Swedish Medical Center/Providence St. Joseph Health & University of Washington, Seattle, WA, USA.
University of Glasgow, Centre for Rheumatic Diseases, United Kingdom.
Rheumatology (Oxford). 2021 May 14;60(5):2109-2121. doi: 10.1093/rheumatology/keab119.
The efficacy of the novel interleukin (IL)-23p19 inhibitor guselkumab for psoriatic arthritis (PsA) has recently been demonstrated in two phase 3 trials (DISCOVER-1 & -2) but has not been evaluated vs other targeted therapies for PsA. The objective was to compare guselkumab to targeted therapies for PsA for safety and joint and skin efficacy through network meta-analysis (NMA).
A systematic literature review was conducted in January 2020 to identify randomized controlled trials. Bayesian NMAs were performed to compare treatments on American College of Rheumatology (ACR) 20/50/70 response, mean change from baseline in van der Heijde-Sharp (vdH-S) score, Psoriasis Area Severity Index (PASI) 75/90/100 response, adverse events (AEs) and serious adverse events (SAEs).
Twenty-six phase 3 studies evaluating 13 targeted therapies for PsA were included. For ACR 20 response, guselkumab 100 mg every 8 weeks (Q8W) was comparable to IL-17A inhibitors and subcutaneous tumor necrosis factor (TNF) inhibitors. Similar findings were observed for ACR 50 and 70. For vdH-S score, guselkumab Q8W was comparable to other agents except intravenous TNF therapies. Results for PASI 75 and PASI 90 response suggested guselkumab Q8W was better than most other agents. For PASI 100, guselkumab Q8W was comparable to other active agents. For AEs and SAEs, guselkumab Q8W ranked highly but comparative conclusions were uncertain. Similar results were observed for all outcomes for guselkumab 100 mg every four weeks.
In this NMA, guselkumab demonstrated favorable arthritis efficacy comparable to IL-17A and subcutaneous TNF inhibitors while offering better PASI response relative to many other treatments.
新型白细胞介素（IL）-23p19 抑制剂古塞单抗治疗银屑病关节炎（PsA）的疗效已在两项 3 期临床试验（DISCOVER-1 和 -2）中得到证实，但尚未与其他针对 PsA 的靶向治疗药物进行比较。本研究旨在通过网络荟萃分析（NMA）比较古塞单抗与针对 PsA 的靶向治疗药物的安全性和关节及皮肤疗效。
2020 年 1 月进行了系统文献检索，以确定随机对照试验。采用贝叶斯 NMA 比较不同治疗方案在美国风湿病学会（ACR）20/50/70 应答、基于 van der Heijde-Sharp（vdH-S）评分的基线变化、银屑病面积严重程度指数（PASI）75/90/100 应答、不良事件（AE）和严重不良事件（SAE）方面的疗效。
纳入了 26 项评估 13 种针对 PsA 的靶向治疗药物的 3 期研究。在 ACR 20 应答方面，古塞单抗 100mg 每 8 周（Q8W）与 IL-17A 抑制剂和皮下肿瘤坏死因子（TNF）抑制剂相当。在 ACR 50 和 70 应答方面也观察到了类似的结果。在 vdH-S 评分方面，古塞单抗 Q8W 与除静脉 TNF 治疗外的其他药物相当。在 PASI 75 和 PASI 90 应答方面，古塞单抗 Q8W 优于大多数其他药物。在 PASI 100 方面，古塞单抗 Q8W 与其他活性药物相当。在 AE 和 SAE 方面，古塞单抗 Q8W 排名较高，但结论不确定。对于所有结局，古塞单抗 Q8W 每四周一次的结果也相似。
在这项 NMA 中，古塞单抗在关节炎疗效方面表现出与 IL-17A 和皮下 TNF 抑制剂相当的优势，同时与许多其他治疗方法相比，具有更好的 PASI 应答。
