评价不同剂量新药治疗银屑病关节炎的有效性及安全性网状Meta分析  

A network meta-analysis to evaluate the efficacy and safety of different dosages of new drugs in the treatment of psoriatic arthritis

作　　者：吴珮涵 王晓霞[2] 刘桂海 迟艳春 毛小琦 靳岩青 韩涛 聂艳聪 尹梅林 Wu Peihan;Wang Xiaoxia;Liu Guihai;Chi Yanchun;Mao Xiaoqi;Jin Yanqing;Han Tao;Nie Yancong;Yin Meilin(Graduate School of Shanxi Medical University,Taiyuan 030001,China;Department of Rheumatology,the Second Hospital of Shanxi Medical University,Taiyuan 03000l,China)

机构地区：[1]山西医科大学研究生学院,太原030001 [2]山西医科大学第二医院风湿免疫科,太原030001

出　　处：《中华风湿病学杂志》2023年第5期321-326,共6页Chinese Journal of Rheumatology

摘　　要：目的通过网状Meta分析比较不同剂量新药治疗银屑病关节炎(PsA)的有效性及安全性。方法通过检索PubMed、Web of Science、Cochrane Library 3个医学文献数据库(自建库至2021年12月)比较不同剂量司库奇尤单抗、伊西贝单抗、阿普斯特、托法替尼治疗活动性PsA的相关文献, 使用Stata 15.0软件对纳入研究的数据进行分析。结果共纳入16项随机对照试验, 网状Meta分析结果显示:(1)全部患者ACR20应答率方面, 累计排序曲线下面积(SUCRA)越大越有效, 司库奇尤单抗300 mg 1次/4周(96.1%)疗效最佳, 其次为伊西贝单抗80 mg 1次/4周(79.0%)、伊西贝单抗80 mg 1次/2周(75.1%)、司库奇尤单抗150 mg 1次/4周(73.2%)、阿普斯特30 mg 2次/d(50.6%)、阿普斯特20 mg 2次/d(38.6%)、托法替尼5 mg 2次/d(18.1%)、托法替尼10 mg 2次/d(17.7%)、安慰剂(2.0%)。(2)在全部患者银屑病面积和严重程度评分改善≥75%(PASI75)应答率方面, SUCRA曲线下面积越大越有效, 伊西贝单抗80 mg 1次/周(96.1%)疗效最佳, 其次为伊西贝单抗80 mg 1次/2周(88.7%)、司库奇尤单抗300 mg 1次/4周(75.6%)、司库奇尤单抗150 mg 1次/4周(63.3%)、阿普斯特30 mg 2次/d(44.5%)、阿普斯特20 mg 2次/d(38.4%)、托法替尼10 mg 2次/d(30.0%)、托法替尼5 mg 2次/d(12.5%)、安慰剂(1.0%)。(3)在全部患者安全性方面, SUCRA曲线下面积越小安全性越高, 司库奇尤单抗300 mg 1次/4周(17.3%)安全性最佳。(4)亚组分析结果显示, 在ACR20应答率方面, 伊西贝单抗80 mg 1次/2周(85.3%)在未使用过bDMARDs的患者中疗效最佳, 而在对bDMARDs治疗反应不充分患者中, 司库奇尤单抗300 mg 1次/4周(83.9%)疗效最佳。结论在全部患者中, 司库奇尤单抗300 mg 1次/4周在ACR20应答率及安全性方面表现最佳, 但在改善PsA皮损方面, 伊西贝单抗80 mg 1次/4周可能更加有效。Objective To compare the efficacy and safety of different dosages of new drugs in the treatment of PsA by using network meta-analysis.Methods Three medical databases(PubMed,Web of Science,Cochrane Library)were searched for the studies that compared the efficacy and safety of 4 new drugs(secukinumab,ixekizumab,apremilast,tofacitinib)with different dosages in the treatment of PsA.Data from included studies were analyzed by Stata 15.0.Results A total of 16 RCTs were included.The results of the network meta-analysis showed that:(1)Among the overall patients,in terms of ACR20 response rate,the larger the surface under the cumulative ranking(SUCRA),the more effective it is.Secukinumab 300 mg Q4W(96.1%)had the best efficacy,followed by ixekizumab 80 mg Q4W(79.0%),ixekizumab 80 mg Q2W(75.1%),secukinumab 150 mg Q4W(73.2%),apremilast 30 mg BID(50.6%),apremilast 20 mg BID(38.6%),tofacitinib 5 mg BID(18.1%),tofacitinib 10 mg BID(17.7%)and placebo(2.0%).(2)In terms of PASI75 response rate,the larger the area under the SUCRA curve,the more effective it is.Ixekizumab 80 mg Q4W(96.1%)had the best efficacy,followed by ixekizumab 80 mg Q2W(88.7%),secukinumab 300 mg Q4W(75.6%),secukinumab 150 mg Q4W(63.3%),apremilast 30 mg BID(44.5%),apremilast 20 mg BID(38.4%),tofacitinib 10 mg BID(30.0%),tofacitinib 5 mg BID(12.5%)and placebo(1.0%).(3)Among the overall patients,in terms of safety,the smaller the area under the SUCRA curve,the higher the safety it is.Secukinumab 300 mg Q4W(17.3%)has the best safety.(4)The results of subgroup analysis showed that in terms of ACR20 response rate,ixekizumab 80 mg Q2W(85.3%)had the best efficacy in bDMARDs-naive patients,while in bDMARDs-IR patients,secukinumab 300 mg Q4W(83.9%)had the best efficacy.Conclusion Among all patients,secukinumab 300 mg Q4W is the best in terms of ACR20 response rate and safety,but ixekizumab 80 mg Q4W is more effective in improving PsA lesions comparing yo other drugs.

关 键 词：银屑病 关节炎 牛皮癣 META分析 司库奇尤单抗 阿普斯特 

分 类 号：R758.63[医药卫生—皮肤病学与性病学] R684.3[医药卫生—临床医学]