。目前尚无金标准治疗方法。
综述 PG 的系统治疗效果。
我们在 6 个数据库中检索了 24 种 PG 的系统治疗方法。主要结局是完全愈合和临床改善；次要结局是愈合时间和不良反应。
我们共检索到 3326 篇文献，并对 375 篇文章进行了全文审查；41 项研究符合纳入标准。26 项回顾性队列研究、3 项前瞻性队列研究、7 项病例系列研究、1 项病例对照研究、2 项开放标签试验和 2 项随机对照试验（RCT）共纳入 704 名参与者。最常研究的系统治疗药物是皮质类固醇（32 项研究），其次是环孢素（21 项研究）、生物制剂（16 项研究）和口服氨苯砜（11 项研究）。一项 RCT（STOP-GAP，n=121）显示，泼尼松龙和环孢素的疗效相似：6 周时分别有 15-20%和 47%的患者完全愈合，6 个月时分别有 47%和 74%的患者完全愈合。另一项 RCT（n=30）发现英夫利昔单抗在 2 周时优于安慰剂（46%比 6%的应答率），6 周时的完全愈合率为 21%。两项非对照试验显示，卡那单抗和英夫利昔单抗分别在 4 个月内的愈合率为 60%和 37%；其他数据表明，同时患有炎症性肠病的患者可能受益于生物制剂。其余研究质量较差，样本量较小，但支持使用皮质类固醇、环孢素和生物制剂。
皮质类固醇、环孢素、英夫利昔单抗和卡那单抗在治疗 PG 方面有最多的证据。然而，目前的文献仅限于小型和低质量的研究，存在较大的异质性。
