阿法西普治疗银屑病随机对照试验的Meta-分析

Alefacept for Psoriasis:a Meta-analysis of the Randomized Controlled Trials

目的 评价阿法西普治疗银屑病的疗效和安全性.方法 计算机检索Cochrane图书馆（2012年第3期）、Cochrane协作网皮肤病专业试验数据库（2012年）、检索MEDLINE（1966～2012年）、Embase数据库（1974～2012年）,中国知网CNKI,收集所有有关阿法西普治疗银屑病的随机对照临床试验（RCT）.两名研究者独立进行各临床试验的质量评估,并进行交叉核对.采用Cochrane协作网提供的RevMan5.0进行统计分析.结果 共纳入6篇RCT,包括1 289例患者,临床诊断为慢性中、重度斑块型银屑病,年龄＞16岁.Jadad评分6篇文献均为高质量.Meta分析显示：阿法西普每周0.075 mg·kg-1或每周7.5 mg静脉滴注、每周10或15 mg肌内注射连续12周,治疗有效.随访12周期间,平均严重性指数（PASI）积分继续下降,生活质量（QOL）维持改善.结论 阿法西普是一种有效的治疗慢性中、重度斑块型银屑病的生化药物,作用持久,有缓解性治疗的趋势.

Objective To evaluate the efficacy and safety of alefacept in the treatment of patients with psoriasis. Methods The randomized controiled trials（RCT） on alefaeept in the treatment of the patients with psoriasis were collected by searching The Cochrane Library （ issue 3, 2012 ）, specialized trials registered in Cochrane Skin Group （ 2012 ）, MEDLINE （ 1966-2012）, and Embase（ 1974-2012 ）. The quality of the trials was assessed according to the Jadad scale by two independent reviewers. RevMan 5.0 software was used for statistical analysis. Results Six RCTs involving 1 289 patients were included in the analysis. All patients were at least 16 years old diagnosed with chronic moderate to severe plaque psoriasis. Significant improvement was achieved in patients receiving alefacept 0. 075 mg· k-1 · w -1 or 7.5 mg· w · intravenously, or 10 mg· w -1 or 15 mg · w -1 intramnscularly for 12 weeks as compared with placebo groups. After treatment for 12 weeks, the mean scores of psoriasis area-and-severity index （PASI） continued to decrease with improvements in quality of life （QOL）. Conclusion Alefacepl therapy tor 12 weeks result in significant improvements in adult patients with moderate to severe psoriasis. More RCTs are required to determine the optimal dose for psoriasis. Alefacept Is well tolerated and provided long lasting remission of psoriasis.