Department of Dermatology, Xiangya Hospital, Central South University.
Hunan Engineering Research Center of Skin Health and Disease, Central South University.
Rheumatology (Oxford). 2020 Dec 1;59(12):3657-3665. doi: 10.1093/rheumatology/keaa449.
We sought to systematically investigate the effectiveness of secukinumab in psoriatic arthritis (PsA) patients who previously received TNFs inhibitor (TNFi) treatment and those who were TNFi naïve.
Databases (PubMed, EMBase and Cochrane library) and ClinicalTrials.gov were searched from inception to 22 May 2020 for randomized control trails and observational studies of secukinumab, with or without a history of previous anti-TNFi treatment, in PsA. Effectiveness data were extracted and combined using a random-effects meta-analysis. The ACR20 and ACR50 (20% and 50% improvement in American College of Rheumatology response criteria) responses were the endpoints.
Six randomized controlled trials that reported the effectiveness of secukinumab by previous anti-TNFi treatment were included. Among patients exposed to a prior anti-TNFi treatment (n = 738), 33.7% (249/738) of patients achieved an ACR20 response. In contrast, in the anti-TNFi-naïve group (n = 1754), 49.8% (873/1754) of patients achieved an ACR20 response. Prior treatment with anti-TNFi was significantly associated with a poorer response to secukinumab compared with the anti-TNFi-naïve group with an effect size of 2.09 (95% CI: 1.69, 2.58).
Some patients benefit from switching from TNFi to secukinumab, but previous anti-TNFi treatment is associated with poorer effectiveness of secukinumab.
我们旨在系统地研究司库奇尤单抗在既往接受 TNF 抑制剂（TNFi）治疗和 TNFi 初治的银屑病关节炎（PsA）患者中的疗效。
从建库至 2020 年 5 月 22 日，我们检索了 PubMed、EMBase 和 Cochrane 图书馆以及 ClinicalTrials.gov 中的随机对照试验和观察性研究，纳入了司库奇尤单抗治疗 PsA 的研究，无论患者是否有既往抗 TNFi 治疗史。使用随机效应荟萃分析提取和合并有效性数据。ACR20 和 ACR50（美国风湿病学会反应标准改善 20%和 50%）应答为终点。
纳入了 6 项报告了既往抗 TNFi 治疗时司库奇尤单抗有效性的随机对照试验。在接受既往抗 TNFi 治疗的患者中（n=738），33.7%（249/738）的患者达到 ACR20 应答。相比之下，在 TNFi 初治组（n=1754）中，49.8%（873/1754）的患者达到 ACR20 应答。与 TNFi 初治组相比，既往接受抗 TNFi 治疗与司库奇尤单抗治疗的应答较差相关，效应量为 2.09（95%CI：1.69，2.58）。
一些患者从 TNFi 转换为司库奇尤单抗中获益，但既往抗 TNFi 治疗与司库奇尤单抗的疗效较差相关。
