Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
JAMA Dermatol. 2024 Aug 1;160(8):830-837. doi: 10.1001/jamadermatol.2024.1677.
Clinical characteristics associated with treatment response to biologics in patients with psoriasis have never been systematically investigated.
To evaluate the association between patient clinical characteristics and the effectiveness of biologics in treating psoriasis.
PubMed, Embase, and Web of Science were searched from their inception through April 2022. Studies in English language that reported response to biologic treatment at approved doses in patients with psoriasis in relation to their clinical characteristics were included. In addition, eligible studies were identified through a search of the reference lists of the included studies.
We only included studies that reported treatment outcomes as Psoriasis Area and Severity Index (PASI) 75 or PASI 90 after 12, 26, and/or 52 weeks of treatment. Both observational studies and randomized clinical trials (RCTs) were considered. Two independent authors conducted the screening process, and 107 studies were assessed for eligibility.
The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed. Relevant data were extracted independently by 2 authors. Data were pooled using random-effects models. RCTs and observational studies were pooled in separate analyses. Data were analyzed from June 1, 2023, to August 1, 2023.
The primary outcome was PASI 90 at 26 weeks (6 months). Before data collection began, an investigation of the association between the main (and secondary) outcomes and several clinical characteristics was planned.
Overall, 40 studies with a total of 21 438 patients were included. Older age (odds ratio [OR], 0.99; 95% CI, 0.98-1.00), previous exposure to biologics (OR, 0.44; 95% CI, 0.29-0.67), higher body mass index (BMI) (OR, 0.96; 95% CI, 0.94-0.99), previous smoking (OR, 0.81; 95% CI, 0.67-0.98), and current smoking (OR, 0.78; 95% CI, 0.66-0.91) were negatively associated with achieving PASI 90 at 6 months in observational studies. In RCTs, only BMI of 30 or higher was negatively associated with treatment response (PASI 90 at 3 months: OR, 0.57; 95% CI, 0.48-0.66).
This meta-analysis found that patients with psoriasis who smoke or have a history of smoking, as well as those with previous exposure to biologics, older age, or higher BMI, exhibited poorer response to biologics in observational studies. However, it remains unclear whether these clinical characteristics influence treatment response differently for the different biologics available for psoriasis.
尚未系统研究与银屑病患者生物制剂治疗反应相关的临床特征。
评估患者临床特征与生物制剂治疗银屑病有效性之间的关系。
从成立到 2022 年 4 月，在 PubMed、Embase 和 Web of Science 上进行了搜索。纳入了在银屑病患者中以批准剂量使用生物制剂治疗，并报告了与临床特征相关的有效性的英文研究。此外，通过纳入研究的参考文献列表，确定了合格的研究。
我们仅纳入了报告在治疗 12、26 和/或 52 周后 PASI 75 或 PASI 90 的治疗结果的研究。纳入了观察性研究和随机临床试验 (RCT)。两位独立的作者进行了筛选过程，评估了 107 项研究的合格性。
遵循系统评价和荟萃分析的首选报告项目 (PRISMA) 报告指南。两位作者独立提取相关数据。使用随机效应模型进行数据汇总。RCT 和观察性研究分别进行汇总分析。数据于 2023 年 6 月 1 日至 2023 年 8 月 1 日进行分析。
主要结局为 26 周（6 个月）时的 PASI 90。在开始数据收集之前，计划调查主要（和次要）结局与几个临床特征之间的关联。
共纳入 40 项研究，总计 21438 例患者。年龄较大（比值比 [OR]，0.99；95%CI，0.98-1.00）、既往使用生物制剂（OR，0.44；95%CI，0.29-0.67）、较高的体重指数 (BMI)（OR，0.96；95%CI，0.94-0.99）、既往吸烟（OR，0.81；95%CI，0.67-0.98）和当前吸烟（OR，0.78；95%CI，0.66-0.91）与观察性研究中 6 个月时达到 PASI 90呈负相关。在 RCT 中，仅 BMI 为 30 或更高与治疗反应呈负相关（PASI 90 3 个月：OR，0.57；95%CI，0.48-0.66）。
这项荟萃分析发现，在观察性研究中，银屑病患者中吸烟或有吸烟史、既往使用生物制剂、年龄较大或 BMI 较高的患者对生物制剂的反应较差。然而，目前尚不清楚这些临床特征是否会对不同的生物制剂对银屑病的治疗反应产生不同的影响。
