Background: Psoriasis is a common, chronic, immune-mediated inflammatory skin disease with increased epidermal proliferation. The objective of this review was to systematically identify the evidence and perform a netw...Background: Psoriasis is a common, chronic, immune-mediated inflammatory skin disease with increased epidermal proliferation. The objective of this review was to systematically identify the evidence and perform a network meta-analysis (NMA) to estimate the relative efficacy of secukinumab (SEC) against adalimumab (ADA) and infliximab (INF) for the treatment of moderate-to-severe plaque psoriasis.Methods: A systematic literature review (SLR) was conducted according to a pre-specified protocol to identify relevant studies. Initially, the databases were searched from database inception till June 2013, and the SLR was updated in April 2020. The eligibility criteria included adult patients (≥18 years old) with moderate-to-severe plaque psoriasis, and the SLR included randomized controlled trials (RCTs). The comparators of interest were SEC, ADA, INF, and placebo (PLA), while outcomes of interest were Psoriasis Area and Severity Index (PASI) (50, 75, and 90) at weeks 12, 16, and 24. A Bayesian NMA for PASI was utilized with a framework that evaluated the probability of PASI responses in different categories of PASI thresholds within a single model.Results: A total of 23 RCTs that assessed the efficacy of SEC, ADA, and INF in patients with moderate-to-severe plaque psoriasis were identified. At 12 weeks, SEC was associated with a significantly better response compared with PLA and ADA for PASI 75 and 90, while response results were comparable against INF. At 12 weeks, risk ratio (95% confidence interval) derived from NMA for SECvs. ADA and INF for PASI 75 was 1.35 (1.19, 1.57) and 1.01 (0.90, 1.18), respectively. At the 16-week and 24-week time interval, SEC was significantly better than PLA, ADA, and INF for PASI 75 and 90.Conclusion: Efficacy of SEC in the treatment of patient populations with moderate-to-severe plaque psoriasis is well demonstrated through NMA.展开更多
目的探讨中性粒细胞和淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)联合超敏C反应蛋白(high sensitive C reaction protein,hs-CRP)在预测甲氨蝶呤(methotrexate,MTX)治疗中-重度斑块型银屑病患者临床疗效中的效能。方法回顾性纳...目的探讨中性粒细胞和淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)联合超敏C反应蛋白(high sensitive C reaction protein,hs-CRP)在预测甲氨蝶呤(methotrexate,MTX)治疗中-重度斑块型银屑病患者临床疗效中的效能。方法回顾性纳入皮肤科门诊及住院的62例中-重度斑块型银屑病患者和45例健康对照组作为研究对象。中-重度斑块型银屑病患者在采用MTX系统性治疗16周后 PASI评分降低75%以上设为应答者(n=49),其余设为非应答者(n=13)。记录并比较中-重度斑块型银屑病患者治疗前和健康对照组的血常规参数和hs-CRP水平的差异,采用Pearson相关分析分析治疗前中-重度斑块型银屑病患者PASI评分与上述指标的相关性;比较血常规参数、hs-CRP及银屑病临床特征等参数在应答者和无应答者中的差异并采用Logistic回归分析无应答者的影响因素;利用受试者操作特征(receiver operating characteristic,ROC)曲线探讨NLR联合hs-CRP预测无应答者的临床效能。结果中-重度斑块型银屑病患者治疗前WBC、N、NLR、hs-CRP和PASI评分显著高于治疗后,差异均具有统计学意义;L、PLT、PDW、RDW在治疗前、治疗后及对照组间差异无统计学意义;Pearson相关分析显示治疗前中-重度斑块型银屑病患者PASI评分与WBC、N、NLR和hs-CRP存在显著正相关性;Logistic 回归分析结果显示NLR和hs-CRP是无应答者的影响因素。ROC曲线显示NLR联合hs-CRP预测无应答者的临床效能较高,敏感度为98.42%,特异性为75.31%。结论 NLR联合hs-CRP对MTX治疗中-重度斑块型银屑病患者的临床疗效具有一定的预测价值,临床医生可常规检查NLR和hs-CRP水平。展开更多
文摘Background: Psoriasis is a common, chronic, immune-mediated inflammatory skin disease with increased epidermal proliferation. The objective of this review was to systematically identify the evidence and perform a network meta-analysis (NMA) to estimate the relative efficacy of secukinumab (SEC) against adalimumab (ADA) and infliximab (INF) for the treatment of moderate-to-severe plaque psoriasis.Methods: A systematic literature review (SLR) was conducted according to a pre-specified protocol to identify relevant studies. Initially, the databases were searched from database inception till June 2013, and the SLR was updated in April 2020. The eligibility criteria included adult patients (≥18 years old) with moderate-to-severe plaque psoriasis, and the SLR included randomized controlled trials (RCTs). The comparators of interest were SEC, ADA, INF, and placebo (PLA), while outcomes of interest were Psoriasis Area and Severity Index (PASI) (50, 75, and 90) at weeks 12, 16, and 24. A Bayesian NMA for PASI was utilized with a framework that evaluated the probability of PASI responses in different categories of PASI thresholds within a single model.Results: A total of 23 RCTs that assessed the efficacy of SEC, ADA, and INF in patients with moderate-to-severe plaque psoriasis were identified. At 12 weeks, SEC was associated with a significantly better response compared with PLA and ADA for PASI 75 and 90, while response results were comparable against INF. At 12 weeks, risk ratio (95% confidence interval) derived from NMA for SECvs. ADA and INF for PASI 75 was 1.35 (1.19, 1.57) and 1.01 (0.90, 1.18), respectively. At the 16-week and 24-week time interval, SEC was significantly better than PLA, ADA, and INF for PASI 75 and 90.Conclusion: Efficacy of SEC in the treatment of patient populations with moderate-to-severe plaque psoriasis is well demonstrated through NMA.
