Dermatology and Venereology, Graduate School of Tianjin Medical University, Tianjin, China.
Department of Dermatology, Tianjin Academy of Traditional Chinese Medicine of Affiliated Hospital, Tianjin, China.
J Dermatolog Treat. 2020 Nov;31(7):680-686. doi: 10.1080/09546634.2019.1610552. Epub 2019 Aug 2.
A growing number of studies have shown that thiazolidinediones (TZD) can be antipsoriatic. Pioglitazone is a representative of the class of antidiabetic drugs known as TZD. TZD can activate nuclear peroxisome proliferator-activated receptors (PPAR)-c. PPARs are expressed on epidermal keratinocytes and exert their effects by promoting the terminal differentiation of keratinocytes, inhibiting epidermal growth, and reducing inflammatory responses. These observations suggest that TZD have potential benefits in the treatment of cutaneous and metabolic pathologies associated with psoriasis. A systematic review and meta-analysis was carried out to evaluate the efficacy of combined pioglitazone treatment. We point out three controversial side effects from administration of pioglitazone in psoriasis: elevated liver enzymes, weight gain, and nausea. Randomized, single blind, or double blind, published studies of pioglitazone compared with placebo given to patients with plaque psoriasis for 10 weeks or 12 weeks were considered for inclusion in this review. The primary outcomes were 75% or greater improvement in the Psoriasis Area and Severity Index score from baseline (PASI 75) with pioglitazone. The systematic literature search was conducted in the PubMed, Embase, Google Scholar, and Cochrane databases from inception up to December 20 2018. Data analysis was done using Revman 5.3 Haymarket, London, United Kingdom. We included six studies (three publications of pioglitazone only; three publications of pioglitazone combination therapy) comprising a total of 294 patients ( = 149 with pioglitazone only and = 145 with pioglitazone combination therapy) in the analysis. There was a significant PASI 75 response, in the pioglitazone only subgroup as compared to placebo (OR = 8.74, 95% CI 3.76-20.31, < .00001), and the pioglitazone combination subgroup as compared to placebo (OR = 4.64, 95% CI 2.03-10.60, < .00001), others, the total of pioglitazone as compared to placebo (OR = 6.37, 95% CI 3.55-11.43, < .00001), and tests of subgroup differences show: = .29, I2 = 9.5%. The incidence rate of elevated liver enzymes (OR = 3.70, 95% CI 0.56-24.31, = .99), weight gain (OR = 1.44, 95% CI 0.60-3.47, = .41), and nausea (OR = 0.76, 95% CI 0.23-2.49, = .65) were not significantly different compared with the control group. Pioglitazone has efficacy for the treatment of plaque psoriasis. There is no significant difference between patients treated with pioglitazone only or in combination with other therapies. The incidence rate of side effects associated with pioglitazone treatment such as elevated liver enzymes, weight gain, and nausea were not significantly different compared with the control group.
越来越多的研究表明，噻唑烷二酮类（TZD）具有抗银屑病作用。吡格列酮是一种被称为 TZD 的抗糖尿病药物的代表。TZD 可以激活核过氧化物酶体增殖物激活受体（PPAR）-c。PPAR 存在于表皮角质形成细胞上，并通过促进角质形成细胞的终末分化、抑制表皮生长和减少炎症反应来发挥作用。这些观察结果表明，TZD 在治疗与银屑病相关的皮肤和代谢疾病方面具有潜在的益处。进行了一项系统评价和荟萃分析，以评估联合吡格列酮治疗的疗效。我们指出了吡格列酮治疗银屑病时存在的三个有争议的副作用：肝酶升高、体重增加和恶心。我们考虑了将随机、单盲或双盲、已发表的研究纳入本综述，这些研究将吡格列酮与安慰剂比较，用于治疗斑块状银屑病 10 周或 12 周。主要结局是吡格列酮治疗后从基线开始（PASI 75）的银屑病面积和严重程度指数评分改善 75%或以上。系统文献检索在 PubMed、Embase、Google Scholar 和 Cochrane 数据库中进行，检索时间截至 2018 年 12 月 20 日。数据分析使用 Revman 5.3 Haymarket，伦敦，英国。我们纳入了六项研究（吡格列酮的三项出版物；吡格列酮联合治疗的三项出版物），共 294 名患者（吡格列酮组 149 名，吡格列酮联合治疗组 145 名）纳入分析。与安慰剂相比，吡格列酮组的 PASI 75 应答显著（OR = 8.74，95%CI 3.76-20.31， <.00001），吡格列酮联合治疗组的 PASI 75 应答也显著（OR = 4.64，95%CI 2.03-10.60， <.00001），与安慰剂相比，吡格列酮的总体应答也显著（OR = 6.37，95%CI 3.55-11.43， < .00001），且亚组差异检验显示： = .29，I2 = 9.5%。与对照组相比，肝酶升高（OR = 3.70，95%CI 0.56-24.31， = .99）、体重增加（OR = 1.44，95%CI 0.60-3.47， =.41）和恶心（OR = 0.76，95%CI 0.23-2.49， =.65）的发生率无显著差异。吡格列酮对斑块状银屑病的治疗有效。与单独使用吡格列酮或联合其他疗法相比，其不良反应发生率（如肝酶升高、体重增加和恶心）无显著差异。
