Wang Huiyun, Deng Tiantian, Wang Jian, Bai Xuesong, Shen Yuhua, Qiu Yan
Department of Pharmacy, Shanghai Pudong New Area People's Hospital, Shanghai, 201299, China.
Eur J Med Res. 2025 Jun 20;30(1):501. doi: 10.1186/s40001-025-02700-6.
BACKGROUND/OBJECTIVES: The mechanism of action of treatment drugs for psoriasis is based on anti-inflammation and the inhibition of epidermal proliferation, and retinoids and vitamin D3 derivatives are first-line therapy drugs for psoriasis. This meta-analysis aimed to comprehensively evaluate the efficacy and safety of calcipotriol-acitretin combination therapy for psoriasis and investigate its effect on serum inflammatory factors.
A systematic search of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, Chinese biomedical literature service system (SinoMed), and Chinese Biomedical Journal Database (VIP), from the earliest record until Dec.13, 2024, was conducted. The outcomes were overall effective rate, Psoriasis Area and Severity Index (PASI) scores, inflammatory factor level and side effects.
A total of 13 studies with 1196 patients were included in this meta-analysis. The results of this study show that the calcipotriol-acitretin combination therapy could improve the total effective rate when compared with acitretin [RR = 1.25, 95% CI (1.18, 1.33)] or calcipotriol [RR = 1.36, 95% CI (1.20, 1.56)] monotherapy. The combined therapy could decrease the PASI score observably when compared with acitretin monotherapy [SMD = - 2.26, 95% CI (-3.24, -1.28)] or calcipotriol monotherapy [SMD = - 3.79, 95% CI (-5.78, -1.79)]. Calcipotriol-acitretin combination therapy remarkably reduced the levels of TNF-α, IL-23, IL-17, INF-γ and IL-6 in serum, while increasing the levels of IL-4 and IL-10 within the serum, compared to acitretin monotherapy. This combination therapy did not increase the risk of skin irritation & burning pain, dry skin and perioral dermatitis. Notably, the incidence of perioral dermatitis was lower in combination therapy than acitretin monotherapy [P = 0.04, RR = 0.24, 95% CI (0.06, 0.93)].
The calcipotriol-acitretin combination therapy could be a safe and effective therapeutic strategy in the treatment of psoriasis. However, the lack of PROSPERO registration and the high heterogeneity in this study limited the conclusion, and more high-quality RCTs were needed for further evaluation.
背景/目的：银屑病治疗药物的作用机制基于抗炎和抑制表皮增殖，维甲酸类药物和维生素D3衍生物是银屑病的一线治疗药物。本荟萃分析旨在全面评估卡泊三醇-阿维A联合疗法治疗银屑病的疗效和安全性，并研究其对血清炎症因子的影响。
对PubMed、Embase、Cochrane图书馆、中国知网（CNKI）、万方数据、中国生物医学文献服务系统（SinoMed）和中文生物医学期刊数据库（维普）进行系统检索，检索时间从最早记录至2024年12月13日。观察指标为总有效率、银屑病面积和严重程度指数（PASI）评分、炎症因子水平及副作用。
本荟萃分析共纳入13项研究，涉及1196例患者。研究结果表明，与阿维A单药治疗[RR = 1.25，95%CI（1.18，1.33）]或卡泊三醇单药治疗[RR = 1.36，95%CI（1.20，1.56）]相比，卡泊三醇-阿维A联合疗法可提高总有效率。与阿维A单药治疗[SMD = -2.26，95%CI（-3.24，-1.28）]或卡泊三醇单药治疗[SMD = -3.79，95%CI（-5.78，-1.79）]相比，联合疗法可显著降低PASI评分。与阿维A单药治疗相比，卡泊三醇-阿维A联合疗法可显著降低血清中TNF-α、IL-23、IL-17、INF-γ和IL-6的水平，同时提高血清中IL-4和IL-10的水平。这种联合疗法不会增加皮肤刺激和灼痛、皮肤干燥及口周皮炎的风险。值得注意的是，联合疗法的口周皮炎发生率低于阿维A单药治疗[P = 0.04，RR = 0.24，95%CI（0.06，0.93）]。
卡泊三醇-阿维A联合疗法可能是治疗银屑病的一种安全有效的治疗策略。然而，本研究缺乏PROSPERO注册且异质性较高，限制了结论的得出，需要更多高质量的随机对照试验进行进一步评估。
