Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, Anhui, China.
J Dtsch Dermatol Ges. 2021 Jan;19(1):47-56. doi: 10.1111/ddg.14308. Epub 2020 Dec 30.
To compare the efficacy and safety of biologics for patients with moderate to severe plaque psoriasis.
We systematically reviewed 60 randomized controlled trials (34,020 participants), which compared 14 biological drugs for treatment of moderate to severe plaque psoriasis. The main assessment criteria were ≥ 90 % reductions in Psoriasis Area and Severity Index (PASI 90) and the number of patients who reported treatment-emergent adverse events (AEs). Secondary criteria were ≥ 75 % reductions in Psoriasis Area and Severity Index (PASI 75), Physician's Global Assessment 0/1 (PGA 0/1) and infections.
This network meta-analysis showed that biologics were significantly more effective than placebo. Ixekizumab, risankizumab, and bimekizumab were among the most effective treatments, and tildrakizumab, guselkumab and risankizumab were better than the other drugs with respect to safety. Risankizumab and guselkumab performed relatively stable with respect to both efficacy and safety. At the class level, blockers of interleukin (IL)-17A showed favorable efficacy while inhibitors of the p19 subunit of IL-23 were best tolerated of all efficient biologics.
Ixekizumab was the most effective biologic in PASI 90, while IL-23p19 inhibitors, risankizumab and guselkumab performed relatively stable with respect to efficacy and safety.
比较生物制剂治疗中重度斑块状银屑病患者的疗效和安全性。
我们系统地综述了 60 项随机对照试验（34020 名参与者），比较了 14 种生物药物治疗中重度斑块状银屑病的疗效。主要评估标准为银屑病面积和严重程度指数（PASI90）≥90%的缓解率和报告治疗中出现不良反应（AE）的患者人数。次要评估标准为 PASI75 缓解率≥75%、医生总体评估 0/1（PGA0/1）和感染情况。
本网络荟萃分析显示，生物制剂明显比安慰剂更有效。依奇珠单抗、里司努单抗和比美吉珠单抗是最有效的治疗方法之一，而替西珠单抗、古塞库单抗和里司努单抗在安全性方面优于其他药物。里司努单抗和古塞库单抗在疗效和安全性方面都相对稳定。在药物类别方面，白细胞介素（IL）-17A 阻断剂显示出良好的疗效，而 IL-23p19 抑制剂中，里司努单抗和古塞库单抗的耐受性最好。
依奇珠单抗在 PASI90 方面疗效最佳，而 IL-23p19 抑制剂、里司努单抗和古塞库单抗在疗效和安全性方面相对稳定。
