Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark.
Dermatology. 2022;238(4):785-792. doi: 10.1159/000519320. Epub 2021 Oct 28.
Pyoderma gangrenosum (PG) is a rare ulcerating skin disease associated with multiple comorbidities and increased mortality. In recent decades, newer biologics such as interleukin inhibitors have been used to treat PG; however, the literature is scarce, consisting predominantly of case reports and caseseries. The aim of our review was to evaluate the effectiveness and safety of interleukin inhibitors for the treatment of PG in adults.
A literature search was conducted using search terms related to PG and interleukin inhibitors in databases such as PubMed, Embase, Scopus, Web of Science, and Cochrane Library. The study eligibility criteria included patients diagnosed with PG, over the age of 18, and treated with an interleukin inhibitor. Our study included 60 papers describing 81 patients fulfilling the eligibility criteria. The treatment with interleukin inhibitors resulted in 70% (95% CI 59-80%) response and 57% (95% CI 45-68%) complete response rates, and few (4%) mild adverse events, hence supporting the off-label use for the treatment of recalcitrant PG in adults. The response and complete response rates were 59% (17/29) and 38% (11/29) for anakinra, 64% (7/11) and 55% (6/11) for canakinumab, and 79% (27/34) and 71% (24/34) for ustekinumab, respectively. Limitations include publication bias that might have overestimated the efficacy as successful cases responding to treatment are more likely to be reported than nonresponding cases. Additionally, the heterogeneity of the treatment groups does not allow conclusions of superiority or inferiority of the different interleukin inhibitors to be drawn. Further studies are needed to investigate the efficacy of the different interleukin inhibitors and to investigate the importance of underlying disease for treatment response.
坏疽性脓皮病（PG）是一种罕见的溃疡性皮肤疾病，与多种合并症和死亡率增加有关。近几十年来，新型生物制剂如白细胞介素抑制剂已被用于治疗 PG；然而，相关文献稀缺，主要由病例报告和病例系列组成。我们的综述旨在评估白细胞介素抑制剂治疗成人 PG 的疗效和安全性。
使用与 PG 和白细胞介素抑制剂相关的检索词在 PubMed、Embase、Scopus、Web of Science 和 Cochrane Library 等数据库中进行了文献检索。研究纳入标准包括诊断为 PG、年龄大于 18 岁并接受白细胞介素抑制剂治疗的患者。我们的研究包括 60 篇描述符合纳入标准的 81 名患者的论文。白细胞介素抑制剂治疗的反应率为 70%（95%CI 59-80%），完全反应率为 57%（95%CI 45-68%），不良反应发生率低（4%），因此支持白细胞介素抑制剂在成人难治性 PG 中的治疗。阿那白滞素的反应率和完全反应率分别为 59%（17/29）和 38%（11/29），卡那单抗分别为 64%（7/11）和 55%（6/11），乌司奴单抗分别为 79%（27/34）和 71%（24/34）。局限性包括发表偏倚，这可能高估了疗效，因为治疗后有反应的成功病例比无反应的病例更有可能被报道。此外，治疗组的异质性不允许得出不同白细胞介素抑制剂的优越性或劣等性的结论。需要进一步研究以调查不同白细胞介素抑制剂的疗效，并研究潜在疾病对治疗反应的重要性。
