Torres Tiago, Barcelos Anabela, Filipe Paulo, Fonseca João Eurico
Department of Dermatology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Multidisciplinar Medical Research Unit, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.
Front Med (Lausanne). 2021 Jan 15;7:618163. doi: 10.3389/fmed.2020.618163. eCollection 2020.
Several new treatments have been developed for psoriatic disease, an inflammatory condition that involves skin and joints. Notwithstanding, few studies have made direct comparisons between treatments and therefore it is difficult to select the ideal treatment for an individual patient. The aim of this systematic review with network meta-analysis (NMA) was to analyze available and approved biologic therapies for each domain of psoriatic disease: skin, peripheral arthritis, axial arthritis, enthesitis, dactylitis, and nail involvement. Data from randomized clinical trials (RCTs) were included. A systematic review was performed using the MEDLINE database (July 2020) using PICO criteria. Bayesian NMA was conducted to compare the clinical efficacy of biological therapy in terms of the American College of Rheumatology criteria (ACR, 24 weeks) and Psoriasis Area and Severity Index (PASI, 10-16 weeks). Fifty-four RCTs were included in the systematic review. Due to the design of the RCTs, namely, outcomes and time points, network meta-analysis was performed for skin and peripheral arthritis domains. For the skin domain, 30 studies reporting PASI100 were included. The peripheral arthritis domain was analyzed through ACR70 in 12 studies. From the therapies approved for both domains, secukinumab and ixekizumab were the ones with the highest probability of reaching the proposed outcomes. There is a lack of outcome uniformization in the dactylitis, enthesitis, and nail domains, and therefore, an objective comparison of the studies was not feasible. Nevertheless, secukinumab was the treatment with the best compromise between the number of studies in each domain and the results obtained in the different outcomes. Secukinumab and ixekizumab were the treatments with the highest probability of reaching both PASI100 and ACR70 outcomes. Due to the lack of a standard evaluation of outcomes of the other psoriatic disease domains, a network meta-analysis for all the domains was not possible to perform.
针对银屑病这一涉及皮肤和关节的炎症性疾病，已经研发出了几种新的治疗方法。尽管如此，很少有研究对各种治疗方法进行直接比较，因此很难为个体患者选择理想的治疗方法。这项采用网状Meta分析的系统评价的目的是分析银屑病各领域（皮肤、外周关节炎、中轴关节炎、附着点炎、指（趾）炎和指甲受累）可用且已获批的生物疗法。纳入了随机临床试验（RCT）的数据。使用PICO标准，通过MEDLINE数据库（2020年7月）进行了系统评价。采用贝叶斯网状Meta分析，根据美国风湿病学会标准（ACR，24周）和银屑病面积和严重程度指数（PASI，10 - 16周）比较生物疗法的临床疗效。系统评价纳入了54项RCT。由于RCT的设计，即结局和时间点，对皮肤和外周关节炎领域进行了网状Meta分析。对于皮肤领域，纳入了30项报告PASI100的研究。通过12项研究中的ACR70对外周关节炎领域进行了分析。在获批用于这两个领域的疗法中，司库奇尤单抗和依奇珠单抗达到预期结局的概率最高。在指（趾）炎、附着点炎和指甲领域缺乏结局一致性，因此无法对这些研究进行客观比较。尽管如此，司库奇尤单抗是在每个领域的研究数量和不同结局所获结果之间取得最佳平衡的治疗方法。司库奇尤单抗和依奇珠单抗是达到PASI100和ACR70结局概率最高的治疗方法。由于缺乏对其他银屑病疾病领域结局的标准评估，无法对所有领域进行网状Meta分析。
