Kaur Hargun, Behroozian Tara, Lansang Rafael Paolo, Caini Saverio, Doccioli Chiara, Abu-Hilal Mohannad
Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada.
Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention, and Clinical Network (ISPRO), Florence, Italy.
Dermatol Pract Concept. 2025 Apr 1;15(2):4793. doi: 10.5826/dpc.1502a4793.
Scalp psoriasis affects up to 80% of patients with plaque-type psoriasis and is often resistant to topical and conventional systemic agents. There is a lack of consensus on a "gold standard" treatment.
This comprehensive review and network meta-analysis aimed to compare the efficacy and safety of studied interventions.
The Ovid MEDLINE(R), Embase, and Cochrane databases were searched from 01 January 2000 to 05 October 2022. All English-language randomized controlled trials evaluating an intervention for scalp psoriasis were included if they reported one of the following clinical outcomes: Psoriasis Scalp Severity Index (PSSI), scalp Physician Global Assessment (ScPGA), scalp-specific Investigator or Physician Global Assessment (IGA/PGA), and Total Sign Score (TSS), and adverse events. A random effects network meta-analysis was performed where possible, and network plots were generated.
Of 1,046 studies identified, 35 met the inclusion criteria, with seven in the PSSI analysis and 16 in the IGA analysis. All interventions led to an improvement in all outcomes when compared to placebo in the PSSI and PGA/IGA. For the PSSI response, secukinumab 300 mg every four weeks (Q4W) was the most effective (SUCRA 0.991). For the PGA/IGA response, bimekizumab 320 mg Q4W was the most effective (SUCRA 0.975).
Several systemic therapies are superior to placebo in improving clinical outcomes, with secukinumab 300 mg Q4W and bimekizumab 320 mg Q4W deemed the most effective among biologic agents analyzed. Efforts to enhance research standardization, including head-to-head trials with standardized outcome measures, diverse patient recruitment, and long-term follow-up, are crucial next steps in assessing treatment efficacy and adverse events.
头皮银屑病影响多达80%的斑块型银屑病患者，且通常对局部和传统全身用药耐药。对于“金标准”治疗方法尚无共识。
本综述和网状Meta分析旨在比较所研究干预措施的疗效和安全性。
检索了Ovid MEDLINE(R)、Embase和Cochrane数据库，检索时间为2000年1月1日至2022年10月5日。纳入所有评估头皮银屑病干预措施的英文随机对照试验，若其报告了以下临床结局之一：银屑病头皮严重程度指数（PSSI）、头皮医师整体评估（ScPGA）、头皮特异性研究者或医师整体评估（IGA/PGA）、总体征评分（TSS）以及不良事件。尽可能进行随机效应网状Meta分析，并绘制网状图。
在识别出的1046项研究中，35项符合纳入标准，其中7项用于PSSI分析，16项用于IGA分析。在PSSI和PGA/IGA方面，与安慰剂相比，所有干预措施均使所有结局得到改善。对于PSSI反应，每四周一次皮下注射司库奇尤单抗300mg（Q4W）最有效（累积排序曲线下面积[SUCRA]为0.991）。对于PGA/IGA反应，每四周一次皮下注射比美吉珠单抗320mg最有效（SUCRA为0.975）。
几种全身治疗在改善临床结局方面优于安慰剂，在所分析的生物制剂中，每四周一次皮下注射司库奇尤单抗300mg和每四周一次皮下注射比美吉珠单抗320mg被认为最有效。提高研究标准化的努力，包括采用标准化结局指标的头对头试验、多样化的患者招募和长期随访，是评估治疗疗效和不良事件的关键下一步。
