{"title":"银屑病和银屑病关节炎接受生物和小分子治疗的患者感染和严重感染的短期风险比较：随机对照试验的系统综述和网络荟萃分析。","authors":"Hsien-Yi Chiu, Yi-Teng Hung, Yu-Huei Huang","doi":"10.1177/20406223231206225","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Infection events are a major concern for patients and physicians when making psoriasis treatment decisions.</p><p><strong>Objective: </strong>To estimate the relative short-term risks of infection and serious infection for biologic and small molecule therapies in the treatment of moderate-to-severe plaque psoriasis (PsO) and psoriatic arthritis (PsA).</p><p><strong>Data sources and methods: </strong>A systematic literature search of the PubMed, EMBASE, and Web of Science databases was conducted on 17 June 2022. We included phase II, III, or IV randomized controlled trials (RCTs) of biologic and small-molecule therapies that are licensed or likely to gain approval soon for PsO and PsA, as well as infection data reports. Two investigators independently extracted the data based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Network meta-analysis (NMA) was performed to estimate the pooled relative risks (RRs) and corresponding 95% confidence intervals of total infections and serious infections for treatments during placebo-controlled phases of RCTs. The surface under the cumulative ranking area (SUCRA) was calculated to rank the infection risk for each treatment.</p><p><strong>Results: </strong>A total of 94 RCTs with a total of 19 treatment arms involving 54,369 participants were analyzed. For patients with PsO, bimekizumab, secukizumab, risankizumab, ustekinumab, apremilast, guselkumab, and adalimumab were associated with significantly higher risks of infection than placebo; SUCRA ranked infliximab, deucravacitinib, and bimekizumab with the highest risks of infection. For patients with PsA, bimekizumab, apremilast, and upadacitinib (30 mg daily) were associated with higher risks of infection; SUCRA ranked bimekizumab with the highest risk of infection. No treatments, except for upadacitinib (30 mg daily), were associated with a higher risk of serious infection than placebo in PsA.</p><p><strong>Conclusion: </strong>This NMA provides a comprehensive assessment of the comparative short-term risks of infection, which could help physicians and patients to select individualized treatments for psoriasis.</p><p><strong>Registration: </strong>CRD42022359873.</p>","PeriodicalId":22960,"journal":{"name":"Therapeutic Advances in Chronic Disease","volume":null,"pages":null},"PeriodicalIF":3.3000,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10612457/pdf/","citationCount":"0","resultStr":"{\"title\":\"Comparative short-term risks of infection and serious infection in patients receiving biologic and small-molecule therapies for psoriasis and psoriatic arthritis: a systemic review and network meta-analysis of randomized controlled trials.\",\"authors\":\"Hsien-Yi Chiu, Yi-Teng Hung, Yu-Huei Huang\",\"doi\":\"10.1177/20406223231206225\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Infection events are a major concern for patients and physicians when making psoriasis treatment decisions.</p><p><strong>Objective: </strong>To estimate the relative short-term risks of infection and serious infection for biologic and small molecule therapies in the treatment of moderate-to-severe plaque psoriasis (PsO) and psoriatic arthritis (PsA).</p><p><strong>Data sources and methods: </strong>A systematic literature search of the PubMed, EMBASE, and Web of Science databases was conducted on 17 June 2022. We included phase II, III, or IV randomized controlled trials (RCTs) of biologic and small-molecule therapies that are licensed or likely to gain approval soon for PsO and PsA, as well as infection data reports. Two investigators independently extracted the data based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Network meta-analysis (NMA) was performed to estimate the pooled relative risks (RRs) and corresponding 95% confidence intervals of total infections and serious infections for treatments during placebo-controlled phases of RCTs. The surface under the cumulative ranking area (SUCRA) was calculated to rank the infection risk for each treatment.</p><p><strong>Results: </strong>A total of 94 RCTs with a total of 19 treatment arms involving 54,369 participants were analyzed. For patients with PsO, bimekizumab, secukizumab, risankizumab, ustekinumab, apremilast, guselkumab, and adalimumab were associated with significantly higher risks of infection than placebo; SUCRA ranked infliximab, deucravacitinib, and bimekizumab with the highest risks of infection. For patients with PsA, bimekizumab, apremilast, and upadacitinib (30 mg daily) were associated with higher risks of infection; SUCRA ranked bimekizumab with the highest risk of infection. 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引用次数: 0
摘要
背景：感染事件是患者和医生在做出银屑病治疗决定时主要关注的问题。目的：评估生物和小分子治疗中重度斑块型银屑病（PsO）和银屑病关节炎（PsA）的感染和严重感染的相对短期风险。数据来源和方法：2022年6月17日，对PubMed、EMBASE和Web of Science数据库进行了系统的文献检索。我们纳入了PsO和PsA获得许可或可能很快获得批准的生物和小分子疗法的II、III或IV期随机对照试验（RCT），以及感染数据报告。两名研究人员根据系统评价首选报告项目和荟萃分析指南独立提取数据。进行网络荟萃分析（NMA），以估计随机对照试验安慰剂对照阶段治疗的总感染和严重感染的合并相对风险（RR）和相应的95%置信区间。计算累积排名区域（SUCRA）下的表面，以对每次治疗的感染风险进行排名。结果：共分析了94项随机对照试验，共19个治疗组，涉及54369名参与者。对于PsO患者，比美单抗、secukizumab、利桑单抗、ustekinumab、阿普司特、古斯库单抗和阿达木单抗的感染风险显著高于安慰剂；SUCRA将英夫利昔单抗、去阿替尼和比美单抗列为感染风险最高的药物。对于患有PsA、比美单抗、阿普司特和乌帕替尼的患者（30 每日mg）与较高的感染风险相关；SUCRA将bimekizumab列为感染风险最高的药物。除乌帕替尼（30 每日mg），与安慰剂相比，银屑病严重感染的风险更高。结论：该NMA提供了对感染的相对短期风险的综合评估，可以帮助医生和患者选择银屑病的个性化治疗。注册号：CRD42022359873。
Comparative short-term risks of infection and serious infection in patients receiving biologic and small-molecule therapies for psoriasis and psoriatic arthritis: a systemic review and network meta-analysis of randomized controlled trials.
Background: Infection events are a major concern for patients and physicians when making psoriasis treatment decisions.
Objective: To estimate the relative short-term risks of infection and serious infection for biologic and small molecule therapies in the treatment of moderate-to-severe plaque psoriasis (PsO) and psoriatic arthritis (PsA).
Data sources and methods: A systematic literature search of the PubMed, EMBASE, and Web of Science databases was conducted on 17 June 2022. We included phase II, III, or IV randomized controlled trials (RCTs) of biologic and small-molecule therapies that are licensed or likely to gain approval soon for PsO and PsA, as well as infection data reports. Two investigators independently extracted the data based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Network meta-analysis (NMA) was performed to estimate the pooled relative risks (RRs) and corresponding 95% confidence intervals of total infections and serious infections for treatments during placebo-controlled phases of RCTs. The surface under the cumulative ranking area (SUCRA) was calculated to rank the infection risk for each treatment.
Results: A total of 94 RCTs with a total of 19 treatment arms involving 54,369 participants were analyzed. For patients with PsO, bimekizumab, secukizumab, risankizumab, ustekinumab, apremilast, guselkumab, and adalimumab were associated with significantly higher risks of infection than placebo; SUCRA ranked infliximab, deucravacitinib, and bimekizumab with the highest risks of infection. For patients with PsA, bimekizumab, apremilast, and upadacitinib (30 mg daily) were associated with higher risks of infection; SUCRA ranked bimekizumab with the highest risk of infection. No treatments, except for upadacitinib (30 mg daily), were associated with a higher risk of serious infection than placebo in PsA.
Conclusion: This NMA provides a comprehensive assessment of the comparative short-term risks of infection, which could help physicians and patients to select individualized treatments for psoriasis.
期刊介绍：
Therapeutic Advances in Chronic Disease publishes the highest quality peer-reviewed research, reviews and scholarly comment in the drug treatment of all chronic diseases. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers involved in the medical treatment of chronic disease, providing a forum in print and online for publishing the highest quality articles in this area.
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