古塞奇尤单抗治疗中重度斑块型银屑病的减停药复发及重启治疗模式观察  

Relapse and Restart Treatment After Prolong Dosing Interval and Withdrawal of Guselkumab in Moderate-to-Severe Plaque Psoriasis

作　　者：郭金竹[1] 张芊[1] 王文慧[1] GUO Jinzhu;ZHANG Qian;WANG Wenhui(Department of Dermatology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院皮肤科,北京100191

出　　处：《中国皮肤性病学杂志》2024年第3期271-278,共8页The Chinese Journal of Dermatovenereology

基　　金：北京自然科学基金面上项目(7232197);北京健康促进会医学科学研究基金项目(Z2022023058008)。

摘　　要：目的研究古塞奇尤单抗治疗中重度斑块型银屑病的疗效及安全性,减停药及重启治疗的长期治疗模式。方法纳入随访时间40周以上的应用古塞奇尤单抗治疗的成人中重度斑块型银屑病患者,达到PASI90后医患共同决策继续治疗、延长给药间隔、停药观察随访及重启治疗,评价短期及长期的疗效及安全性,停药后重启治疗的时间及方案。结果共纳入39例患者,男25例,女14例,平均年龄(39.7±13.2)岁,平均基线PASI评分(16.3±12.1)分,平均用药时间为(64.9±41.0)周,平均随访时间(99.7±36.3)周。12周时达到PASI100/90/75/50分别为23.08%/58.97%/87.18%/97.44%,20周时89.74%的患者达到PASI90。15例(38.46%)延长了用药间隔,延长期间均可维持在PASI90。26例(66.67%)进行了停药,平均用药时间为(37.6±18.1)周,平均在达到PASI90后的(22.1±18.9)周停药,停药后重启治疗的平均时间为(45.9±21.8)周。停药的26例患者中25例复发重启治疗,其中15例仍用古塞奇尤单抗,均可重新达到PASI90,10例转换为其他生物制剂的患者中4例由于疗效欠佳又再次转换为古塞奇尤单抗,均可重新达到PASI90。7例患者在20周及之前停药,19例在20周之后停药,20周及之前停药组的重启治疗时间虽然长于20周之后停药组,但差异无统计学意义(P=0.111)。16例(41.03%)患者报告了不影响继续用药的不良事件,无严重不良事件。结论古塞奇尤单抗治疗中重度斑块型银屑病的短期及长期疗效和安全性良好,达到PASI90后维持稳定可适当延长用药间隔或停药,停药至重启系统治疗平均时间45.9周,重启治疗可再次应答。Objective To study the efficacy and safety of guselkumab in the treatment of moderate-to-severe plaque psoriasis,and the long-term treatment model of prolong dosing interval,withdrawal and restart.Methods Patients with moderate-to-severe plaque psoriasis treated with guselkumab with a follow-up time of more than 40 weeks were included.After reaching PASI90,doctors and patients co-decided to continue treatment,prolong the dosing interval,withdrawal and restart treatment.The short-term and long-term efficacy and safety,and the withdrawal time and restart time were evaluated.Results A total of 39 patients were included,including 25 males and 14 females,with a mean age of(39.7±13.2)years.The mean baseline PASI score was 16.3±12.1.The mean duration of treatment was(64.9±41.0)weeks,and the mean follow-up time was(99.7±36.3)weeks.PASI100/90/75/50 at 12 weeks was 23.08%/58.97%/87.18%/97.44%.At 20 weeks,89.74%of patients achieved PASI90.Fifteen cases(38.46%)prolonged the dosing interval,and PASI90 could be maintained during the prolonged period.A total of 26 patients(66.67%)withdrew,the mean duration of treatment prior to withdrawal was(37.6±18.1)weeks,the mean duration from achieving PASI90 to withdrawal was(22.1±18.9)weeks,and the mean duration of restart was(45.9±21.8)weeks after withdrawal.Among the 26 patients who withdrew,25 cases restarted systemic treatment,of which 15 cases were still on guselkumab,all of which could achieve PASI90,10 cases were switched to other biologics,including 4 cases were switched to guselkumab again due to poor efficacy,of which could achieve PASI90.Seven patients withdrew treatment at or before 20 weeks,and 19 patients withdrew after 20 weeks.Although the restart time after withdrawal in the group stopped treatment at or before 20 weeks was longer than that in the group after 20 weeks,there was no significant difference(P=0.111).Sixteen(41.03%)patients reported adverse events that did not affect the continuation of treatment,and no serious adverse events occurred.Conclusion The sh

关 键 词：银屑病 生物制剂 IL-23 古塞奇尤单抗 停药 复发 

分 类 号：R758.63[医药卫生—皮肤病学与性病学]