Menter Alan, Bhutani Tina, Ehst Benjamin, Elewski Boni, Jacobson Abby
Baylor Scott and White, Dallas, TX, USA.
Department of Dermatology, University of California, San Francisco, CA, USA.
Dermatol Ther (Heidelb). 2022 Jun;12(6):1289-1302. doi: 10.1007/s13555-022-00746-6. Epub 2022 Jun 7.
Psoriatic involvement in areas of the body such as nails, palms and soles (palmoplantar), and scalp is associated with dramatically negative effects on quality of life relative to involvement elsewhere in the body. Although numerous evidence-based studies demonstrate the efficacy of biologics for overall skin clearance in moderate-to-severe plaque psoriasis (including tumor necrosis factor α [TNFα] inhibitors and interleukin [IL]-17A, IL-12/IL-23, IL-23, IL-17F, and IL-17A/F inhibitors), large, randomized, placebo-controlled clinical studies of psoriasis with nail, palmoplantar, and scalp involvement are needed to better inform decision-making in clinical practice. Moreover, biologic failure caused by drug ineffectiveness is a common occurrence in patients who do not respond, lose response, or are intolerant to treatment. Brodalumab is a fully human IL-17 receptor A antagonist that demonstrates high rates of skin clearance among the latest generation of biologic therapies for treatment of moderate-to-severe psoriasis. This review summarizes current literature on the efficacy of brodalumab and other therapies in difficult-to-treat psoriasis including psoriasis in difficult-to-treat locations (such as psoriasis with nail, palmoplantar, or scalp involvement) and psoriasis in patients whose disease did not respond to other biologics.
银屑病累及身体的某些部位，如指甲、手掌和脚底（掌跖）以及头皮，相对于身体其他部位的累及而言，会对生活质量产生极其负面的影响。尽管众多基于证据的研究表明生物制剂对中重度斑块状银屑病的整体皮肤清除有效（包括肿瘤坏死因子α [TNFα] 抑制剂以及白细胞介素 [IL]-17A、IL-12/IL-23、IL-23、IL-17F和IL-17A/F抑制剂），但仍需要开展针对累及指甲、掌跖和头皮的银屑病的大型、随机、安慰剂对照临床研究，以便为临床实践中的决策提供更充分的信息。此外，在无反应、失去反应或不耐受治疗的患者中，药物无效导致的生物制剂治疗失败很常见。布罗达单抗是一种全人源IL-17受体A拮抗剂，在用于治疗中重度银屑病的新一代生物疗法中显示出较高的皮肤清除率。本综述总结了关于布罗达单抗及其他疗法在难治性银屑病（包括难治部位的银屑病，如累及指甲、掌跖或头皮的银屑病）以及对其他生物制剂无反应的患者的银屑病中的疗效的当前文献。
