Izumiyama Takuya, Mori Yu, Oizumi Itsuki, Hamada Soshi, Kurishima Hiroaki, Terui Hitoshi, Omori-Shimada Ryoko, Yamasaki Kenshi, Itoi Eiji
Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Department of Dermatology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
J Orthop Surg (Hong Kong). 2021 May-Aug;29(2):23094990211012286. doi: 10.1177/23094990211012286.
The patient of severe psoriatic arthritis (PsA) is mainly treated with oral methotrexate, ciclosporin, and anti-tumor necrosis factor-alpha inhibitors (TNFi). Recently, anti-interleukin-17A inhibitors (IL-17Ai) have been used in the treatment of PsA. This study aimed to evaluate the efficacy and safety of IL-17Ai in Japanese patients with PsA compared with those of TNFi.
This was a longitudinal and retrospective study. The study population included 31 Japanese patients with PsA. All enrolled patients fulfilled the Classification Criteria for Psoriatic Arthritis. All patients were treated with TNFi or IL-17Ai. The assessed clinical manifestations were C-reactive protein (CRP)-based Disease Activity Score in 28 Joints (DAS28-CRP), disease activity in psoriatic arthritis (DAPSA), 20% achievement of American College of Rheumatology core set, swollen joint count (SJC), tender joint count (TJC), and visual analog scale (VAS). Functional ability of patients with PsA was analyzed using the modified health assessment questionnaire (mHAQ) score. We evaluated the parameters at baseline and weeks 12, 24, and 52.
The change in SJC, TJC, VAS, mHAQ, and DAPSA had no significant difference at weeks 12, 24, and 52. The improvements of CRP and DAS28-CRP were significantly higher in TNFi group only at week 12. The biologics retention rate was significantly higher in TNFi group by the log-rank test. No critical adverse events occurred.
Our study presented that IL-17Ai had treatment effects comparable to TNFi. IL-17Ai might have the potential to become an alternative to the previous drug, but more large-scale studies are expected.
重度银屑病关节炎（PsA）患者主要接受口服甲氨蝶呤、环孢素和抗肿瘤坏死因子-α抑制剂（TNFi）治疗。近年来，抗白细胞介素-17A抑制剂（IL-17Ai）已用于PsA的治疗。本研究旨在评估IL-17Ai在日本PsA患者中的疗效和安全性，并与TNFi进行比较。
这是一项纵向回顾性研究。研究人群包括31例日本PsA患者。所有入组患者均符合银屑病关节炎分类标准。所有患者均接受TNFi或IL-17Ai治疗。评估的临床表现包括基于C反应蛋白（CRP）的28个关节疾病活动评分（DAS28-CRP）、银屑病关节炎疾病活动度（DAPSA）、美国风湿病学会核心指标20%达标率、肿胀关节计数（SJC）、压痛关节计数（TJC）和视觉模拟量表（VAS）。使用改良健康评估问卷（mHAQ）评分分析PsA患者的功能能力。我们在基线以及第12、24和52周评估各项参数。
在第12、24和52周时，SJC、TJC、VAS、mHAQ和DAPSA的变化无显著差异。仅在第12周时，TNFi组CRP和DAS28-CRP的改善显著更高。通过对数秩检验，TNFi组的生物制剂保留率显著更高。未发生严重不良事件。
我们的研究表明，IL-17Ai具有与TNFi相当的治疗效果。IL-17Ai可能有潜力成为先前药物的替代品，但仍需要更多大规模研究。
