Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan.
Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
J Dermatol Sci. 2020 Jul;99(1):53-61. doi: 10.1016/j.jdermsci.2020.06.003. Epub 2020 Jun 18.
Complete lesion clearance is important to patients with psoriasis.
To conduct a network meta-analysis of randomized controlled trials of biologic agents available for psoriasis in Japan, using mixed-treatment comparisons.
MEDLINE and EMBASE were searched to identify randomized clinical trials (placebo-controlled or head-to-head) of infliximab, adalimumab, ustekinumab, secukinumab, ixekizumab, brodalumab, risankizumab or guselkumab in adult patients with moderate-to-severe plaque psoriasis published in English between 01 January 2000 and 31 August 2019. We assessed the proportion of patients who achieved a 100 %, 90 % and 75 % reduction in their Psoriasis Area and Severity Index (PASI) score (PASI100, PASI90 and PASI75) at 10, 12 or 16 weeks after starting biologic treatment, using contrast-based network meta-analysis methods and risk difference (RD). Probabilities of rank and surface under the cumulative ranking (SUCRA) were also estimated.
Data were pooled from 41 trials in 19,248 patients. All biologics were significantly more effective than placebo for PASI100, PASI90 and PASI75. The RD for PASI100 for brodalumab vs ixekizumab was 0.05 (95 % Confidence intervals [CI] -0.02, 0.11), brodalumab vs risankizumab was 0.04 (95 %CI -0.03, 0.11), and risankizumab vs ixekizumab was -0.01 (95 %CI -0.08, 0.06). The SUCRA for PASI100 and PASI90 achievement was 96.8 % and 86.8 %, respectively, for brodalumab, 82.6 % and 90.3 %, respectively for risankizumab, and 78.3 %, 80.9 %, respectively, for ixekizumab.
Of the biologics assessed, brodalumab, ixekizumab and risankizumab were the greatest rates of PASI90 and PASI100 achievement, and a higher probability of being most effective in the induction phase, compared with the other biologics.
对于银屑病患者来说，完全清除皮损很重要。
通过混合治疗比较，对日本可用于银屑病的生物制剂的随机对照试验进行网络荟萃分析。
检索 MEDLINE 和 EMBASE，以确定 2000 年 1 月 1 日至 2019 年 8 月 31 日期间以英文发表的用于中重度斑块状银屑病成年患者的英夫利昔单抗、阿达木单抗、乌司奴单抗、司库奇尤单抗、依奇珠单抗、布罗达单抗、瑞莎珠单抗或古塞奇尤单抗的随机临床试验（安慰剂对照或头对头比较）。我们使用基于对照的网络荟萃分析方法和风险差异（RD）评估了生物治疗开始后 10、12 或 16 周时患者达到银屑病面积和严重程度指数（PASI）评分降低 100%、90%和 75%（PASI100、PASI90 和 PASI75）的患者比例。还估计了秩和累积排序曲线下面积（SUCRA）的概率。
来自 19248 例患者的 41 项试验的数据被汇总。与安慰剂相比，所有生物制剂在治疗 PASI100、PASI90 和 PASI75 方面均更为有效。与依奇珠单抗相比，布罗达单抗的 PASI100 RD 为 0.05（95%置信区间 [CI] -0.02，0.11），与瑞莎珠单抗相比为 0.04（95%CI -0.03，0.11），与依奇珠单抗相比为 -0.01（95%CI -0.08，0.06）。布罗达单抗在 PASI100 和 PASI90 达标方面的 SUCRA 分别为 96.8%和 86.8%，瑞莎珠单抗分别为 82.6%和 90.3%，依奇珠单抗分别为 78.3%和 80.9%。
在所评估的生物制剂中，与其他生物制剂相比，布罗达单抗、依奇珠单抗和瑞莎珠单抗在诱导期实现 PASI90 和 PASI100 缓解的速度更快，并且更有可能成为最有效的药物。
