From the Faculty of Medicine and Dentistry, and the Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
A. Mourad, BSc, Medical Student, University of Alberta Faculty of Medicine and Dentistry; R. Gniadecki, MD, PhD, DMSci, Professor, Divisional Director, Division of Dermatology, University of Alberta.
J Rheumatol. 2020 Jan;47(1):59-65. doi: 10.3899/jrheum.180797. Epub 2019 Mar 1.
Biologic agents with different mechanisms of action [inhibitors of tumor necrosis factor-α (TNF-α), interleukin (IL)-12/23, and IL-17] showed efficacy in randomized controlled trials (RCT) in the treatment of psoriatic arthritis. We conducted a pooled metaanalysis of these agents for treatment of dactylitis and enthesitis and compared results with the American College of Rheumatology 20 (ACR20) response and Health Assessment Questionnaire-Disability Index (HAQ-DI) scores.
A systematic literature search was performed and a pooled metaanalysis of RCT with anti-TNF-α (infliximab, golimumab, adalimumab), anti-IL-12/23 (ustekinumab), and anti-IL-17 (secu kinumab, ixekizumab) was conducted using the random-effects model. Bias was assessed using the Cochrane risk-of-bias tool.
Eighteen RCT were included in the pooled analysis (n = 6981). Both TNF-α inhibitors and novel biologics (ustekinumab, secukinumab, ixekizumab) demonstrated significant resolution of dactylitis at Week 24 with pooled risk ratios (RR) versus placebo of 2.57 (95% CI 1.36-4.84) and 1.88 (95% CI 1.33-2.65), respectively. For resolution of enthesitis at Week 24, RR for TNF-α inhibitors was 1.93 (95% CI 1.33-2.79) versus 1.95 (95% CI 1.60-2.38) for novel biologics. Both biologic categories showed overlapping ranges of ACR20 responses (TNF-α inhibitors: RR = 2.23, 95% CI 1.60-3.11; pooled IL-12/23 and -17: RR = 2.30, 95% CI 1.94-2.72) and similar quality of life improvement scores with mean HAQ-DI score changes of -0.29 (95% CI -0.39 to -0.19) and -0.26 (95% CI -0.31 to -0.22), respectively.
The pooled analysis demonstrated that anti-TNF-α agents have the same efficacy as novel agents (ustekinumab, secukinumab, and ixekizumab) in dactylitis and enthesitis.
具有不同作用机制的生物制剂（肿瘤坏死因子-α [TNF-α]抑制剂、白细胞介素 [IL]-12/23 和 IL-17）在治疗银屑病关节炎的随机对照试验（RCT）中显示出疗效。我们对这些药物治疗指（趾）炎和附着点炎进行了荟萃分析，并将结果与美国风湿病学会 20 项（ACR20）反应和健康评估问卷残疾指数（HAQ-DI）评分进行了比较。
进行了系统的文献检索，并对 TNF-α 抑制剂（英夫利昔单抗、戈利木单抗、阿达木单抗）、IL-12/23 抑制剂（乌司奴单抗）和 IL-17 抑制剂（司库奇尤单抗、依奇珠单抗）的 RCT 进行了荟萃分析，采用随机效应模型。使用 Cochrane 偏倚风险工具评估偏倚。
荟萃分析纳入了 18 项 RCT（n = 6981）。TNF-α 抑制剂和新型生物制剂（乌司奴单抗、司库奇尤单抗、依奇珠单抗）在第 24 周时均显著缓解了指（趾）炎，与安慰剂相比，风险比（RR）分别为 2.57（95%CI 1.36-4.84）和 1.88（95%CI 1.33-2.65）。对于第 24 周时附着点炎的缓解，TNF-α 抑制剂的 RR 为 1.93（95%CI 1.33-2.79），新型生物制剂的 RR 为 1.95（95%CI 1.60-2.38）。两种生物制剂类别在 ACR20 反应率（TNF-α 抑制剂：RR = 2.23，95%CI 1.60-3.11；新型 IL-12/23 和 -17：RR = 2.30，95%CI 1.94-2.72）和相似的生活质量改善评分方面存在重叠范围，平均 HAQ-DI 评分变化分别为 -0.29（95%CI -0.39 至 -0.19）和 -0.26（95%CI -0.31 至 -0.22）。
汇总分析表明，抗 TNF-α 药物在指（趾）炎和附着点炎方面与新型药物（乌司奴单抗、司库奇尤单抗和依奇珠单抗）具有相同的疗效。
