针对老年人牛皮病和严重感染的系统疗法
Aaron M Drucker1,2,3,4, Rinku Sutradhar4,5, Vicki Ling4
1Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
JAMA dermatology
|March 19, 2025
概括
老年人牛皮病的全身治疗显示出不同的感染风险. 针对IL-12,IL-23或IL-17的生物药物与较少的严重感染有关,而托法西提尼布增加了风险.
科学领域:
- 免疫学 免疫学 免疫学
- 皮肤病学 皮肤病学
- 老年病的医生 老年病的医生
背景情况:
- 牛皮病的全身治疗可以增加感染风险,特别是在更容易受到伤害的老年人中.
- 不同系统性牛皮病治疗方法在老年人群中的比较安全性在很大程度上是未知的.
研究的目的:
- 评估各种系统性治疗牛皮病和老年人严重感染的发病率之间的关联.
- 确定在这个人口群体中可能会产生更高或更低的严重感染风险的特定系统疗法.
主要方法:
- 一项基于人口的队列研究,利用加拿大安大略省 (2002-2021) 的链接卫生行政数据.
- 纳入标准:安大略省66岁及以上的居民被诊断患有牛皮病,开始第一次全身治疗.
- 分析涉及系统性药物的时间变化使用 (甲托雷克萨特,较旧的系统性药物,抗TNF生物药物,针对IL-12/23/17的其他生物药物和托法西提尼布) 和复发事件回归以确定严重感染率.
主要成果:
- 这项研究包括11,641名老年人,他们开始治疗牛皮病的全身治疗.
- 针对IL-12,IL-23或IL-17的生物药物与严重感染率显著降低相关 (RR,0.65;95% CI,0.48-0.88).
- 托法西提尼布与严重感染的发生率明显高 (RR,2.89;95% CI,1.14-7.34),而甲状腺素,其他较旧的全身药物和抗TNF生物药物没有显著的关联.
结论:
- 针对IL-12,IL-23或IL-17的生物药物在老年人患有牛皮病的严重感染方面表现出有利的安全性.
- 这些特定的生物药物可能为感染风险增加的老年患者提供安全益处.
- 在这个人群中使用托法西提尼布需要仔细考虑,因为它与严重感染风险的增加有关.
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