Husson B, Barbe C, Hegazy S, Seneschal J, Aubin F, Mahé E, Jullien D, Sbidian E, D'Incan M, Conrad C, Brenaut E, Girard C, Richard M A, Bachelez H, Viguier M
Dermatology Department, Hôpital Robert-Debré, Reims, France.
Clinical Research Unit, Hôpital Robert-Debré, Reims, France.
J Eur Acad Dermatol Venereol. 2020 Oct;34(10):2330-2338. doi: 10.1111/jdv.16265. Epub 2020 Mar 30.
Palmoplantar pustulosis (PPP) and acrodermatitis continua of Hallopeau (ACH) are rare variants of psoriasis. Knowledge of the efficacy of biologics is scarce.
To evaluate the real-life efficacy of tumour necrosis factor blockers and ustekinumab in PPP and in ACH.
A multicentre retrospective descriptive study was conducted in 19 dermatology departments, including all patients with PPP or ACH seen from 2014 to 2016 who received one of the studied biologics. The data were collected by a standardized document. Factors associated with complete clearance (CC) were analysed by multivariate analysis, estimating odds ratios (ORs) and 95% confidence intervals (CIs).
Among 92 patients included, 50 received adalimumab, 44 ustekinumab, 36 etanercept and 31 infliximab. Improvement and CC were observed in 83.9% and 20.0% patients receiving infliximab, 75.0% and 38.6% ustekinumab, 57.1% and 20.0% etanercept and 60.4% and 29.2% adalimumab. We found no significant difference in CC rates or duration of treatment among the biological treatments (P = 0.18 and P = 0.10, respectively). On multivariate analysis, CC with etanercept was associated with the ACH form and not smoking [OR = 9.5 (95% CI 1.1-82.7), P = 0.04 and 0.1 (0.01-0.9), P = 0.04]; with ustekinumab, male sex and absence of obesity [6.0 (1.3-28.6), P = 0.02 and 4.7 (1.0-22.7), P = 0.05]; with adalimumab, the ACH form [11.9 (2.7-52.3), P = 0.001]; and with infliximab, obesity [5.6 (1.1-29.4), P = 0.04].
We found no difference in efficacy between TNF blockers and ustekinumab and among the three different TNF blockers in real life for PPP or ACH, which reveals the heterogeneity of clinical response to biologics in pustular psoriasis as compared with plaque psoriasis.
掌跖脓疱病（PPP）和Hallopeau连续性肢端皮炎（ACH）是银屑病的罕见变异型。关于生物制剂疗效的了解很少。
评估肿瘤坏死因子阻滞剂和乌司奴单抗在PPP和ACH中的实际疗效。
在19个皮肤科进行了一项多中心回顾性描述性研究，纳入2014年至2016年期间接受过其中一种研究生物制剂治疗的所有PPP或ACH患者。数据通过标准化文件收集。通过多变量分析分析与完全清除（CC）相关的因素，估计比值比（OR）和95%置信区间（CI）。
纳入的92例患者中，50例接受阿达木单抗，44例接受乌司奴单抗，36例接受依那西普，31例接受英夫利昔单抗。接受英夫利昔单抗的患者中，改善和CC分别为83.9%和20.0%；接受乌司奴单抗的患者中，改善和CC分别为75.0%和38.6%；接受依那西普的患者中，改善和CC分别为57.1%和20.0%；接受阿达木单抗的患者中，改善和CC分别为60.4%和29.2%。我们发现生物治疗之间的CC率或治疗持续时间没有显著差异（P分别为0.18和0.10）。多变量分析显示，依那西普实现CC与ACH型和不吸烟相关[OR = 9.5（95%CI 1.1 - 82.7），P = 0.04和0.1（0.01 - 0.9），P = 0.04]；与乌司奴单抗实现CC与男性和无肥胖相关[6.0（1.3 - 28.6），P = 0.02和4.7（1.0 - 22.7），P = 0.05]；与阿达木单抗实现CC与ACH型相关[11.9（2.7 - 52.3），P = 0.001]；与英夫利昔单抗实现CC与肥胖相关[5.6（1.1 - 29.4），P = 0.04]。
我们发现，在实际治疗PPP或ACH时，肿瘤坏死因子阻滞剂和乌司奴单抗之间以及三种不同的肿瘤坏死因子阻滞剂之间疗效无差异，这揭示了脓疱型银屑病与斑块状银屑病相比，对生物制剂临床反应的异质性。
