英夫利西单抗长疗程治疗中重度寻常性银屑病的疗效评价

Evaluation of efficacy of infliximab in the long-term treatment of moderate and severe psoriasis vulgaris

目的观察长期使用英夫利西单抗治疗中重度寻常性银屑病的疗效。方法随访分析2016年3月至2018年5月在北京大学第三医院皮肤科应用英夫利西单抗治疗的中重度寻常性银屑病患者,纳入用药超过54周的患者。用药剂量5 mg/kg,总剂量以100 mg为间隔取整数。前两次用药间隔依次为2、4周,然后间隔均为8周。采用Mauchly球性检验法、随机区组的方差分析法及Bonferroni法分析治疗前、治疗2、6、14、22、30、38、46及54周银屑病皮损面积和严重程度指数(PASI)变化,同时记录病情转归及不良反应。结果12例患者接受治疗,9例持续用药超过54周,遂纳入数据分析。治疗前,9例患者PASI值[M(P25,P75)]为26.3(23.4,27.7)。不同治疗时间点的PASI值不等(F=7.12,P=0.0004),且患者PASI值呈总体下降趋势。治疗30周时,PASI值为4(2.5,5.2),PASI改善率为86.38%±6.98%。其中,改善率达PASI50的患者8例,达PASI75的患者7例,达PASI90的患者2例。治疗54周时,PASI值为8(3.5,8.9),PASI改善率为64.23%±17.32%,8例达PASI50,4例达PASI75,1例达PASI90。Bonferroni法显示,与治疗30周时相比,治疗54周时PASI评分显著升高(t=3.269,P=0.0048),但治疗30周及54周时PASI评分值均显著低于治疗前(30周:t=18.49,P<0.0001;54周:t=5.81,P=0.0004)。结论英夫利西单抗治疗中重度寻常性银屑病在长达54周的时间内有显著疗效。

ObjectiveTo evaluate the efficacy of long-term treatment with infliximab in patients with moderate to severe psoriasis vulgaris.MethodsPatients with moderate to severe psoriasis vulgaris,who started infliximab therapy in Department of Dermatology,Peking University Third Hospital between March 2016 and May 2018,were followed up.The patients treated with infliximab for more than 54 weeks were enrolled into this study.The patients were treated with infliximab at a weight-based dosage of 5 mg/kg,and the total dosage used per session was 200,300 and 400 mg for patients with the body weight of 40-59 kg,60-79 kg,and >80 kg respectively.The patients were treated at week 0,2,6,14,22,30,38,46 and 54,and the psoriasis area and severity index(PASI)score was determined before each treatment.Mauchly′s test of sphericity,randomized block analysis of variance and Bonferroni method were used to analyze changes of PASI scores after 2-,6-,14-,22-,30-,38-,46-and 54-week treatment.Sequelae and adverse reactions were also recorded.ResultsTwelve patients received the treatment with infliximab,and 9 patients were treated for more than 54 weeks,whose clinical data were analyzed.Before the treatment,the PASI score(M[P25,P75])of the 9 patients was 26.3(23.4,27.7).There were significant differences in the PASI score among different time points(F=7.12,P=0.0004),and the PASI score of the patients showed a generally decreasing trend over time.After 30-week treatment,the PASI score was 4(2.5,5.2),and the PASI improvement rate was 86.38%±6.98%;of the 9 patients,8 achieved PASI50,7 achieved PASI75,and 2 achieved PASI90.After 54-week treatment,the PASI score was 8(3.5,8.9),the PASI improvement rate was 64.23%±17.32%,and the number of patients achieving PASI50,PASI75 and PASI90 was 8,4 and 1 respectively.Bonferroni method showed that the PASI score significantly increased at week 54 compared with that at week 30(t=3.269,P=0.0048),but significantly decreased at weeks 30 and 54 compared with that before the treatment(week 30:t=18.49,P<0.0001;week 54:t=5.81,P=0.0004).ConclusionInfliximab is remarkably effective for moderate and severe psoriasis vulgaris in the 54-week treatment.