Berlin Institute of Health, Department of Dermatology, Venerology and Allergy, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.
J Eur Acad Dermatol Venereol. 2019 Jul;33(7):1249-1260. doi: 10.1111/jdv.15482. Epub 2019 May 2.
Twenty per cent of patients with plaque psoriasis also have psoriatic arthritis - a disease affecting joints and entheses. Different treatment options exist but currently no succinct systematic overview exists. A systematic review of approved systemic treatments for psoriatic arthritis was conducted. We systematically searched in three databases (last update September 2017). Data were extracted for ACR20/50, HAQ-DI, SF-36 and adverse/serious adverse events after 16-24 weeks. We assessed the quality of evidence using GRADE. Twenty trials were included. Three trials compared two active substances. Results for ACR20 were infliximab + methotrexate vs. methotrexate: RR 1.40 (95% CI 1.07-1.84) very low quality evidence; ixekizumab Q2W vs. adalimumab Q2W: RR 1.08 (95% CI 0.86-1.36) very low quality, leflunomide vs. methotrexate: RR 1.01, (95% CI 0.84-1.21) low quality. Eighteen drug vs. placebo comparisons were included. For ACR20/50, HAQ-DI and SF-36, the active treatment was efficacious and the quality of the evidence was mostly moderate to low (15 of 18 comparisons). The quality of evidence for (serious) adverse events was mostly low; differences were rare. In three placebo-controlled comparisons, leflunomide, MTX and sulfasalazine failed to show statistical superiority for ACR. Besides the established treatment of anti-TNF antibodies and ustekinumab for psoriatic arthritis, the newer treatment options of IL17 antibodies and apremilast are also effective for the treatment of psoriatic arthritis. Based on just one comparative trial and one drug each, the new class of anti-IL 17 antibodies appears to be equally effective as the group of anti-TNF antibodies; for apremilast, this is yet unclear.
20%的斑块型银屑病患者也患有银屑病关节炎——一种影响关节和附着点的疾病。有不同的治疗选择，但目前尚无简明的系统综述。我们对银屑病关节炎的批准系统治疗进行了系统评价。我们在三个数据库中系统地检索（最后更新时间为 2017 年 9 月）。提取了 ACR20/50、HAQ-DI、SF-36 和 16-24 周后不良/严重不良事件的数据。我们使用 GRADE 评估证据质量。纳入了 20 项试验。三项试验比较了两种活性物质。ACR20 的结果为英夫利昔单抗+甲氨蝶呤与甲氨蝶呤相比：RR 1.40（95%CI 1.07-1.84）极低质量证据；Ixekizumab Q2W 与阿达木单抗 Q2W 相比：RR 1.08（95%CI 0.86-1.36）极低质量，来氟米特与甲氨蝶呤相比：RR 1.01（95%CI 0.84-1.21）低质量。纳入了 18 项药物与安慰剂对照比较。对于 ACR20/50、HAQ-DI 和 SF-36，活性治疗有效，证据质量大多为中低（18 项比较中的 15 项）。（严重）不良事件证据的质量大多较低；差异罕见。在三项安慰剂对照比较中，来氟米特、MTX 和柳氮磺胺吡啶在 ACR 方面未能显示统计学优势。除了抗 TNF 抗体和乌司奴单抗的既定治疗方法外，IL17 抗体和阿普米司特等新型治疗选择也对银屑病关节炎有效。基于仅有一项比较试验和一种药物，新型抗 IL17 抗体似乎与抗 TNF 抗体同样有效；对于阿普米司特，目前尚不清楚。
