司库奇尤单抗治疗中重度斑块状银屑病20例临床观察

目的:观察司库奇尤单抗注射液治疗中重度斑块状银屑病的临床疗效及安全性.方法:纳入20例中重度斑块状银屑病患者,给予司库奇尤单抗注射液皮下注射治疗,300 mg/次,分别于第0、1、2、3、4周注射1次,随后每4周1次,于第4、8、12周时记录患者银屑病皮损面积和严重度指数(PASI)、中性粒细胞和淋巴细胞比值(NLR)...     

司库奇尤单抗治疗中重度斑块状银屑病的近期疗效及安全性观察

【摘要】 目的 观察司库奇尤单抗治疗中重度斑块状银屑病的近期疗效及安全性。方法 2019年6 - 11月收集就诊于河南省人民医院皮肤科的中重度斑块状银屑病患者36例,给予司库奇尤单抗单药皮下注射治疗,300 mg/次,分别于基线、第1、2、3、4周注射1次,随后每4周1次,分别于第4、8、12周时记录患者银屑病皮损面积和严重度指数（PASI）,观察药物不良反应。结果 36例患者均接受至少12周的治疗。4周时,8例达PASI75,其中3例达PASI90,1例达PASI100;8周时,26例达PASI75,其中16例达PASI90,4例达PASI100;12周时,32例达PASI75,其中26例达PASI90,8例达PASI100。所有患者均未发生严重感染或恶性肿瘤等严重药物不良反应,1例腹部皮下注射后出现腹痛、腹胀,持续3 d后症状消失;1例患者出现扁桃体炎,之后原有皮损处出现湿疹样改变;1例颈部出现化脓性淋巴结炎。结论 司库奇尤单抗治疗中重度斑块状银屑病疗效显著,不良反应较少,是中重度斑块状银屑病患者新的治疗选择之一。     

司库奇尤单抗治疗中重度斑块型银屑病诱发面部皮炎3例

报告3例中重度斑块型银屑病患者接受司库奇尤单抗标准方案治疗后出现了面部红斑。3例患者均在使用司库奇尤单抗治疗3周后面部出现了不同程度的红斑、灼热、瘙痒及干燥脱屑,诊断为“面部皮炎”,予以对症治疗或司库奇尤单抗减量处理,面部皮疹有所缓解。其致病原因尚不清楚,考虑为免疫漂移、IL-17C代偿性高表达以及皮肤屏障功能受损共同作用的结果。     

司库奇尤单抗及依奇珠单抗治疗中重度斑块型银屑病小样本短期疗效评价

目的 探讨比较司库奇尤单抗和依奇珠单抗治疗中重度斑块型银屑病的疗效和安全性.方法 采用随机对照研究设计,纳入上海市皮肤病医院2019年6月-2020年12月门诊中重度斑块状银屑病患者20例,随机分配进入两个治疗组,司库奇尤单抗治疗组及依奇珠单抗治疗组.用药第4、8、12周后分别评价两组药物的疗效及安全性.计量资料两组间...     

司库奇尤单抗治疗红皮病型银屑病一例并文献复习

报道一例司库奇尤单抗治疗红皮病型银屑病治疗效果并复习相关文献.41岁红皮病型银屑病男性患者,在排除肝炎、结核的基础上,经知情同意后,给予司库奇尤单抗标准方案:0～4周每周皮下注射300 mg,随后每4周注射300 mg.在第4周达到PASI 75,第8周达到PASI 100.随访32周未见明显复发及不良反应.     

斑块状银屑病司库奇尤单抗应答不良转换为依奇珠单抗的疗效及安全性观察

目的 探讨司库奇尤单抗治疗中重度斑块状银屑病出现应答不良的患者,转换为依奇珠单抗治疗的疗效和安全性。方法 纳入司库奇尤单抗治疗的中重度斑块状银屑病患者,达到PASI50但从未达到PASI90,以及曾达到PASI90后失去PASI75的患者,转换为依奇珠单抗治疗,观察其12周及长期疗效及安全性。结果 共纳入7例患者,男5例,女2例,年龄中位数39.7(34.0,57.3)岁,平均病程(26.7±9.1)年,平均BMI 30.6±4.8。PASI评分从基线时(9.8±4.3)分下降至12周时(1.4±1.2)分,平均治疗时间(46.9±11.2)周,末次随访PASI评分(2.5±2.3)分。3例(42.86%)患者出现局限性湿疹,1例(14.29%)出现注射部位反应,1例(14.29%)出现口腔念珠菌病。结论 司库奇尤单抗应答不良的中重度斑块状银屑病患者转换为依奇珠单抗,仍然能获得较好的治疗效果,且其安全性可。     

司库奇尤单抗治疗中重度斑块状银屑病疗效及安全性的真实世界研究

目的 观察真实世界司库奇尤单抗治疗中重度斑块状银屑病的临床疗效及安全性。方法 本研究共纳入45例中重度斑块状银屑病患者,接受司库奇尤单抗150 mg或300 mg治疗,持续至少24周。通过银屑病皮损面积及严重程度指数(PASI)、体表受累面积(BSA)、皮肤病生活质量指数(DLQI)的变化来评估疗效,并对其安全性进行分析。结果 所有患者经过24周治疗,PASI、BSA及DLQI评分均显著下降(P<0.001)。其中16例接受150 mg治疗的患者第12周PASI75、PASI90、PASI100的应答率分别为93.75%、62.50%和12.50%,在第24周时达到100.00%、93.75%和43.75%。而29例接受300 mg治疗的患者第12周时PASI75、PASI90、PASI100应答率分别为100.00%、79.31%和34.48%,第24周时则为100%、93.10%和62.07%。而在改善患者生活质量上,150 mg组患者第12周和第24周DLQI 0/1的应答率分别为50.00%和75.00%;300 mg组患者第12、24周DLQI 0/1的应答率分别为51...     

司库奇尤单抗治疗妊娠期重度斑块状银屑病1例

患者女,26岁,头皮、躯干及四肢鳞屑性丘疹、斑块反复8年,诊断为重度斑块状银屑病。使用司库奇尤单抗治疗,治疗期间患者意外妊娠,随即停用司库奇尤单抗。患者孕24周时,银屑病复发,严重影响母体妊娠。给予司库奇尤单抗治疗后,患者PASI评分明显下降,孕40周,顺利产下一名健康女婴。     

司库奇尤单抗治疗甲银屑病一例

报道一例司库奇尤单抗成功治疗甲银屑病治疗效果。患者,女,65岁,指甲增厚碎裂7年,诊断为甲银屑病,常规治疗效果不佳,予司库奇尤单抗300 mg,病情好转,目前随访中。     

司库奇尤单抗治疗七例银屑病疗效评价

目的：评价司库奇尤单抗治疗银屑病的疗效和安全性。方法：选取中重度斑块状银屑病患者及泛发性脓疱型银屑病患者,给予司库奇尤单抗,300 mg/次,0～4周每周一次,后每4周一次,并分别于治疗前、1周后、4周后、8周后记录斑块状银屑病患者的银屑病皮损面积和严重度指数(PASI)、泛发性银屑病患者银屑病症状量表(PSS)评分。结果：共治疗6例斑块状银屑病和1例脓疱型银屑病患者,所选的患者均接受至少8周的司库奇尤单抗治疗,起效时间为（1.6±0.73)天;治疗4周时,6例斑块状银屑病患者中全部达到PASI 75,3例达到PASI 90;脓疱型患者PSS评分为2。治疗8周时6例斑块状银屑病患者均达到PASI 100;脓疱型患者PSS评分为0。所有患者治疗期间均未出现严重的药物不良反应。结论：司库奇尤单抗治疗中重度银屑病起效迅速,疗效显著,不良反应少。     

Correlation between BMI and PASI in patients affected by moderate to severe psoriasis undergoing biological therapy

Obesity is common in psoriatic patients, and it has been shown to be important for many aspects of the condition. In particular, low-calorie diets can improve the symptoms and response to treatment in pustular psoriasis. The present study investigates the influence of body-weight alteration on the disease's clinical manifestations in moderate to severe psoriasis patients treated with biological drugs. Finally, the influence of a caloric restriction was assessed. This observational transversal study enrolled 33 patients attending our Severe Psoriasis Outpatient Clinic, who were treated with biological drugs. Body Mass Index (BMI) was used as a diagnostic indicator of being overweight and of obesity. Waist circumference was also measured. Body weight and Psoriasis Area Severity Index (PASI) index were measured at follow-up visits at 4 and 8 months. Nonparametric test of Mann–Whitney was used to detect the differences between patient groups. Fisher's exact test was performed to evaluate the different results depending on the therapeutic changes of BMI. There was a strong prevalence of overweight-obese individuals in the group with a mean BMI of 30.59 ± 6.94. Waist circumference was also above normal in the majority of the patients. Obese patients had a PASI index higher than the average of the whole group (25.03 ± 12.43), with grade III obese patients having an average PASI of 44 ± 3.37. At the first and second follow-ups, patients who put on weight did not achieve PASI 50; patients who had a stable weight presented variable response to treatment, while patients who decreased their weight achieved PASI 90 or PASI 75 even when not responding at the first. Further studies are needed to understand if the poor response observed in heavier patients is due to biological drugs pharmacokinetics or because therapy should be BMI based rather than administered in fixed doses, posing then an ethical consideration.     

Effectiveness and safety of secukinumab in 69 patients with moderate to severe plaque psoriasis: A retrospective multicenter study

Secukinumab (anti‐IL17A) is effective as treatment for moderate to severe plaque psoriasis, but real‐life data on effectiveness and safety lack. We aimed to present real‐life data of all Danish patients treated with secukinumab (n = 69). At baseline, before initiation of treatment with secukinumab 300 mg (47.8%) or off‐label treatment with secukinumab 150 mg (52.2%), the median PASI score was 7.1. A total of 66.7% (34/51) and 52.9% (27/51) of patients still on secukinumab at week 12 achieved a PASI (Psoriasis Area and Severity Index)‐50 and PASI‐75 of 66.7% and 52.9%, respectively. A total of 83.0% (44/53) and 60.4% (32/53) of the patients had a PASI‐score < 5 and PASI‐score < 2, respectively, after 12 weeks on treatment with secukinumab. A third of the patients had secukinumab discontinued due to limited clinical improvement or adverse events (n = 23) within a median of 92 days (interquartile range 51–212 days). Notably, the majority of the patients may represent a particularly difficult‐to‐treat group of patients, as 92.8% had been refractory to other biologic treatment. A total of 26.1% (n = 18) experienced adverse events. Secukinumab appears to be an effective treatment option with a favorable side effect profile in patients with plaque psoriasis who are refractory to or have side effects of traditional biologic drugs.     

Efficacy and safety of secukinumab in Taiwanese patients with moderate to severe plaque psoriasis: Subanalysis from ERASURE phase III study

The efficacy and safety of secukinumab, a fully human anti‐interleukin‐17A monoclonal antibody, has been evaluated for moderate to severe plaque psoriasis in global trials which have included a low proportion of Asian subjects. We analyzed the efficacy and safety of secukinumab in Taiwanese patients in a phase III global clinical trial (ERASURE). Fifty‐one Taiwanese patients were randomized into s.c. placebo, 150 and 300 mg secukinumab treatment groups. The proportions of patients who achieved 75% or more improvement in Psoriasis Area and Severity Index (PASI‐75) at week 12 were 87.5% with 300 mg secukinumab, 70% with 150 mg secukinumab, 0% with placebo. Of the patients receiving 300 mg secukinumab, 68.8% achieved PASI‐90 at week 12. Analysis of overall patients receiving 300 mg secukinumab for 12 weeks showed that the proportion of PASI‐75 responders was less in patients with body mass index of 25 or more than less than 25. During the entire 52 weeks, the incidence of adverse events (AE) was consistent with the overall population in ERASURE. The most common AE (cases/per 100 patient‐year) during the entire treatment period were upper respiratory tract infection and pruritus. The duration of upper respiratory tract infection per 100 patient‐year was approximately 399 days in placebo, 1261 days in 150 mg secukinumab and 1805 days in 300 mg secukinumab. The safety and efficacy of secukinumab in Taiwanese patients was compatible with the global phase III study in the treatment of moderate to severe plaque psoriasis.     

Low-dose etanercept therapy in moderate to severe psoriasis in Korean

Etanercept is a fully humanized soluble tumor necrosis factor (TNF)-alpha receptor that competitively inhibits the interaction of TNF-alpha with cell-surface receptors. It was approved as monotherapy for psoriasis in the USA in 2004, but in Korea, no clinical reports on its use for psoriasis are available. We performed a retrospective analysis of 26 moderate-to-severe psoriasis patients who had been treated with etanercept. Patients received twice-weekly injections of 25 mg etanercept s.c. for at least 4 weeks. When the patients achieved a 50% reduction of the psoriasis area severity index (PASI 50) they received once-weekly injections, then biweekly injections were provided for maintenance. Patients were evaluated biweekly by clinical photographs and PASI scoring. Treatment efficacy was as follows. A PASI 75 was achieved in 14 patients (54%) and the mean number of injections before achieving a PASI 75 was 10 +/- 7.5. Patients whose initial PASI was less than 10 (iPASI < 10) showed an earlier response (2.6 +/- 1.3 weeks) and a higher PASI 75 rate (63%), than with iPASI > or = 10 (6.9 +/- 4.5 weeks, 50%). Eight patients (31%) received additional phototherapy or systemic therapy because of insufficient responses or for faster improvements and they were excluded in the efficacy evaluation. Adverse events were observed in eight patients (31%), but were not serious. This is the first report on the effectiveness of low-dose etanercept regimen on Asian psoriasis patients. Results in this study showed that low-dose etanercept therapy is effective for moderate-to-severe Asian psoriasis patients, and it may be a valuable treatment option even for relatively moderate psoriasis patients not responsive to conventional treatment. In addition, the medical cost was relatively low compared to that of the standard regimen for white patients.     

阿维A治疗斑块状银屑病临床疗效观察

目的:观察阿维A治疗中、重度斑块状银屑病的疗效.方法:将中、重度斑块状银屑病患者随机分成两组,分别给予阿维A和海棠合剂治疗,疗程均为8周,以银屑病面积和严重度指数(PASI)和皮肤病生活质量指数(DLQI)作为观察指标,比较两种药物的疗效.结果:治疗后,两组患者的PASI评分和DLQI评分与治疗前比较均显著下降(P＜0.01),但PASI改善率和DLQI改善率两组间比较差异无统计学意义,PASI50和PASI75有效率亦无统计学意义(P＞0.05).结论:阿维A治疗中、重度斑块状银屑病有效.     

甲氨蝶呤治疗中、重度银屑病的疗效观察

目的:观察甲氨蝶呤(methotrexate,MTX)治疗中、重度银屑病的临床疗效和安全性。方法:41例银屑病患者每周接受MTX5～15mg静脉滴注治疗1次,共20次。结果:41例患者经过10～20周治疗后,痊愈16例(39.0%),显效17例(41.5%),好转7例(17.1%),无效1例(2.4%),有效率为80.5%,不良反应为纳差、恶心、呕吐、头痛、荨麻疹、月经过多、丙氨酸转氨酶轻度升高。结论:MTX5～15mg每周1次静脉滴注治疗中、重度银屑病安全有效。     

Assessment of serum biomarkers in patients with plaque psoriasis on secukinumab

The molecular basis of interleukin (IL)-17A in driving psoriasis pathogenesis is not fully elucidated yet. To investigate the underlying mechanisms and biomarkers associated with IL-17A and the role in psoriasis pathogenesis, over 30 serum proteins were evaluated in a study assessing the effectiveness and safety of secukinumab, where treatment was directly switched from cyclosporin A to secukinumab. Serum β-defensin 2 (BD-2) levels rapidly and robustly reduced following secukinumab treatment. BD-2 levels were well-correlated with Psoriasis Area and Severity Index (PASI) score; changes in BD-2 levels preceded change in PASI score. Serum BD-2, an easily measurable protein, can possibly be used as a suitable surrogate biomarker to monitor responses to IL-17A-targeted therapies for psoriasis in clinical practice.     

甲氨蝶呤对中重度斑块型银屑病患者T细胞相关细胞因子表达水平的影响

 目的:探讨甲氨蝶呤（MTX）治疗中重度斑块型银屑病16周后,应答组和未应答组外周血T细胞相关细胞因子IFN-γ、IL-4、IL-17a、IL-21及TGF-β表达水平的变化。方法：纳入采用MTX系统性治疗16周后的中重度斑块型银屑病患者作为研究对象,其中应答组49例、未应答组13例、健康对照组35例,分析并比较62例银屑病患者治疗前后、应答组和未应答组治疗后生化指标及外周血IFN-γ、IL-4、IL-17a、IL-21、TGF-β表达水平的差异,采用Pearson相关分析银屑病患者治疗前PASI评分与血清IFN-γ、IL-4、IL-17a、IL-21、TGF-β表达水平的相关性。结果:银屑病患者治疗16周后血清肌酐、尿酸、尿素氮、ALT及AST较治疗前明显升高（P值均＜0.05）,而应答组与未应答组所有生化指标相比较无明显差异。应答组治疗后血清IFN-γ［（749.03±76.77) pg/mL vs (953.69±101.58） pg/mL］、IL-17a［（756.96±101.73) pg/mL vs (963.75±64.38) pg/mL］、IL-21［（514.76±53.48) pg/mL vs (693.45±87.91) pg/mL］较治疗前明显降低（P值均＜0.05）,TGF-β［（433.59±65.39) pg/mL vs (298.36±77.83) pg/mL］较治疗前明显升高（P＜0.05）,而IL-4［（218.72±67.39) pg/mL vs (198.78±47.71) pg/ mL］较治疗前无明显差异;未应答组治疗前后所有细胞因子相比较均无明显差异（P值均＞0.05）。Pearson相关分析结果显示,治疗前患者PASI评分与IFN-γ、IL-17a、IL-21、TGF-β水平均存在明显相关（r值分别为0.25、0.75、0.66、-0.11,P值均＜0.05)。结论:MTX治疗银屑病的潜在机制可能与改善Th1/Th2、Th17/Treg细胞免疫失衡有关。     

Economic evaluation of systemic therapies for moderate to severe psoriasis

Background New biologics have dramatically changed therapeutic options for psoriasis, albeit at additional cost. Objectives To determine the cost‐effectiveness and optimal treatment sequence for moderate to severe psoriasis. Methods Psoriasis Area and Severity Index (PASI) response rates from 22 randomized controlled trials evaluating biologic (adalimumab, efalizumab, etanercept, infliximab) and nonbiologic systemic (methotrexate, ciclosporin) agents were considered. Short‐term efficacy was based on relative probabilities of achieving PASI response (50/75/90) in a meta‐analysis of trials. Published evidence and assumptions were used to predict long‐term efficacy. Treatment benefits were determined by the relationship between PASI response and the EuroQOL 5D health utility measure. Costs included therapy, administration, monitoring and hospitalization. Incremental cost‐effectiveness ratios (ICERs) were calculated and treatments ranked relative to supportive care. Results Infliximab provided the most incremental quality‐adjusted life‐years (QALYs) vs. supportive care (0·18 QALYs; 95% confidence interval, CI 0·13–0·24), followed by adalimumab (0·16 QALYs; 95% CI 0·11–0·22). Methotrexate and ciclosporin were less beneficial (0·13 and 0·08 QALYs, respectively) but were cost saving and considered the first two treatments in the optimal sequence. Comparing biologics, adalimumab was most cost effective (ICER £30 000 per QALY), followed by etanercept (£37 000 per QALY), efalizumab (£40 000 per QALY) and infliximab (£42 000 per QALY). Conclusions Methotrexate and ciclosporin are cost effective but require monitoring for toxicities. Of the biologics, adalimumab was most cost effective following conventional systemic treatment failure or inadequate response. Payers and policymakers will have to decide how to utilize their budgets effectively for treating patients with moderate to severe psoriasis.