疾病活动引导剂量减少对银屑病中IL-17和IL-23抑制剂的影响:疗效、安全性和经济效益的真实世界评估

IF 2.3 4区 医学 Q2 DERMATOLOGY
Edoardo Cammarata, Chiara Airoldi, Jacopo Colombo, Andrealuna Ucciero, Luca Mastorino, Veronica Arese, Lorenza Burzi, Franco Castelli, Massimo Chiarpenello, Francesca Graziola, Claudia Leporati, Michela Ortoncelli, Paolo Pella, Ginevra Pertusi, Alessia Pisterna, Pietro Quaglino, Simone Ribero, Gianluca Rossotto, Rossana Tiberio, Paolo Dapavo, Paola Savoia
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引用次数: 0

摘要

银屑病是一种慢性炎症性多系统疾病,IL-17和IL-23抑制剂已经改变了治疗方法。然而,高成本和对具有良好和持续反应的患者过度治疗的可能性促使人们对减少剂量(DR)的兴趣,以在不影响疗效的情况下降低费用。材料与方法:我们进行了一项多中心观察性试验,评估DRs治疗secukinumab、brodalumab、guselkumab和risankizumab对成人稳定斑块型银屑病的疗效和安全性。符合条件的参与者是低疾病活动性的成年人(PASI≤3,DLQI≤3至少持续9个月)。DR涉及延长间隔至约67%的授权标准剂量。从361名入组患者(2023年3月至2025年1月)中,我们分析了156名随访≥12个月或因DR失败而早期停药的患者的数据。结果:接受IL-17抑制剂治疗者70例(44.87%),接受IL-23抑制剂治疗者86例(55.13%)。52周后,总剂量减少生存期为0.75 (95% CI: 0.69-0.82)。对于IL-23抑制剂和IL-17抑制剂队列,剂量减少生存率分别为0.83 (95% CI: 0.75-0.91)和0.66 (95% CI: 0.55-0.78)。此外,Kaplan-Meier曲线显示,与IL-17相比,IL-23抑制剂的剂量降低生存率显著(p值log-rank检验=0.018)。讨论:我们的初步研究结果表明,延长IL-17和IL-23抑制剂的给药间隔可以有效地维持稳定斑块型银屑病的疾病控制。需要更大规模的随机试验来证实这些结果,确定DR成功的预测标记,并优化患者选择,以安全、经济地管理牛皮癣。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of Disease Activity-Guided Dose Reduction on IL-17 and IL-23 Inhibitors in Psoriasis: A Real-World Assessment of Efficacy, Safety, and Economic Benefits.

Introduction: Psoriasis is a chronic inflammatory multisystem disease for which IL-17 and IL-23 inhibitors have transformed treatment. However, high costs and the possibility of overtreatment in patients with excellent and sustained responses have driven interest in dose reduction (DR) to lower expenses without compromising efficacy.

Materials & methods: We conducted a multicenter observational trial assessing the efficacy and safety of DRs for secukinumab, brodalumab, guselkumab, and risankizumab in adults with stable plaque psoriasis. Eligible participants were adults with low disease activity (PASI ≤ 3, DLQI ≤ 3 for at least 9 months). DR involved lengthening intervals to approximately 67% of the authorized standard dose. From the 361 enrolled (March 2023-January 2025), we analyzed data on 156 participants with ≥12 months of follow-up or early discontinuation due to DR failure.

Results: Seventy of these patients (44.87%) received IL-17 inhibitors, and 86 (55.13%) received IL-23 inhibitors. After 52 weeks, the overall dose-reduction survival was 0.75 (95% CI: 0.69-0.82). For IL-23 inhibitor and IL-17 inhibitor cohorts, the dose-reduction survival was 0.83 (95% CI: 0.75-0.91) and 0.66 (95% CI: 0.55-0.78), respectively. Moreover, Kaplan-Meier curves suggested significant (p-value log-rank test=0.018) higher dose reduction survival for IL-23 inhibitors compared to IL-17.

Discussion: Our preliminary findings suggest that extended dosing intervals for IL-17 and IL-23 inhibitors can effectively maintain disease control in stable plaque psoriasis. Larger randomized trials are needed to confirm these results, identify predictive markers of DR success, and optimize patient selection for safe and cost-effective management of psoriasis.

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