中重度银屑病及早期肌肉骨骼症状患者使用白细胞介素-23抑制剂的真实世界分析
Real-world analysis of IL-23 inhibitors in patients with moderate-to-severe psoriasis and early musculoskeletal symptoms.
作者信息
Dattola Annunziata, Bernardini Nicoletta, Anedda Jasmine, Atzori Laura, Bonifati Claudio, Bruni Pier Luigi, Giordano Domenico, Graceffa Dario, Molinelli Elisa, Moretta Gaia, Mugheddu Cristina, Offidani Annamaria, Pagnanelli Gianluca, Pallotta Sabatino, Papini Manuela, Persechino Severino, Richetta Antonio Giovanni, Tolino Ersilia, Trovato Federica, Pellacani Giovanni, Potenza Concetta
机构信息
Dermatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Science, University of La Sapienza, Rome, Italy.
Dermatological Unit "Daniele Innocenzi" ASL Latina - Sapienza University of Rome - Polo Pontino, Rome, Italy.
出版信息
Drugs Context. 2025 Sep 8;14. doi: 10.7573/dic.2025-5-1. eCollection 2025.
BACKGROUND
Psoriasis is a chronic inflammatory condition that may develop into psoriatic arthritis (PsA) in a significant number of patients. Clinical signs such as enthesitis and nail involvement have been suggested as early indicators of this progression. IL-23 inhibitors have demonstrated effectiveness in psoriasis and, more recently, in PsA. This article aims to evaluate the effect of IL-23 inhibitors on clinical outcomes and progression of PsA in patients with moderate-to-severe psoriasis and early musculoskeletal involvement.
METHODS
This was a retrospective, multicentre observational study conducted in Italy. Data were collected from 207 adult patients who had already started treatment with guselkumab, risankizumab or tildrakizumab prior to inclusion. All clinical data, including baseline characteristics and follow-up outcomes, were retrieved retrospectively from medical records across eight dermatology centres.
RESULTS
Enthesitis was observed in 44.8% of patients with joint involvement. Guselkumab was the most commonly used treatment (57%) and demonstrated sustained improvements in Psoriasis Area and Severity Index, Visual Analogue Scale pain and Dermatology Life Quality Index scores. Importantly, no patients with enthesitis treated with guselkumab progressed to overt PsA. At 52 weeks, the average Psoriasis Area and Severity Index score was 0.61, Visual Analogue Scale pain score was 0.59 and Dermatology Life Quality Index score was 0.91.
CONCLUSION
IL-23 inhibitors have proven effective in managing both skin and joint symptoms in patients with psoriasis at risk for PsA. Whilst the findings suggest that IL-23 inhibitors may help control early musculoskeletal symptoms in patients with psoriasis at risk of PsA, the absence of systematic rheumatological evaluation and the retrospective design preclude definitive conclusions about their disease-modifying potential. These results suggest a potential disease-modifying role that warrants further prospective validation.
背景
银屑病是一种慢性炎症性疾病，许多患者可能会发展为银屑病关节炎（PsA）。诸如附着点炎和指甲受累等临床体征已被认为是这种病情进展的早期指标。白细胞介素-23（IL-23）抑制剂已在银屑病治疗中显示出有效性，最近在银屑病关节炎治疗中也有成效。本文旨在评估IL-23抑制剂对中重度银屑病且有早期肌肉骨骼受累的患者的银屑病关节炎临床结局及病情进展的影响。
方法
这是一项在意大利进行的回顾性、多中心观察性研究。数据收集自207名成年患者，这些患者在纳入研究前已开始使用古塞库单抗、司库奇尤单抗或替拉珠单抗进行治疗。所有临床数据，包括基线特征和随访结果，均从八个皮肤科中心的医疗记录中进行回顾性检索。
结果
在有关节受累的患者中，44.8%观察到附着点炎。古塞库单抗是最常用的治疗药物（57%），并在银屑病面积和严重程度指数、视觉模拟评分法疼痛评分以及皮肤病生活质量指数评分方面显示出持续改善。重要的是，接受古塞库单抗治疗的附着点炎患者中，没有患者进展为明显的银屑病关节炎。在52周时，银屑病面积和严重程度指数平均评分为0.61，视觉模拟评分法疼痛评分为0.59，皮肤病生活质量指数评分为0.91。
结论
IL-23抑制剂已被证明对有银屑病关节炎风险的银屑病患者的皮肤和关节症状均有效。虽然研究结果表明IL-23抑制剂可能有助于控制有银屑病关节炎风险的银屑病患者的早期肌肉骨骼症状，但缺乏系统的风湿病学评估以及回顾性设计妨碍了对其改善病情潜力得出明确结论。这些结果表明其具有潜在的改善病情作用，值得进一步进行前瞻性验证。
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