Gustav Hjort, Christopher Willy Schwarz, Lone Skov, Nikolai Loft
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In addition, eligible studies were identified through a search of the reference lists of the included studies.</p><p><strong>Study selection: </strong>We only included studies that reported treatment outcomes as Psoriasis Area and Severity Index (PASI) 75 or PASI 90 after 12, 26, and/or 52 weeks of treatment. Both observational studies and randomized clinical trials (RCTs) were considered. Two independent authors conducted the screening process, and 107 studies were assessed for eligibility.</p><p><strong>Data extraction and synthesis: </strong>The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed. Relevant data were extracted independently by 2 authors. Data were pooled using random-effects models. RCTs and observational studies were pooled in separate analyses. Data were analyzed from June 1, 2023, to August 1, 2023.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was PASI 90 at 26 weeks (6 months). 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引用次数: 0
摘要
重要性：从未对银屑病患者与生物制剂治疗反应相关的临床特征进行过系统研究：评估患者临床特征与生物制剂治疗银屑病效果之间的关联：对PubMed、Embase和Web of Science从开始到2022年4月的数据进行了检索。纳入了报告银屑病患者对经批准剂量的生物制剂治疗的反应与其临床特征相关的英文研究。此外，还通过检索所纳入研究的参考文献列表确定了符合条件的研究：我们仅纳入了在治疗 12、26 和/或 52 周后以银屑病面积和严重程度指数 (PASI) 75 或 PASI 90 为标准报告治疗结果的研究。观察性研究和随机临床试验（RCT）均在考虑之列。两位独立作者进行了筛选，共评估了 107 项研究的资格：数据提取与综合：遵循《系统综述和荟萃分析首选报告项目》（PRISMA）报告指南。相关数据由两名作者独立提取。采用随机效应模型对数据进行汇总。随机对照研究和观察性研究分别进行汇总分析。数据分析时间为2023年6月1日至2023年8月1日：主要结果为 26 周（6 个月）时的 PASI 90。在开始收集数据之前，计划调查主要（和次要）结果与若干临床特征之间的关联：结果：共纳入了 40 项研究，共计 21 438 名患者。在观察性研究中，既往吸烟（OR，0.81；95% CI，0.67-0.98）和当前吸烟（OR，0.78；95% CI，0.66-0.91）与 6 个月后 PASI 达到 90 负相关。在研究性试验中，只有体重指数为 30 或更高的患者与治疗反应（3 个月后 PASI 90：OR，0.57；95% CI，0.48-0.66）呈负相关：这项荟萃分析发现，在观察性研究中，吸烟或有吸烟史的银屑病患者以及既往接触过生物制剂、年龄较大或体重指数较高的患者对生物制剂的反应较差。然而，这些临床特征是否会对治疗银屑病的不同生物制剂的治疗反应产生不同影响，目前仍不清楚。
Clinical Characteristics Associated With Response to Biologics in the Treatment of Psoriasis: A Meta-analysis.
Importance: Clinical characteristics associated with treatment response to biologics in patients with psoriasis have never been systematically investigated.
Objective: To evaluate the association between patient clinical characteristics and the effectiveness of biologics in treating psoriasis.
Data sources: PubMed, Embase, and Web of Science were searched from their inception through April 2022. Studies in English language that reported response to biologic treatment at approved doses in patients with psoriasis in relation to their clinical characteristics were included. In addition, eligible studies were identified through a search of the reference lists of the included studies.
Study selection: We only included studies that reported treatment outcomes as Psoriasis Area and Severity Index (PASI) 75 or PASI 90 after 12, 26, and/or 52 weeks of treatment. Both observational studies and randomized clinical trials (RCTs) were considered. Two independent authors conducted the screening process, and 107 studies were assessed for eligibility.
Data extraction and synthesis: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed. Relevant data were extracted independently by 2 authors. Data were pooled using random-effects models. RCTs and observational studies were pooled in separate analyses. Data were analyzed from June 1, 2023, to August 1, 2023.
Main outcomes and measures: The primary outcome was PASI 90 at 26 weeks (6 months). Before data collection began, an investigation of the association between the main (and secondary) outcomes and several clinical characteristics was planned.
Results: Overall, 40 studies with a total of 21 438 patients were included. Older age (odds ratio [OR], 0.99; 95% CI, 0.98-1.00), previous exposure to biologics (OR, 0.44; 95% CI, 0.29-0.67), higher body mass index (BMI) (OR, 0.96; 95% CI, 0.94-0.99), previous smoking (OR, 0.81; 95% CI, 0.67-0.98), and current smoking (OR, 0.78; 95% CI, 0.66-0.91) were negatively associated with achieving PASI 90 at 6 months in observational studies. In RCTs, only BMI of 30 or higher was negatively associated with treatment response (PASI 90 at 3 months: OR, 0.57; 95% CI, 0.48-0.66).
Conclusions and relevance: This meta-analysis found that patients with psoriasis who smoke or have a history of smoking, as well as those with previous exposure to biologics, older age, or higher BMI, exhibited poorer response to biologics in observational studies. However, it remains unclear whether these clinical characteristics influence treatment response differently for the different biologics available for psoriasis.
期刊介绍：
JAMA Dermatology is an international peer-reviewed journal that has been in continuous publication since 1882. It began publication by the American Medical Association in 1920 as Archives of Dermatology and Syphilology. The journal publishes material that helps in the development and testing of the effectiveness of diagnosis and treatment in medical and surgical dermatology, pediatric and geriatric dermatology, and oncologic and aesthetic dermatologic surgery.
JAMA Dermatology is a member of the JAMA Network, a consortium of peer-reviewed, general medical and specialty publications. It is published online weekly, every Wednesday, and in 12 print/online issues a year. The mission of the journal is to elevate the art and science of health and diseases of skin, hair, nails, and mucous membranes, and their treatment, with the aim of enabling dermatologists to deliver evidence-based, high-value medical and surgical dermatologic care.
The journal publishes a broad range of innovative studies and trials that shift research and clinical practice paradigms, expand the understanding of the burden of dermatologic diseases and key outcomes, improve the practice of dermatology, and ensure equitable care to all patients. It also features research and opinion examining ethical, moral, socioeconomic, educational, and political issues relevant to dermatologists, aiming to enable ongoing improvement to the workforce, scope of practice, and the training of future dermatologists.
JAMA Dermatology aims to be a leader in developing initiatives to improve diversity, equity, and inclusion within the specialty and within dermatology medical publishing.
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