Armstrong April W, Fitzgerald Timothy, McLean Robert R, Teeple Amanda, Uy Jonathan P, Olurinde Mobolaji, Rowland Katelyn, Guo Lin, Shan Ying, Callis Duffin Kristina
University of Southern California, Los Angeles, CA, USA.
Harvard Medical School, Boston, MA, USA.
Adv Ther. 2023 May;40(5):2493-2508. doi: 10.1007/s12325-023-02467-4. Epub 2023 Mar 17.
Prior studies have demonstrated guselkumab improves disease activity and patient-reported outcomes (PROs) among patients with moderate-to-severe plaque psoriasis. However, the real-world effectiveness of guselkumab across different subgroups [e.g., body mass index (BMI) categories] remains an area of active research.
This study included patients enrolled in the CorEvitas Psoriasis Registry between July 18, 2017 and March 10, 2020 who had moderate-to-severe psoriasis [Investigator's Global Assessment (IGA) score ≥ 3], initiated guselkumab at a registry visit (index date), and had a follow-up registry visit after persistent guselkumab therapy for 9-12 months. Patients were stratified into three BMI categories: obese (≥ 30 kg/m), overweight (25- < 30 kg/m), and underweight/normal weight (< 25 kg/m). Response rates and mean changes for disease activity outcomes and PROs at follow-up were assessed within each BMI category.
Of the 180 patients included in the study, 101 (56%) were obese, 52 (29%) were overweight, and 27 (15%) were underweight/normal weight. Among the obese, overweight, and underweight/normal weight patients, 57%, 58%, and 72%, respectively, achieved an IGA score of 0/1 after 9-12 months of persistent guselkumab treatment. An IGA score of 0 was achieved by 33%, 35%, and 48% of obese, overweight, and underweight/normal weight patients, respectively. A 90% improvement in the Psoriasis Area and Severity Index was achieved by 46%, 46%, and 56% in these respective subgroups. Mean improvements in disease activity and PRO scores were similar among BMI subgroups.
The results of this real-world study showed improvements in disease severity and several PRO scores within all BMI categories among patients with moderate-to-severe psoriasis treated with guselkumab. These unadjusted findings suggest that obese and overweight patients have comparable absolute improvements to those with lower BMI; however, they may be less likely to achieve relative endpoints. Additional analyses are needed to fully characterize this relationship.
既往研究表明，古塞库单抗可改善中度至重度斑块状银屑病患者的疾病活动度及患者报告结局（PROs）。然而，古塞库单抗在不同亚组（如体重指数（BMI）类别）中的真实世界有效性仍是一个活跃的研究领域。
本研究纳入了2017年7月18日至2020年3月10日期间登记在CorEvitas银屑病登记处的患者，这些患者患有中度至重度银屑病[研究者整体评估（IGA）评分≥3]，在登记处就诊时（索引日期）开始使用古塞库单抗，并在持续使用古塞库单抗治疗9至12个月后进行了一次随访登记处就诊。患者被分为三个BMI类别：肥胖（≥30kg/m²）、超重（25-<30kg/m²）和体重过轻/正常体重（<25kg/m²）。在每个BMI类别中评估随访时疾病活动度结局和PROs的缓解率及平均变化。
在纳入研究的180例患者中，101例（56%）为肥胖，52例（29%）为超重，27例（15%）为体重过轻/正常体重。在肥胖、超重和体重过轻/正常体重的患者中，分别有57%、58%和72%在持续使用古塞库单抗治疗9至12个月后达到IGA评分为0/1。肥胖、超重和体重过轻/正常体重的患者分别有33%、35%和48%达到IGA评分为0。在这些相应亚组中，银屑病面积和严重程度指数改善90%的比例分别为46%、46%和56%。BMI亚组之间疾病活动度和PRO评分的平均改善相似。
这项真实世界研究的结果显示，在接受古塞库单抗治疗的中度至重度银屑病患者中，所有BMI类别患者的疾病严重程度及多个PRO评分均有改善。这些未经调整的结果表明，肥胖和超重患者的绝对改善与BMI较低的患者相当；然而，他们达到相对终点的可能性可能较小。需要进一步分析以全面描述这种关系。
