在斑块性牛皮患者中降低生物制剂剂量:一篇综述
C A M van Riel1,2, C A J Michielsens1,2, M E van Muijen3,4
1Radboud University Medical Centre, Nijmegen, Netherlands.
Frontiers in pharmacology
|April 12, 2024
概括
治疗牛皮的生物药物剂量减小 (DR) 是有效的,节省成本,特别是对于较旧的治疗方法. 需要对较新的生物制剂进行更多研究 (IL-17/23i),以改进指导方针和实际实施.
科学领域:
- 皮肤病学和免疫学
- 药物经济学 药物经济学
- 基于证据的医学 基于证据的医学
背景情况:
- 之前的审查涵盖了第一代生物药物 (TNF-α抑制剂,IL-12/23抑制剂) 在斑块性牛皮中的剂量减少 (DR).
- 对于较新的生物药物,如IL-17/23抑制剂,存在关于DR的有限文献.
研究的目的:
- 更新关于DR策略的文献,用于所有用于斑块性牛皮的生物药物.
- 专注于生物DR的实际采用和实施.
- 评估第一代和较新的生物制剂的DR (IL-17/23i).
主要方法:
- 在文献搜索中,除了之前的范围审查之外,还发现了14篇新文章.
- 分析测试DR策略的研究,重点关注资格标准 (PASI,DLQI,BSA,PGA) 和方法 (逐步延长间隔,固定的剂量减少,按需剂量).
- 包括关于恢复响应,安全性,成本效益以及实施障碍/促进者的研究.
主要成果:
- 四项新的研究测试了DR策略,主要是针对第一代生物制剂;古塞尔库马布 (IL-23i) 被纳入一项研究.
- 对于TNF-α抑制剂,IL-12/23抑制剂和IL-23i (guselkumab) 观察到成功的DR策略.
- 在TNF-α抑制剂和IL-12/23抑制剂的DR方面报告了大量的成本节约.
- 阻碍DR实施的障碍包括缺乏指导方针和证据;促进者包括明确的指导方针,可行的协议和教育.
结论:
- 对斑块性牛皮的生物治疗似乎是有希望的,证明了有效性和成本节省.
- 在随机,前性研究中存在显著的研究缺口,特别是对于IL-17/23抑制剂,这阻碍了指南的完成.
- 解决已识别的障碍和促进因素对于成功实施生物DR至关重要.
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