Nakatsubo Daisuke, Morita Takayoshi, Kumanogoh Atsushi
Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan.
The Centre for Rheumatic Diseases, Nara Medical University, Nara, Japan.
Rheumatol Adv Pract. 2025 Jul 7;9(3):rkaf077. doi: 10.1093/rap/rkaf077. eCollection 2025.
Enthesitis plays a key role in the pathogenesis of PsA. This study aimed to evaluate the efficacy of molecular-targeted therapies for enthesitis in patients with PsA.
In this network meta-analysis (PROSPERO registration number: CRD42024590257), studies published up to April 2025 were searched in PubMed, Web of Science, Scopus and ClinicalTrials.gov. Only randomized controlled trials assessing molecular-targeted therapies for enthesitis in PsA were included. The primary outcomes were enthesitis resolution rates and Leeds enthesitis index score reductions at 12 and 24 weeks. A random-effects model was employed to calculate risk differences (RDs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs), analysing both drug classes and individual agents.
Out of 5762 screened studies, 28 randomized controlled trials were included, encompassing 10 383 patients with PsA presenting with enthesitis. Therapies included TNF-alpha inhibitors, Janus kinase inhibitors, IL-17/IL-17 receptor inhibitors, IL-23 inhibitors and a cytotoxic T lymphocyte-associated antigen-4 immunoglobulin. At 24 weeks, upadacitinib significantly improved the enthesitis resolution rate [RD: 11.24 (95% CI: 4.26 to 18.23)] and reduced the Leeds enthesitis index scores [SMD: -0.72 (95% CI: -1.36 to -0.09)] compared with adalimumab; meanwhile, other Janus kinase inhibitors did not. Certolizumab also reduced the Leeds enthesitis index scores [SMD: -0.92 (95% CI: -1.72 to -0.13)].
This network meta-analysis identified the more therapeutic efficacy of upadacitinib and certolizumab for enthesitis in patients with PsA than those of other molecular-targeted drugs. Notably, efficacy varied among molecular-targeted therapies, even within drug classes, underscoring the need for tailored therapeutic strategies.
附着点炎在银屑病关节炎（PsA）的发病机制中起关键作用。本研究旨在评估分子靶向治疗对PsA患者附着点炎的疗效。
在这项网状Meta分析（PROSPERO注册号：CRD42024590257）中，检索了截至2025年4月在PubMed、科学网、Scopus和ClinicalTrials.gov上发表的研究。仅纳入评估PsA附着点炎分子靶向治疗的随机对照试验。主要结局为12周和24周时附着点炎缓解率和利兹附着点炎指数评分降低情况。采用随机效应模型计算风险差异（RDs）或标准化均数差异（SMDs）及95%置信区间（CIs），分析药物类别和单个药物。
在5762项筛选研究中，纳入了28项随机对照试验，涵盖10383例有附着点炎的PsA患者。治疗方法包括肿瘤坏死因子-α抑制剂、Janus激酶抑制剂、白细胞介素-17/白细胞介素-17受体抑制剂、白细胞介素-23抑制剂和细胞毒性T淋巴细胞相关抗原4免疫球蛋白。在24周时，与阿达木单抗相比，乌帕替尼显著提高了附着点炎缓解率[RD：11.24（95%CI：4.26至18.23）]，并降低了利兹附着点炎指数评分[SMD：-0.72（95%CI：-1.36至-0.09）]；同时，其他Janus激酶抑制剂则未达到此效果。赛妥珠单抗也降低了利兹附着点炎指数评分[SMD：-0.92（95%CI：-1.72至-0.13）]。
这项网状Meta分析确定，与其他分子靶向药物相比，乌帕替尼和赛妥珠单抗对PsA患者附着点炎的治疗效果更佳。值得注意的是，即使在同一药物类别中，分子靶向治疗的疗效也存在差异，这突出了制定个性化治疗策略的必要性。
