College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
Symmetron Limited, London, UK
RMD Open. 2022 Mar;8(1). doi: 10.1136/rmdopen-2021-002074.
Randomised controlled trials (RCTs) have compared biological and targeted systemic disease-modifying antirheumatic drugs (DMARDS) against placebo in psoriatic arthritis (PsA); few have compared them head to head.
To compare the efficacy and safety of all evaluated DMARDs for active PsA, with a special focus on biological DMARDs (bDMARDs) licensed for PsA or psoriasis.
A systematic review identified RCTs and Bayesian network meta-analysis (NMA) compared treatments on efficacy (American College of Rheumatology (ACR) response, Psoriasis Area and Severity Index (PASI) response, resolution of enthesitis and dactylitis) and safety (patients discontinuing due to adverse events (DAE)) outcomes. Subgroup analyses explored ACR response among patients with and without prior biological therapy exposure.
The NMA included 46 studies. Results indicate that some tumour necrosis factor inhibitors (anti-TNFs) may perform numerically, but not significantly, better than interleukin (IL) inhibitors on ACR response but perform worse on PASI response. Few significant differences between bDMARDs on ACR response were observed after subgrouping for prior bDMARD exposure. Guselkumab and IL-17A or IL-17RA inhibitors-brodalumab, ixekizumab, secukinumab-were best on PASI response. These IL-inhibitors and adalimumab were similarly efficacious on resolution of enthesitis and dactylitis. Infliximab with and without methotrexate, certolizumab 400 mg every 4 weeks and tildrakizumab showed the highest rates of DAE; abatacept, golimumab and the IL-inhibitors, the lowest.
Despite similar efficacy for ACR response, IL-17A and IL-17RA inhibitors and guselkumab offered preferential efficacy to anti-TNFs in skin manifestations, and for enthesitis and dactylitis, thereby supporting drug selection based on predominant clinical phenotype.
随机对照试验（RCT）已比较生物制剂和靶向系统性疾病修饰抗风湿药物（DMARDs）与安慰剂在银屑病关节炎（PsA）中的疗效；很少有研究直接比较它们的疗效。
比较所有评估的 DMARDs 在活动性 PsA 中的疗效和安全性，特别关注针对 PsA 或银屑病获批的生物 DMARDs（bDMARDs）。
系统检索确定 RCT，并进行贝叶斯网络荟萃分析（NMA）比较治疗的疗效（美国风湿病学会（ACR）反应、银屑病面积和严重程度指数（PASI）反应、附着点炎和指（趾）炎的缓解）和安全性（因不良事件（AE）停药的患者）结局。亚组分析探索了有和无既往生物治疗暴露的患者的 ACR 反应。
NMA 纳入 46 项研究。结果表明，一些肿瘤坏死因子抑制剂（抗-TNFs）在 ACR 反应方面可能表现出数值上但不显著优于白细胞介素（IL）抑制剂，但在 PASI 反应方面表现较差。对既往 bDMARD 暴露进行亚组分析后，bDMARDs 之间在 ACR 反应方面观察到的差异较小。古塞单抗和 IL-17A 或 IL-17RA 抑制剂-布罗达单抗、依奇珠单抗、司库奇尤单抗在 PASI 反应方面最佳。这些 IL 抑制剂和阿达木单抗在附着点炎和指（趾）炎的缓解方面同样有效。英夫利昔单抗联合或不联合甲氨蝶呤、依那西普 400mg 每 4 周和替西珠单抗显示出最高的 AE 发生率；阿巴西普、戈利木单抗和 IL 抑制剂发生率最低。
尽管 ACR 反应的疗效相似，但 IL-17A 和 IL-17RA 抑制剂和古塞单抗在皮肤表现方面提供了优于抗-TNFs 的疗效，在附着点炎和指（趾）炎方面也提供了疗效，从而支持基于主要临床表型选择药物。
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