白细胞介素(IL)-12/23、IL-17和IL-23抑制剂治疗中度至重度斑块状银屑病的疗效和安全性的系统评价  

A systematic review of the efficacy and safety of the interleukin(IL)-12/23, IL-17 and IL-23 inhibitors for the treatment of moderate to severe plaque psoriasis

作　　者：李明洙 钟伟章[1] LI Ming-zhu;ZHONG Wei-zhang(Department of Pharmacy,the People's Hospital of Gaozhou,Gaozhou 525200,China)

机构地区：[1]高州市人民医院药剂科,广东高州525200

出　　处：《临床皮肤科杂志》2022年第1期11-18,共8页Journal of Clinical Dermatology

摘　　要：目的:对白细胞介素(IL)抑制剂治疗中度至重度斑块状银屑病的疗效和安全性进行系统评价,为临床选用银屑病治疗药物提供参考依据。方法:通过计算机检索PubMed、Cochrane Library、EMbase、Web of Science、CNKI、WanFang Data和CBM数据库2000年1月至2019年9月公开发表的IL抑制剂治疗中度至重度斑块状银屑病的Ⅱ或Ⅲ期临床试验研究。根据纳入和排除标准筛选文献,并采用Cochrane评价工具对纳入文献的质量和偏倚风险进行评价。采用RevMan 5.3对疗效和安全性指标进行Meta分析。结果:共纳入29项随机对照研究,银屑病面积和严重程度指数(psoriasis area and severity index, PASI)PASI 75和PASI 90及医师的全面评估(Physician’s Global Assessment, s PGA)0/1或研究者的全面评估(Investigator’s Global Assessment, sIGA)0/1的Meta分析共同表明,与安慰剂相比,依奇珠单抗疗效最佳,其次是司库奇尤单抗、优特克诺和布罗达单抗,古塞奇尤单抗、替拉珠单抗和瑞莎珠单抗疗效略差;不良反应(Adverse Event, AE)的Meta分析表明替拉珠单抗最安全,其次是优特克诺和古塞奇尤单抗,依奇珠单抗和司库奇尤单抗的风险最高。结论:IL-17抑制剂相对选择性IL-23抑制剂更有效,选择性IL-23抑制剂比IL-17抑制剂更安全,IL-12/23抑制剂的疗效和安全性介于两者之间。Objective: To evaluate the efficacy and safety of interleukin(IL) inhibitors in the treatment of moderate to severe plaque psoriasis, and to provide the clinician with treatment options. Methods: PubMed, Cochrane Library, EMbase, Web of Science, CNKI, WanFang Data, and CBM database were searched for IL inhibitors for the treatment of moderate to severe plaque psoriasis, and the studies of phase Ⅱ or Ⅲ clinical trials published from January 2000 to September 2019 were collected. The literature was screened according to the inclusion and exclusion criteria, and the Cochrane tool was used to assess the quality and risk of bias of the included studies. Efficacy and safety were analyzed with meta-analysis using Revman5.3. Results: A total of 29 randomized controlled trials were included. The result of meta-analysis from PASI 75, PASI 90 reaction and the sPGA 0/1 or sIGA 0/1 showed that ixekizumab ranked the highest in efficacy, followed by secukinumab,ustekinumab and brodalumab, while guselkumab, tildtakizumab and risankizumab were slightly less effective, compared with the placebo group. In terms of having a risk of adverse events, tildtakizumab was found to be the safest, followed by ustekinumab and guselkumab, while ixekizumab and secukinumab were found to be the least safe. Conclusion: IL-17 inhibitors were found to be more effective than selective IL-23 inhibitors, selective IL-23 inhibitors were safer than IL-17 inhibitors,and the efficacy and safety of IL-12/23 inhibitors were somewhere in between.

关 键 词：银屑病 斑块状 白细胞介素 白细胞介素抑制剂 系统评价 

分 类 号：R758.63[医药卫生—皮肤病学与性病学]