Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venerology und Allergy, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Rheumatol Int. 2019 Apr;39(4):605-618. doi: 10.1007/s00296-019-04244-5. Epub 2019 Jan 25.
Psoriatic arthritis (PsA) is associated with progressive joint destruction and reduced quality of life. The time until a drug treatment starts to show an effect (TOA) is important for preventing joint destruction. The objective was to assess the time until onset of action of drugs when treating PsA. A systematic review of PsA drug trials was performed. Outcomes were: time until 25% of patients (TOA) reached (1) ≥ 20%, (2) ≥ 50% improvement in modified American College of Rheumatology response criteria (ACR), (3) ≥ 75% reduction in Psoriasis Area and Severity Index (PASI75). 95% confidence intervals were calculated extracting data from graphs using a novel method. Meta-analysis was conducted. Two head-to-head trials show no difference between ixekizumab and adalimumab or adalimumab and tofacitinib for TOA-ACR outcomes. For PASI75, ixekizumab had a faster onset than adalimumab. Infliximab plus MTX was faster than MTX alone. Pooled results from 32 study arms for TOA-ACR20 (week [95% CI]) are: < 2 weeks: infliximab (1.18 [0.72-1.65]), ixekizumab (1.04 [0.80-1.28]), tofacitinib (10 mg 1.56 [1.14-1.98]); ≤ 4 weeks: adalimumab (1.95 [1.35-2.55]), secukinumab (75 mg 1.89 [0.16-3.62], 150 mg 2.13 [1.34-2.91], 300 mg 2.26 [1.75-2.76]), tofacitinib (5 mg 2.20 [1.41-2.99]); 4 + weeks: apremilast, ustekinumab. For TOA-ACR50, all pooled point estimates are > 4 weeks. For TOA-PASI75, the range is between 2.24 [1.65-2.84] for ixekizumab and 6.03 [3.76-8.29] for adalimumab. Indirect, mixed comparison suggest a faster onset of infliximab, ixekizumab and tofacitinib compared to apremilast, methotrexate and ustekinumab for ACR20, not ACR50. For PASI75, ixekizumab is faster than adalimumab.
银屑病关节炎（PsA）与进行性关节破坏和生活质量下降有关。药物治疗开始产生效果的时间（TOA）对于预防关节破坏非常重要。本研究旨在评估治疗 PsA 时药物起效的时间。对 PsA 药物试验进行了系统评价。结果为：达到以下终点的时间：（1）患者比例达到 25%（TOA），（2）改良美国风湿病学会反应标准（ACR）≥20%改善，（3）银屑病面积和严重程度指数（PASI）≥75%改善。使用一种新方法从图表中提取数据计算 95%置信区间。进行了荟萃分析。两项头对头试验显示，依奇珠单抗与阿达木单抗或阿达木单抗与托法替尼在 TOA-ACR 结果方面没有差异。对于 PASI75，依奇珠单抗的起效速度快于阿达木单抗。英夫利昔单抗联合 MTX 比 MTX 单药起效更快。TOA-ACR20（周[95%CI]）的 32 项研究臂汇总结果为：<2 周：英夫利昔单抗（1.18[0.72-1.65]）、依奇珠单抗（1.04[0.80-1.28]）、托法替尼（10mg 1.56[1.14-1.98]）；≤4 周：阿达木单抗（1.95[1.35-2.55]）、司库奇尤单抗（75mg 1.89[0.16-3.62]，150mg 2.13[1.34-2.91]，300mg 2.26[1.75-2.76]）、托法替尼（5mg 2.20[1.41-2.99]）；4+周：阿普米司特、乌司奴单抗。对于 TOA-ACR50，所有汇总点估计值均>4 周。对于 TOA-PASI75，范围为依奇珠单抗的 2.24[1.65-2.84]至阿达木单抗的 6.03[3.76-8.29]。间接、混合比较表明，与阿普米司特、甲氨蝶呤和乌司奴单抗相比，英夫利昔单抗、依奇珠单抗和托法替尼在 ACR20 方面起效更快，而不是 ACR50。对于 PASI75，依奇珠单抗比阿达木单抗起效更快。
