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Efficacy, Safety, and Long-Term Disease Control of Ruxolitinib Cream Among Adolescents with Atopic Dermatitis: Pooled Results from Two Randomized Phase 3 Studies Ruxolitinib乳膏在青少年特应性皮炎患者中的疗效、安全性和长期疾病控制:两项随机 3 期研究的汇总结果。
IF 8.6 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-05-02 DOI: 10.1007/s40257-024-00855-2
Lawrence F. Eichenfield, Eric L. Simpson, Kim Papp, Jacek C. Szepietowski, Andrew Blauvelt, Leon Kircik, Jonathan I. Silverberg, Elaine C. Siegfried, Michael E. Kuligowski, May E. Venturanza, Howard Kallender, Haobo Ren, Amy S. Paller
<div><h3>Background</h3><p>Atopic dermatitis (AD), a highly pruritic, inflammatory skin disease, affects approximately 7% of adolescents globally. A topical formulation of ruxolitinib, a Janus kinase (JAK) 1/JAK2 inhibitor, demonstrated safety and efficacy among adolescents/adults in two phase 3 studies (TRuE-AD1/TRuE-AD2).</p><h3>Objective</h3><p>To describe safety and efficacy of 1.5% ruxolitinib cream versus vehicle and long-term disease control of ruxolitinib cream among adolescents aged 12–17 years from pooled phase 3 study data.</p><h3>Methods</h3><p>Patients [≥ 12 years old with AD for ≥ 2 years, Investigator’s Global Assessment score (IGA) 2/3, and 3–20% affected body surface area (BSA) at baseline] were randomized 2:2:1 to ruxolitinib cream (0.75%/1.5%) or vehicle for 8 weeks of continuous use followed by a long-term safety (LTS) period up to 52 weeks with as-needed use. Patients originally applying vehicle were rerandomized 1:1 to 0.75%/1.5% ruxolitinib cream. Efficacy measures at week 8 included IGA treatment success (IGA-TS; i.e., score of 0/1 with ≥ 2 grade improvement from baseline), ≥ 75% improvement in Eczema Area and Severity Index (EASI-75), and ≥ 4-point improvement in itch numerical rating scale (NRS4). Measures of disease control during the LTS period included IGA score of 0 (clear) or 1 (almost clear) and percentage affected BSA. Safety was assessed throughout the study.</p><h3>Results</h3><p>Of 1249 randomized patients, 245 (19.6%) were aged 12–17 years. Of these, 45 patients were randomized to vehicle and 92 patients to 1.5% ruxolitinib cream. A total of 104/137 (75.9%) patients continued on 1.5% ruxolitinib cream in the LTS period [82/92 (89.1%) continued on 1.5% ruxolitinib cream; 22/45 (48.9%) patients on vehicle were reassigned to 1.5% ruxolitinib cream], and 83/104 (79.8%) of these patients completed the LTS period. At week 8, substantially more patients who applied 1.5% ruxolitinib cream versus vehicle achieved IGA-TS (50.6% versus 14.0%), EASI-75 (60.9% versus 34.9%), and NRS4 (52.1% versus 17.4%; <i>P</i> = 0.009). The mean (SD) reduction in itch NRS scores was significantly greater in patients applying 1.5% ruxolitinib cream versus vehicle from day 2 [− 0.9 (1.9) versus −0.2 (1.4); <i>P</i> = 0.03]. During the LTS period, mean (SD) trough steady-state ruxolitinib plasma concentrations at weeks 12/52 were 27.2 (55.7)/15.5 (31.5) nM. The percentage of patients achieving IGA score of 0 or 1 was sustained or further increased with 1.5% ruxolitinib cream; mean affected BSA was generally low (< 3%; i.e., mild disease). Through 52 weeks, application site reactions occurred in 1.8% of adolescent patients applying 1.5% ruxolitinib cream at any time; no patients had serious adverse events. There were no serious infections, malignancies, major adverse cardiovascular events, or thromboembolic events.</p><h3>Conclusions</h3><p>Meaningful anti-inflammatory and antipruritic effects were demonstrated with 1.5% ruxolitinib crea
背景:特应性皮炎(AD)是一种高度瘙痒的炎症性皮肤病,全球约有 7% 的青少年患有该病。在两项三期研究(TRuE-AD1/TRuE-AD2)中,一种Janus激酶(JAK)1/JAK2抑制剂Ruxolitinib的外用制剂在青少年/成人中显示出安全性和有效性:目的:通过汇总3期研究数据,描述1.5%鲁索利替尼乳膏与载体的安全性和有效性,以及鲁索利替尼乳膏在12-17岁青少年中的长期疾病控制情况:患者[年龄≥12岁,AD病程≥2年,研究者总体评估评分(IGA)2/3,基线时受影响体表面积(BSA)3-20%]按2:2:1随机分配至鲁索利替尼乳膏(0.75%/1.5%)或载体,连续使用8周,然后按需使用,长期安全(LTS)期长达52周。最初使用载体的患者按1:1重新随机分配到0.75%/1.5%的芦可利替尼乳膏。第8周的疗效测量包括IGA治疗成功率(IGA-TS;即评分为0/1,与基线相比改善≥2级)、湿疹面积和严重程度指数(EASI-75)改善≥75%、瘙痒数字评分量表(NRS4)改善≥4分。长效治疗期间的疾病控制指标包括IGA评分为0(无)或1(基本无)以及受影响的BSA百分比。安全性评估贯穿整个研究过程:在 1249 名随机患者中,有 245 人(19.6%)的年龄在 12-17 岁之间。其中,45名患者被随机分配使用药物,92名患者被随机分配使用1.5%芦索替尼乳膏。共有104/137(75.9%)名患者在长效治疗期继续使用1.5%芦可利替尼乳膏[82/92(89.1%)名患者继续使用1.5%芦可利替尼乳膏;22/45(48.9%)名使用药物的患者被重新分配到1.5%芦可利替尼乳膏],其中83/104(79.8%)名患者完成了长效治疗期。第8周时,使用1.5% ruxolitinib乳膏的患者达到IGA-TS(50.6%对14.0%)、EASI-75(60.9%对34.9%)和NRS4(52.1%对17.4%;P = 0.009)的人数远多于使用药物的患者。从第 2 天起,使用 1.5% Ruxolitinib 乳膏的患者瘙痒 NRS 评分的平均(标度)降幅明显高于使用药物的患者[- 0.9 (1.9) 对 -0.2 (1.4); P = 0.03]。在LTS期间,第12/52周的平均(标度)稳态鲁索利替尼血浆谷浓度为27.2 (55.7)/15.5 (31.5) nM。使用1.5% ruxolitinib乳膏后,IGA评分达到0或1分的患者比例保持不变或进一步增加;受影响的BSA平均值普遍较低(< 3%;即病情较轻)。在使用 1.5% Ruxolitinib 乳膏的 52 周内,1.8% 的青少年患者在任何时候都发生过涂抹部位反应;没有患者出现严重不良事件。没有发生严重感染、恶性肿瘤、重大不良心血管事件或血栓栓塞事件:结论:1.5%芦可利替尼乳膏在青少年AD患者中具有显著的抗炎和止痒效果,与在整个研究人群中观察到的效果相当;长期按需使用可维持疾病控制,且耐受性良好:临床试验注册:ClinicalTrials.gov标识符NCT03745638(2018年11月19日注册)和NCT03745651(2018年11月19日注册)。
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引用次数: 0
American Academy of Dermatology Annual Meeting: San Diego, CA, USA, 8–12 March 2024 美国皮肤病学会年会:美国加利福尼亚州圣地亚哥,2024 年 3 月 8-12 日。
IF 8.6 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-04-26 DOI: 10.1007/s40257-024-00860-5
Kathy A. Fraser
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引用次数: 0
Merkel Cell Carcinoma: Integrating Epidemiology, Immunology, and Therapeutic Updates 梅克尔细胞癌:整合流行病学、免疫学和最新治疗方法
IF 8.6 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-04-22 DOI: 10.1007/s40257-024-00858-z
Jürgen C. Becker, Andreas Stang, David Schrama, Selma Ugurel

Merkel cell carcinoma (MCC) is a rare skin cancer characterized by neuroendocrine differentiation. Its carcinogenesis is based either on the integration of the Merkel cell polyomavirus or on ultraviolet (UV) mutagenesis, both of which lead to high immunogenicity either through the expression of viral proteins or neoantigens. Despite this immunogenicity resulting from viral or UV-associated carcinogenesis, it exhibits highly aggressive behavior. However, owing to the rarity of MCC and the lack of epidemiologic registries with detailed clinical data, there is some uncertainty regarding the spontaneous course of the disease. Historically, advanced MCC patients were treated with conventional cytotoxic chemotherapy yielding a median response duration of only 3 months. Starting in 2017, four programmed cell death protein 1 (PD-1)/programmed cell death-ligand 1 (PD-L1) immune checkpoint inhibitors—avelumab, pembrolizumab, nivolumab (utilized in both neoadjuvant and adjuvant settings), and retifanlimab—have demonstrated efficacy in treating patients with disseminated MCC on the basis of prospective clinical trials. However, generating clinical evidence for rare cancers, such as MCC, is challenging owing to difficulties in conducting large-scale trials, resulting in small sample sizes and therefore lacking statistical power. Thus, to comprehensively understand the available clinical evidence on various immunotherapy approaches for MCC, we also delve into the epidemiology and immune biology of this cancer. Nevertheless, while randomized studies directly comparing immune checkpoint inhibitors and chemotherapy in MCC are lacking, immunotherapy shows response rates comparable to those previously reported with chemotherapy but with more enduring responses. Notably, adjuvant nivolumab has proven superiority to the standard-of-care therapy (observation) in the adjuvant setting.

梅克尔细胞癌(MCC)是一种以神经内分泌分化为特征的罕见皮肤癌。梅克尔细胞癌的发生是基于梅克尔细胞多瘤病毒的整合或紫外线(UV)诱变,两者都会通过病毒蛋白或新抗原的表达导致高免疫原性。尽管这种免疫原性是由病毒或紫外线相关致癌作用产生的,但它仍表现出高度的侵袭性。然而,由于 MCC 的罕见性以及缺乏具有详细临床数据的流行病学登记,该病的自发病程还存在一定的不确定性。从历史上看,晚期 MCC 患者接受常规细胞毒性化疗的中位反应持续时间仅为 3 个月。从2017年开始,四种程序性细胞死亡蛋白1(PD-1)/程序性细胞死亡配体1(PD-L1)免疫检查点抑制剂--阿维单抗、pembrolizumab、nivolumab(用于新辅助治疗和辅助治疗)和retifanlimab--在前瞻性临床试验的基础上证明了治疗播散性MCC患者的疗效。然而,由于难以开展大规模试验,样本量较小,因此缺乏统计效力,为 MCC 等罕见癌症提供临床证据具有挑战性。因此,为了全面了解 MCC 各种免疫疗法的现有临床证据,我们还深入研究了这种癌症的流行病学和免疫生物学。尽管如此,虽然缺乏直接比较免疫检查点抑制剂和化疗在 MCC 中的应用的随机研究,但免疫疗法显示的反应率与之前报道的化疗反应率相当,而且反应更持久。值得注意的是,在辅助治疗中,nivolumab 辅助治疗已被证明优于标准治疗(观察)。
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引用次数: 0
Ultrasound Surveillance in Melanoma Management: Bridging Diagnostic Promise with Real-World Adherence: A Systematic Review and Meta-Analysis 黑色素瘤管理中的超声监测:连接诊断承诺与现实世界的坚持:系统回顾与元分析
IF 8.6 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-04-18 DOI: 10.1007/s40257-024-00862-3
Zhao Feng Liu, Amy Sylivris, Johnny Wu, Darren Tan, Samuel Hong, Lawrence Lin, Michael Wang, Christopher Chew

Background

Ultrasound surveillance has become the new standard of care in stage III melanoma after the 2017 Multicenter Selective Lymphadenectomy Trial II (MSLT-II) demonstrated non-inferior 3-year survival compared with complete lymph node dissection.

Objective

We aimed to quantify diagnostic performance and adherence rates of ultrasound surveillance for melanoma locoregional metastasis, offering insights into real-world applicability.

Methods

Conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we systematically searched the Medline, Embase, Cochrane Library, CINAHL, Scopus, and Web of Science databases from inception until 11 October 2023. All primary studies that reported data on the diagnostic performance or adherence rates to ultrasound surveillance in melanoma were included. R statistical software was used for data synthesis and analysis. Sensitivity and specificity were aggregated across studies using the meta-analytic method for diagnostic tests outlined by Rutter and Gatsonis. Adherence rates were calculated as the ratio of patients fully compliant to planned follow-up to those who were not.

Results

A total of 36 studies including 18,273 patients were analysed, with a mean age of 56.6 years and a male-to-female ratio of 1:1.11. The median follow-up duration and frequency was 36 and 4 months, respectively. The pooled sensitivity of ultrasound examination was 0.879 (95% confidence interval [CI] 0.878–0.879) and specificity was 0.969 (95% CI 0.968–0.970), representing a diagnostic odds ratio of 224.5 (95% CI 223.1–225.9). Ultrasound examination demonstrated a substantial improvement in absolute sensitivity over clinical examination alone, with a number needed to screen (NNS) of 2.95. The overall adherence rate was 77.0% (95% CI 76.0–78.1%), with significantly lower rates in the United States [US] (p <  0.001) and retrospective studies (p <  0.001).

Conclusion

Ultrasound is a powerful diagnostic tool for locoregional melanoma metastasis. However, the real applicability to surveillance programmes is limited by low adherence rates, especially in the US. Further studies should seek to address this adherence gap.

背景2017年多中心选择性淋巴结切除术试验II(MSLT-II)显示,与完全淋巴结清扫术相比,超声监测的3年生存率并不劣于完全淋巴结清扫术,因此超声监测已成为III期黑色素瘤治疗的新标准。方法 根据系统综述和元分析首选报告项目(PRISMA)指南,我们系统检索了 Medline、Embase、Cochrane Library、CINAHL、Scopus 和 Web of Science 数据库中从开始到 2023 年 10 月 11 日的所有研究。纳入了所有报告黑色素瘤超声监测诊断效果或坚持率数据的主要研究。使用 R 统计软件进行数据综合与分析。采用 Rutter 和 Gatsonis 概述的诊断测试荟萃分析方法对各研究的敏感性和特异性进行汇总。坚持率按完全按计划随访的患者与未按计划随访的患者之比计算。结果 共分析了 36 项研究,包括 18 273 名患者,平均年龄为 56.6 岁,男女比例为 1:1.11。随访时间和次数的中位数分别为 36 个月和 4 个月。超声检查的汇总灵敏度为 0.879(95% 置信区间 [CI] 0.878-0.879),特异性为 0.969(95% CI 0.968-0.970),诊断几率比为 224.5(95% CI 223.1-225.9)。与单纯的临床检查相比,超声检查大大提高了绝对灵敏度,筛查所需人数(NNS)为 2.95。总体坚持率为 77.0%(95% CI 76.0-78.1%),美国(US)和回顾性研究(P< 0.001)的坚持率明显较低(P< 0.001)。结论超声波是局部黑色素瘤转移的强大诊断工具,但由于使用率较低,特别是在美国,其在监测计划中的实际应用受到了限制。进一步的研究应设法解决这一问题。
{"title":"Ultrasound Surveillance in Melanoma Management: Bridging Diagnostic Promise with Real-World Adherence: A Systematic Review and Meta-Analysis","authors":"Zhao Feng Liu,&nbsp;Amy Sylivris,&nbsp;Johnny Wu,&nbsp;Darren Tan,&nbsp;Samuel Hong,&nbsp;Lawrence Lin,&nbsp;Michael Wang,&nbsp;Christopher Chew","doi":"10.1007/s40257-024-00862-3","DOIUrl":"10.1007/s40257-024-00862-3","url":null,"abstract":"<div><h3>Background</h3><p>Ultrasound surveillance has become the new standard of care in stage III melanoma after the 2017 Multicenter Selective Lymphadenectomy Trial II (MSLT-II) demonstrated non-inferior 3-year survival compared with complete lymph node dissection.</p><h3>Objective</h3><p>We aimed to quantify diagnostic performance and adherence rates of ultrasound surveillance for melanoma locoregional metastasis, offering insights into real-world applicability.</p><h3>Methods</h3><p> Conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we systematically searched the Medline, Embase, Cochrane Library, CINAHL, Scopus, and Web of Science databases from inception until 11 October 2023. All primary studies that reported data on the diagnostic performance or adherence rates to ultrasound surveillance in melanoma were included. R statistical software was used for data synthesis and analysis. Sensitivity and specificity were aggregated across studies using the meta-analytic method for diagnostic tests outlined by Rutter and Gatsonis. Adherence rates were calculated as the ratio of patients fully compliant to planned follow-up to those who were not.</p><h3>Results</h3><p>A total of 36 studies including 18,273 patients were analysed, with a mean age of 56.6 years and a male-to-female ratio of 1:1.11. The median follow-up duration and frequency was 36 and 4 months, respectively. The pooled sensitivity of ultrasound examination was 0.879 (95% confidence interval [CI] 0.878–0.879) and specificity was 0.969 (95% CI 0.968–0.970), representing a diagnostic odds ratio of 224.5 (95% CI 223.1–225.9). Ultrasound examination demonstrated a substantial improvement in absolute sensitivity over clinical examination alone, with a number needed to screen (NNS) of 2.95. The overall adherence rate was 77.0% (95% CI 76.0–78.1%), with significantly lower rates in the United States [US] (<i>p</i> &lt;  0.001) and retrospective studies (<i>p</i> &lt;  0.001).</p><h3>Conclusion</h3><p>Ultrasound is a powerful diagnostic tool for locoregional melanoma metastasis. However, the real applicability to surveillance programmes is limited by low adherence rates, especially in the US. Further studies should seek to address this adherence gap.</p></div>","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":"25 4","pages":"513 - 525"},"PeriodicalIF":8.6,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140629942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Secondary Bacterial Infections in Patients with Atopic Dermatitis or Other Common Dermatoses 特应性皮炎或其他常见皮肤病患者的继发性细菌感染
IF 8.6 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-04-05 DOI: 10.1007/s40257-024-00856-1
Romain Salle, Pascal Del Giudice, Charbel Skayem, Camille Hua, Olivier Chosidow

Secondary bacterial infections of common dermatoses such as atopic dermatitis, ectoparasitosis, and varicella zoster virus infections are frequent, with Staphylococcus aureus and Streptococcus pyogenes being the bacteria most involved. There are also Gram-negative infections secondary to common dermatoses such as foot dyshidrotic eczema and tinea pedis. Factors favoring secondary bacterial infections in atopic dermatitis, ectoparasitosis, and varicella zoster virus infections mainly include an epidermal barrier alteration as well as itch. Mite-bacteria interaction is also involved in scabies and some environmental factors can promote Gram-negative bacterial infections of the feet. Furthermore, the bacterial ecology of these superinfections may depend on the geographical origin of the patients, especially in ectoparasitosis. Bacterial superinfections can also have different clinical aspects depending on the underlying dermatoses. Subsequently, the choice of class, course, and duration of antibiotic treatment depends on the severity of the infection and the suspected bacteria, primarily targeting S. aureus. Prevention of these secondary bacterial infections depends first and foremost on the management of the underlying skin disorder. At the same time, educating the patient on maintaining good skin hygiene and reporting changes in the primary lesions is crucial. In the case of recurrent secondary infections, decolonization of S. aureus is deemed necessary, particularly in atopic dermatitis.

特应性皮炎、体外寄生虫病和水痘带状疱疹病毒感染等常见皮肤病的继发性细菌感染很常见,其中金黄色葡萄球菌和化脓性链球菌是最常见的细菌。常见的皮肤病如足部湿疹和足癣也会继发革兰氏阴性菌感染。特应性皮炎、体外寄生虫病和水痘带状疱疹病毒感染中继发细菌感染的有利因素主要包括表皮屏障改变和瘙痒。疥疮还涉及螨虫与细菌的相互作用,某些环境因素会促进足部革兰氏阴性细菌感染。此外,这些超级感染的细菌生态可能取决于患者的地理来源,尤其是在体外寄生虫病中。细菌性超级感染还可能因潜在的皮肤病而有不同的临床表现。随后,抗生素治疗的种类、疗程和持续时间的选择取决于感染的严重程度和可疑细菌,主要针对金黄色葡萄球菌。这些继发性细菌感染的预防首先取决于对潜在皮肤疾病的治疗。同时,教育患者保持良好的皮肤卫生并报告原发病灶的变化也至关重要。对于反复出现的继发性感染,有必要对金黄色葡萄球菌进行去势处理,尤其是特应性皮炎患者。
{"title":"Secondary Bacterial Infections in Patients with Atopic Dermatitis or Other Common Dermatoses","authors":"Romain Salle,&nbsp;Pascal Del Giudice,&nbsp;Charbel Skayem,&nbsp;Camille Hua,&nbsp;Olivier Chosidow","doi":"10.1007/s40257-024-00856-1","DOIUrl":"10.1007/s40257-024-00856-1","url":null,"abstract":"<div><p>Secondary bacterial infections of common dermatoses such as atopic dermatitis, ectoparasitosis, and varicella zoster virus infections are frequent, with <i>Staphylococcus aureus</i> and <i>Streptococcus pyogenes</i> being the bacteria most involved. There are also Gram-negative infections secondary to common dermatoses such as foot dyshidrotic eczema and tinea pedis. Factors favoring secondary bacterial infections in atopic dermatitis, ectoparasitosis, and varicella zoster virus infections mainly include an epidermal barrier alteration as well as itch. Mite-bacteria interaction is also involved in scabies and some environmental factors can promote Gram-negative bacterial infections of the feet. Furthermore, the bacterial ecology of these superinfections may depend on the geographical origin of the patients, especially in ectoparasitosis. Bacterial superinfections can also have different clinical aspects depending on the underlying dermatoses. Subsequently, the choice of class, course, and duration of antibiotic treatment depends on the severity of the infection and the suspected bacteria, primarily targeting <i>S. aureus</i>. Prevention of these secondary bacterial infections depends first and foremost on the management of the underlying skin disorder. At the same time, educating the patient on maintaining good skin hygiene and reporting changes in the primary lesions is crucial. In the case of recurrent secondary infections, decolonization of <i>S. aureus</i> is deemed necessary, particularly in atopic dermatitis.</p></div>","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":"25 4","pages":"623 - 637"},"PeriodicalIF":8.6,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140587422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Early and Sustained Improvements in Symptoms and Quality of Life with Upadacitinib in Adults and Adolescents with Moderate-to-Severe Atopic Dermatitis: 52-Week Results from Two Phase III Randomized Clinical Trials (Measure Up 1 and Measure Up 2) 中重度特应性皮炎成人和青少年使用乌达帕替尼后症状和生活质量的早期和持续改善:两项 III 期随机临床试验(Measure Up 1 和 Measure Up 2)的 52 周结果。
IF 8.6 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-03-25 DOI: 10.1007/s40257-024-00853-4
Jonathan I. Silverberg, Melinda J. Gooderham, Amy S. Paller, Mette Deleuran, Christopher G. Bunick, Linda F. Stein Gold, DirkJan Hijnen, Brian M. Calimlim, Wan-Ju Lee, Henrique D. Teixeira, Xiaofei Hu, Shiyu Zhang, Yang Yang, Ayman Grada, Andrew M. Platt, Diamant Thaçi
<div><h3>Background</h3><p>Atopic dermatitis is a chronic inflammatory disease characterized by increased itch, skin pain, poor sleep quality, and other symptoms that negatively affect patient quality of life. Upadacitinib, an oral selective Janus kinase (JAK) inhibitor with greater inhibitory potency for JAK1 than JAK2, JAK3, or tyrosine kinase 2, is approved to treat moderate-to-severe atopic dermatitis.</p><h3>Objective</h3><p>We aimed to evaluate the effect of upadacitinib on patient-reported outcomes over 52 weeks in adults and adolescents with moderate-to-severe atopic dermatitis.</p><h3>Methods</h3><p>Data from two phase III monotherapy trials of upadacitinib (Measure Up 1, NCT03569293; Measure Up 2, NCT03607422) were integrated. Changes in pruritus, pain, other skin symptoms, sleep, quality of life, mental health, and patient impression were evaluated. Patient-reported outcome assessments included the Worst Pruritus Numerical Rating Scale, Patient-Oriented Eczema Measure, Dermatology Life Quality Index, Atopic Dermatitis Symptom Scale, Atopic Dermatitis Impact Scale, Hospital Anxiety and Depression Scale, SCORing Atopic Dermatitis index, Patient Global Impression of Severity, Patient Global Impression of Change, and Patient Global Impression of Treatment. Minimal clinically important differences, achievement of scores representing minimal disease burden, and the change from baseline were evaluated in patients who received upadacitinib through week 52 and in patients who received placebo through week 16.</p><h3>Results</h3><p>This analysis included 1609 patients (upadacitinib 15 mg, <i>N</i> = 557; upadacitinib 30 mg, <i>N</i> = 567; placebo, <i>N</i> = 485). Baseline demographics and disease characteristics were generally similar across all arms. The proportion of patients treated with upadacitinib reporting improvements in itch increased rapidly by week 1, increased steadily through week 8, and was sustained through week 52. Patients receiving upadacitinib also experienced improvements in pain and other skin symptoms by week 1, which continued through week 16; improvements were maintained through week 52. Patient reports of improved sleep increased rapidly from baseline to week 1, increased steadily through week 32, and were sustained through week 52. Patients experienced quality-of-life improvements through week 8, which were maintained through week 52. By week 1, patients in both upadacitinib groups experienced rapid improvements in emotional state, and by week 12, patients also achieved meaningful improvements in anxiety and depression. Improvements in mental health continued steadily through week 32 and were maintained through week 52. Patients treated with upadacitinib 30 mg generally experienced improvements in patient-reported outcomes earlier than those treated with upadacitinib 15 mg. Through week 16, patients receiving upadacitinib experienced greater improvements versus those receiving placebo in all assessed patient-reported
背景:特应性皮炎是一种慢性炎症性疾病,其特点是瘙痒加剧、皮肤疼痛、睡眠质量差以及对患者生活质量产生负面影响的其他症状。乌达帕替尼是一种口服选择性Janus激酶(JAK)抑制剂,对JAK1的抑制效力大于JAK2、JAK3或酪氨酸激酶2,已被批准用于治疗中度至重度特应性皮炎:我们旨在评估达达替尼对中重度特应性皮炎成人和青少年患者52周内患者报告结果的影响:我们整合了两项奥达替尼III期单药治疗试验(Measure Up 1,NCT03569293;Measure Up 2,NCT03607422)的数据。对瘙痒、疼痛、其他皮肤症状、睡眠、生活质量、心理健康和患者印象的变化进行了评估。患者报告的结果评估包括最严重瘙痒数字评分量表、以患者为导向的湿疹测量、皮肤科生活质量指数、特应性皮炎症状量表、特应性皮炎影响量表、医院焦虑和抑郁量表、SCORing 特应性皮炎指数、患者对严重程度的总体印象、患者对变化的总体印象以及患者对治疗的总体印象。评估了接受达达替尼治疗至第52周的患者和接受安慰剂治疗至第16周的患者的最小临床重要差异、达到代表最小疾病负担的评分以及与基线相比的变化:该分析包括1609名患者(达帕替尼15毫克,N = 557;达帕替尼30毫克,N = 567;安慰剂,N = 485)。所有治疗组的基线人口统计学和疾病特征基本相似。接受奥达帕替尼治疗的患者中,瘙痒症状有所改善的比例在第1周时迅速增加,在第8周时稳步上升,并持续到第52周。接受奥达替尼治疗的患者在第1周时疼痛和其他皮肤症状也有所改善,这种情况一直持续到第16周;这种改善一直维持到第52周。患者对睡眠改善的报告从基线到第1周迅速增加,在第32周稳步上升,并持续到第52周。患者的生活质量从第 8 周开始得到改善,并一直保持到第 52 周。到第1周时,两组达帕替尼患者的情绪状态都得到了迅速改善,到第12周时,患者的焦虑和抑郁情绪也得到了显著改善。心理健康状况的改善一直持续到第32周,并保持到第52周。与接受奥达替尼15毫克治疗的患者相比,接受奥达替尼30毫克治疗的患者通常更早出现患者报告结果的改善。在第16周,接受达达替尼治疗的患者与接受安慰剂治疗的患者相比,在所有评估的患者报告结果方面都有了更大的改善:结论:成人和青少年中重度特应性皮炎患者接受每天一次的奥达帕替尼15毫克或30毫克治疗后,在瘙痒、疼痛、其他皮肤症状、睡眠、生活质量和心理健康方面均有早期改善,并可持续到第52周:临床试验注册:ClinicalTrials.gov标识符NCT03569293(2018年8月13日)和NCT03607422(2018年7月27日)。
{"title":"Early and Sustained Improvements in Symptoms and Quality of Life with Upadacitinib in Adults and Adolescents with Moderate-to-Severe Atopic Dermatitis: 52-Week Results from Two Phase III Randomized Clinical Trials (Measure Up 1 and Measure Up 2)","authors":"Jonathan I. Silverberg,&nbsp;Melinda J. Gooderham,&nbsp;Amy S. Paller,&nbsp;Mette Deleuran,&nbsp;Christopher G. Bunick,&nbsp;Linda F. Stein Gold,&nbsp;DirkJan Hijnen,&nbsp;Brian M. Calimlim,&nbsp;Wan-Ju Lee,&nbsp;Henrique D. Teixeira,&nbsp;Xiaofei Hu,&nbsp;Shiyu Zhang,&nbsp;Yang Yang,&nbsp;Ayman Grada,&nbsp;Andrew M. Platt,&nbsp;Diamant Thaçi","doi":"10.1007/s40257-024-00853-4","DOIUrl":"10.1007/s40257-024-00853-4","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Atopic dermatitis is a chronic inflammatory disease characterized by increased itch, skin pain, poor sleep quality, and other symptoms that negatively affect patient quality of life. Upadacitinib, an oral selective Janus kinase (JAK) inhibitor with greater inhibitory potency for JAK1 than JAK2, JAK3, or tyrosine kinase 2, is approved to treat moderate-to-severe atopic dermatitis.&lt;/p&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;p&gt;We aimed to evaluate the effect of upadacitinib on patient-reported outcomes over 52 weeks in adults and adolescents with moderate-to-severe atopic dermatitis.&lt;/p&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;Data from two phase III monotherapy trials of upadacitinib (Measure Up 1, NCT03569293; Measure Up 2, NCT03607422) were integrated. Changes in pruritus, pain, other skin symptoms, sleep, quality of life, mental health, and patient impression were evaluated. Patient-reported outcome assessments included the Worst Pruritus Numerical Rating Scale, Patient-Oriented Eczema Measure, Dermatology Life Quality Index, Atopic Dermatitis Symptom Scale, Atopic Dermatitis Impact Scale, Hospital Anxiety and Depression Scale, SCORing Atopic Dermatitis index, Patient Global Impression of Severity, Patient Global Impression of Change, and Patient Global Impression of Treatment. Minimal clinically important differences, achievement of scores representing minimal disease burden, and the change from baseline were evaluated in patients who received upadacitinib through week 52 and in patients who received placebo through week 16.&lt;/p&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;This analysis included 1609 patients (upadacitinib 15 mg, &lt;i&gt;N&lt;/i&gt; = 557; upadacitinib 30 mg, &lt;i&gt;N&lt;/i&gt; = 567; placebo, &lt;i&gt;N&lt;/i&gt; = 485). Baseline demographics and disease characteristics were generally similar across all arms. The proportion of patients treated with upadacitinib reporting improvements in itch increased rapidly by week 1, increased steadily through week 8, and was sustained through week 52. Patients receiving upadacitinib also experienced improvements in pain and other skin symptoms by week 1, which continued through week 16; improvements were maintained through week 52. Patient reports of improved sleep increased rapidly from baseline to week 1, increased steadily through week 32, and were sustained through week 52. Patients experienced quality-of-life improvements through week 8, which were maintained through week 52. By week 1, patients in both upadacitinib groups experienced rapid improvements in emotional state, and by week 12, patients also achieved meaningful improvements in anxiety and depression. Improvements in mental health continued steadily through week 32 and were maintained through week 52. Patients treated with upadacitinib 30 mg generally experienced improvements in patient-reported outcomes earlier than those treated with upadacitinib 15 mg. Through week 16, patients receiving upadacitinib experienced greater improvements versus those receiving placebo in all assessed patient-reported ","PeriodicalId":7706,"journal":{"name":"American Journal of Clinical Dermatology","volume":"25 3","pages":"485 - 496"},"PeriodicalIF":8.6,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11070400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140288060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Expert Panel Review of Skin and Hair Dermatophytoses in an Era of Antifungal Resistance 抗真菌抗药性时代的皮肤和毛发皮癣菌专家小组综述。
IF 8.6 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-03-18 DOI: 10.1007/s40257-024-00848-1
Rachel C. Hill, Avrom S. Caplan, Boni Elewski, Jeremy A. W. Gold, Shawn R. Lockhart, Dallas J. Smith, Shari R. Lipner

Dermatophytoses are fungal infections of the skin, hair, and nails that affect approximately 25% of the global population. Occlusive clothing, living in a hot humid environment, poor hygiene, proximity to animals, and crowded living conditions are important risk factors. Dermatophyte infections are named for the anatomic area they infect, and include tinea corporis, cruris, capitis, barbae, faciei, pedis, and manuum. Tinea incognito describes steroid-modified tinea. In some patients, especially those who are immunosuppressed or who have a history of corticosteroid use, dermatophyte infections may spread to involve extensive skin areas, and, in rare cases, may extend to the dermis and hair follicle. Over the past decade, dermatophytoses cases not responding to standard of care therapy have been increasingly reported. These cases are especially prevalent in the Indian subcontinent, and Trichophyton indotineae has been identified as the causative species, generating concern regarding resistance to available antifungal therapies. Antifungal-resistant dermatophyte infections have been recently recognized in the United States. Antifungal resistance is now a global health concern. When feasible, mycological confirmation before starting treatment is considered best practice. To curb antifungal-resistant infections, it is necessary for physicians to maintain a high index of suspicion for resistant dermatophyte infections coupled with antifungal stewardship efforts. Furthermore, by forging partnerships with federal agencies, state and local public health agencies, professional societies, and academic institutions, dermatologists can lead efforts to prevent the spread of antifungal-resistant dermatophytes.

皮癣是皮肤、毛发和指甲的真菌感染,影响着全球约 25% 的人口。衣着暴露、生活在炎热潮湿的环境中、卫生条件差、接近动物和拥挤的生活环境是重要的风险因素。皮肤癣菌感染因其感染的解剖部位而得名,包括体癣、毛癣、头癣、倒刺癣、面癣、足癣和疥癣。隐性癣菌是指类固醇改变的癣菌。有些患者,尤其是免疫抑制患者或有皮质类固醇使用史的患者,皮癣菌感染可能会扩散到大面积皮肤,在极少数情况下,可能会扩展到真皮层和毛囊。在过去十年中,对标准疗法无效的皮癣病例报告越来越多。这些病例在印度次大陆尤为普遍,而且已确定吲哚毛癣菌是致病菌种,这引起了人们对现有抗真菌疗法耐药性的担忧。抗真菌耐药性皮癣菌感染最近在美国得到确认。抗真菌抗药性现已成为全球健康问题。在可行的情况下,最佳做法是在开始治疗前进行真菌学确认。为遏制抗真菌感染,医生有必要对耐药性皮真菌感染保持高度怀疑,并努力做好抗真菌管理工作。此外,通过与联邦机构、州和地方公共卫生机构、专业协会和学术机构建立合作关系,皮肤科医生可以领导防止抗真菌皮癣菌传播的工作。
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引用次数: 0
Tree-Based Machine Learning to Identify Predictors of Psoriasis Incidence at the Neighborhood Level: A Populational Study from Quebec, Canada 基于树型机器学习的邻里牛皮癣发病率预测方法:加拿大魁北克人口研究
IF 8.6 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-03-18 DOI: 10.1007/s40257-024-00854-3
Anastasiya Muntyanu, Raymond Milan, Mohammed Kaouache, Julien Ringuet, Wayne Gulliver, Irina Pivneva, Jimmy Royer, Max Leroux, Kathleen Chen, Qiuyan Yu, Ivan V. Litvinov, Christopher E. M. Griffiths, Darren M. Ashcroft, Elham Rahme, Elena Netchiporouk

Background

Psoriasis is a major global health burden affecting ~ 60 million people worldwide. Existing studies on psoriasis focused on individual-level health behaviors (e.g. diet, alcohol consumption, smoking, exercise) and characteristics as drivers of psoriasis risk. However, it is increasingly recognized that health behavior arises in the context of larger social, cultural, economic and environmental determinants of health. We aimed to identify the top risk factors that significantly impact the incidence of psoriasis at the neighborhood level using populational data from the province of Quebec (Canada) and advanced tree-based machine learning (ML) techniques.

Methods

Adult psoriasis patients were identified using International Classification of Disease (ICD)-9/10 codes from Quebec (Canada) populational databases for years 1997–2015. Data on environmental and socioeconomic factors 1 year prior to psoriasis onset were obtained from the Canadian Urban Environment Health Consortium (CANUE) and Statistics Canada (StatCan) and were input as predictors into the gradient boosting ML. Model performance was evaluated using the area under the curve (AUC). Parsimonious models and partial dependence plots were determined to assess directionality of the relationship.

Results

The incidence of psoriasis varied geographically from 1.6 to 325.6/100,000 person-years in Quebec. The parsimonious model (top 9 predictors) had an AUC of 0.77 to predict high psoriasis incidence. Amongst top predictors, ultraviolet (UV) radiation, maximum daily temperature, proportion of females, soil moisture, urbanization, and distance to expressways had a negative association with psoriasis incidence. Nighttime light brightness had a positive association, whereas social and material deprivation indices suggested a higher psoriasis incidence in the middle socioeconomic class neighborhoods.

Conclusion

This is the first study to highlight highly variable psoriasis incidence rates on a jurisdictional level and suggests that living environment, notably climate, vegetation, urbanization and neighborhood socioeconomic characteristics may have an association with psoriasis incidence.

背景银屑病是一种严重的全球性健康负担,影响着全球约 6000 万人。现有的银屑病研究侧重于个人层面的健康行为(如饮食、饮酒、吸烟、运动)和特征,将其视为银屑病风险的驱动因素。然而,人们越来越认识到,健康行为是在社会、文化、经济和环境等更大的健康决定因素的背景下产生的。我们旨在利用魁北克省(加拿大)的人口数据和先进的基于树的机器学习(ML)技术,在邻里层面确定对银屑病发病率有重大影响的首要风险因素。方法利用魁北克省(加拿大)人口数据库中 1997-2015 年的国际疾病分类(ICD)-9/10 代码确定成人银屑病患者。银屑病发病前 1 年的环境和社会经济因素数据来自加拿大城市环境健康联合会(CANUE)和加拿大统计局(StatCan),这些数据被作为预测因子输入梯度提升 ML。模型性能使用曲线下面积(AUC)进行评估。结果在魁北克省,银屑病发病率的地域差异从 1.6 到 325.6/100,000 人年不等。预测银屑病高发病率的简约模型(前 9 个预测因子)的 AUC 为 0.77。在最主要的预测因素中,紫外线(UV)辐射、日最高气温、女性比例、土壤湿度、城市化程度和与高速公路的距离与银屑病发病率呈负相关。结论:这是第一项在辖区层面上突出显示牛皮癣发病率高度可变性的研究,表明生活环境,尤其是气候、植被、城市化和辖区社会经济特征可能与牛皮癣发病率有关。
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引用次数: 0
Management of Acne in Pregnancy 妊娠期痤疮管理。
IF 8.6 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-03-07 DOI: 10.1007/s40257-024-00851-6
Akash Rau, Jonette Keri, Jenny E. Murase

Acne is one of the most common dermatological conditions to affect women of childbearing age, so it is important to consider the safety of long-term acne treatments on women who could become pregnant. In this review article, we clarify what management options are available to treat acne during pregnancy. Topical treatments, typically first-line for acne, such as azelaic acid, clindamycin, erythromycin, metronidazole, benzoyl peroxide, salicylic acid, dapsone, and retinoids, were reviewed. Systemic treatments, such as zinc supplements, cephalexin, cefadroxil, amoxicillin, azithromycin, erythromycin, and corticosteroids, typically second-line for acne, were also reviewed. Alternative treatments such as light therapy and cosmetic procedures were also evaluated. Due to recommendation of sunscreen utilization during acne treatments, sunscreen usage during pregnancy was also assessed. Management of acne during unplanned pregnancy was discussed in further detail regarding safety and adverse effects. Through summarized tables and examples of studies demonstrating safety and efficacy of treatments, the following is a resource for providers and patients to utilize for management of acne during pregnancy.

痤疮是影响育龄妇女最常见的皮肤病之一,因此考虑长期治疗痤疮对可能怀孕的妇女的安全性非常重要。在这篇综述文章中,我们将阐明孕期痤疮的治疗方法。我们回顾了通常作为痤疮一线治疗药物的外用疗法,如阿折酸,克林霉素,红霉素,甲硝唑,过氧化苯甲酰,水杨酸,达泊松和维A酸。此外,还综述了系统治疗方法,如锌补充剂、头孢氨苄、头孢羟氨苄、阿莫西林、阿奇霉素、红霉素和皮质类固醇,它们通常是治疗痤疮的二线药物。此外,还对光疗和美容手术等替代治疗方法进行了评估。由于建议在治疗痤疮期间使用防晒霜,因此还评估了孕期使用防晒霜的情况。还进一步详细讨论了意外怀孕期间痤疮治疗的安全性和不良反应。通过汇总表和证明治疗安全性和有效性的研究实例,以下内容可作为孕期痤疮治疗的参考资料,供医疗机构和患者使用。
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引用次数: 0
Small-Molecule Inhibitors and Biologics for Palmoplantar Psoriasis and Palmoplantar Pustulosis: A Systematic Review and Network Meta-Analysis 治疗掌跖银屑病和掌跖脓疱病的小分子抑制剂和生物制剂:系统综述与网络元分析》。
IF 8.6 1区 医学 Q1 DERMATOLOGY Pub Date : 2024-03-04 DOI: 10.1007/s40257-024-00849-0
I-Hsin Huang, Po-Chien Wu, Hsien-Yi Chiu, Yu-Huei Huang

Background

The comparative efficacy of biologics and small-molecule inhibitors in treating palmoplantar psoriasis (PP) and palmoplantar pustulosis (PPP) remains uncertain.

Objective

The aim was to perform a systematic review and network meta-analysis (NMA) to compare the efficacy of biologics and small-molecule inhibitors for the treatment of PP and PPP.

Methods

MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched for eligible studies from inception to May 13, 2023. This NMA was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension Statement for Network Meta-Analyses guidelines. Frequentist random-effects models NMA was performed with the surface under the cumulative ranking curve calculated for ranking. Our primary outcome was the proportion of patients achieving a clear/minimal Palmoplantar Psoriasis/Pustulosis Physician Global Assessment score (PPPGA 0/1 or PPPPGA 0/1) response at 12–16 weeks. Secondary outcomes consisted of the percentage of overall improvement in palmoplantar score and of improvement ≥ 75%, at 12–16 weeks.

Results

The study comprised a total of 29 randomized controlled trials (RCTs), involving 4798 psoriasis patients with palmoplantar diseases. For PP, 16 RCTs with nine different treatments, including adalimumab, apremilast, bimekizumab, etanercept, guselkumab, infliximab, ixekizumab, secukinumab, and ustekinumab were included for the analysis. In the NMA of PP, secukinumab 300 mg ranked highest (odds ratio [OR] 33.50, 95% confidence interval [CI] 4.37–256.86) in achieving PPPGA 0/1, followed by guselkumab 100 mg (OR 18.68, 95% CI 10.07–34.65). In the case of PPP, seven RCTs with six treatments, including apremilast, etanercept, guselkumab, imsidolimab, spesolimab, and ustekinumab, were included for the analysis. In the NMA of PPP, although no treatment demonstrated a significant difference compared to placebo in achieving PPPPGA 0/1, guselkumab 100 mg showed the greatest statistically significant improvement in the palmoplantar score (weighted mean difference 31.73, 95% CI 19.89–43.57) as a secondary outcome.

Conclusion

Among all available biologics and small-molecule inhibitors, secukinumab 300 mg and guselkumab 100 mg had the most favorable efficacy in treating PP and PPP, respectively.

背景:生物制剂和小分子抑制剂治疗掌跖银屑病(PP)和掌跖脓疱病(PPP)的疗效比较仍不确定:目的:对生物制剂和小分子抑制剂治疗掌跖银屑病和掌跖脓疱病的疗效进行系统综述和网络荟萃分析(NMA):方法:检索了 MEDLINE、Embase 和 Cochrane Central Register of Controlled Trials 中从开始到 2023 年 5 月 13 日符合条件的研究。该 NMA 遵循《系统综述和 Meta 分析首选报告项目》和《网络 Meta 分析扩展声明》指南进行并报告。采用频数随机效应模型进行 NMA,并计算累积排名曲线下的表面进行排名。我们的主要结果是在 12-16 周时达到明确/轻度掌跖银屑病/脓疱病医师总体评估评分(PPPGA 0/1 或 PPPPGA 0/1)反应的患者比例。次要结果包括12-16周时掌跖评分总体改善的百分比和改善≥75%的百分比:研究共包括 29 项随机对照试验(RCT),涉及 4798 名患有掌跖疾病的银屑病患者。其中,16项随机对照试验涉及9种不同的治疗方法,包括阿达木单抗、阿普瑞米拉司特、比美奇珠单抗、依那西普、古谢库单抗、英夫利昔单抗、依克珠单抗、赛库单抗和乌斯特库单抗。在PP的NMA中,secukinumab 300 mg在实现PPPGA 0/1方面排名最高(赔率[OR]33.50,95%置信区间[CI]4.37-256.86),其次是guselkumab 100 mg(赔率18.68,95%置信区间10.07-34.65)。就 PPP 而言,分析纳入了 7 项 RCT,包括阿普司特、依那西普、古舍库单抗、伊西多利单抗、斯贝索利单抗和乌司替库单抗等 6 种治疗方法。在PPP的NMA中,虽然没有一种疗法与安慰剂相比在实现PPPPGA 0/1方面有显著差异,但作为次要结果,古谢库单抗100毫克在掌跖评分方面显示出最大的统计学显著改善(加权平均差31.73,95% CI 19.89-43.57):结论:在所有可用的生物制剂和小分子抑制剂中,secukinumab 300 毫克和 guselkumab 100 毫克在治疗 PP 和 PPP 方面的疗效最为显著。
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引用次数: 0
期刊
American Journal of Clinical Dermatology
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