Shi Jianzhen, Xu Jianru, Chen Yanmei
Nantong University Xinglin College, NanTong, Jiangsu, China.
Department of Emergency, Nantong Third People's Hospital, NanTong, Jiangsu, China.
Dermatol Ther. 2020 Jul;33(4):e13802. doi: 10.1111/dth.13802. Epub 2020 Jul 8.
A variety of interleukin-23 targeted drugs have been used to treat moderate to severe psoriasis, but it is not clear which is most effective. This network meta-analysis compared and summarized the short-term efficacy and safety of interleukin-23 (IL-23) targeted drugs in the treatment of moderate to severe psoriasis. PubMed, Embase, Web of Science, and Cochrane Library were used to search randomized controlled trials (RCTs) about the treatment of moderate to severe psoriasis with ustekinumab (Ust), guselkumab (Gus), tildrakizumab (Til), and risankizumab (Ris). Bayesian Network Meta-analysis (NMA) was used to calculate Psoriasis Area and Severity Index 75%, 90%; Physician Global Assessment score of 0 or 1 (PGA 0/1); Dermatology Life Quality Index of 0 or 1 (DLQI 0/1), and safety (adverse events [AEs]) effect estimates (odds ratio OR) and 95% confidence intervals. Direct, indirect, and network meta-analysis estimates were calculated using a random-effects model. The GRADE method was used to assess the quality of evidence for each pair-wise comparison. In addition, the surface under the cumulative ranking curve (SUCRA) analysis was used to rank the treatment level for each outcome indicator. This network meta-analysis included 14 RCTs with 8402 patients. The results indicate that the curative effect of the IL-23 targeted drugs is better than that of a placebo. Network meta-analysis showed that Ris90 mg and Ris180 mg were significantly more effective than Til (5, 25, 100, and 200 mg), Ust (45 mg, 90 mg, body weight-based administration), Gus 100 mg and Ris (75 and 150 mg). Regarding safety, there is no significant difference in the risk of adverse events between drugs targeting IL-23 and placebo. In addition, according to the ranking of SUCRA, Ris 90 mg has the best efficacy index for PASI 75 and PGA 0/1, with SUCRA values of 97.6% and 97.1%, respectively. Ris 180 mg ranked first in PASI 90 (91.1%), while Ris 75 mg performed best in DLQI 0/1 (73.7%). In this network meta-analysis, risankizumab showed the best curative effect in the short-term treatment of moderate to severe psoriasis, and the risk of adverse events was not significantly different from placebo. However, more research data are needed for further study in the field of cost to evaluate which drug strikes the most favorable balance among efficacy, safety, and cost of access.
多种白细胞介素-23靶向药物已被用于治疗中度至重度银屑病，但哪种药物最有效尚不清楚。这项网状Meta分析比较并总结了白细胞介素-23（IL-23）靶向药物治疗中度至重度银屑病的短期疗效和安全性。使用PubMed、Embase、Web of Science和Cochrane图书馆检索关于使用优特克单抗（Ust）、古塞库单抗（Gus）、替拉珠单抗（Til）和司库奇尤单抗（Ris）治疗中度至重度银屑病的随机对照试验（RCT）。采用贝叶斯网状Meta分析（NMA）计算银屑病面积和严重程度指数达到75%、90%；医生整体评估评分为0或1（PGA 0/1）；皮肤病生活质量指数为0或1（DLQI 0/1），以及安全性（不良事件[AEs]）效应估计值（比值比OR）和95%置信区间。使用随机效应模型计算直接、间接和网状Meta分析估计值。采用GRADE方法评估每对比较的证据质量。此外，使用累积排序曲线下面积（SUCRA）分析对每个结局指标的治疗水平进行排序。这项网状Meta分析纳入了14项RCT，共8402例患者。结果表明，IL-23靶向药物的疗效优于安慰剂。网状Meta分析显示，司库奇尤单抗90mg和180mg比替拉珠单抗（5、25、100和200mg）、优特克单抗（45mg、90mg、基于体重给药）、古塞库单抗100mg和司库奇尤单抗（75和150mg）显著更有效。在安全性方面，IL-23靶向药物与安慰剂之间不良事件风险无显著差异。此外，根据SUCRA排序，司库奇尤单抗90mg在PASI 75和PGA [0/1]方面具有最佳疗效指数，SUCRA值分别为97.6%和97.1%。司库奇尤单抗180mg在PASI 90方面排名第一（91.1%），而司库奇尤单抗75mg在DLQI 0/1方面表现最佳（73.7%）。在这项网状Meta分析中，司库奇尤单抗在中度至重度银屑病的短期治疗中显示出最佳疗效，且不良事件风险与安慰剂无显著差异。然而,在成本领域还需要更多的研究数据来进一步评估哪种药物在疗效、安全性和可及成本之间达到最有利的平衡。
