司库奇尤单抗及依奇珠单抗治疗中重度斑块型银屑病小样本短期疗效评价

Evaluation of Short-term Curative Effect of Secukinumab and Ixekizumab in the Treatment of Moderate to Severe Plaque Psoriasis with a Small Sample

目的探讨比较司库奇尤单抗和依奇珠单抗治疗中重度斑块型银屑病的疗效和安全性。方法采用随机对照研究设计,纳入上海市皮肤病医院2019年6月-2020年12月门诊中重度斑块状银屑病患者20例,随机分配进入两个治疗组,司库奇尤单抗治疗组及依奇珠单抗治疗组。用药第4、8、12周后分别评价两组药物的疗效及安全性。计量资料两组间比较采用t检验,计数资料两组间比较采用Fisher精确检验。分析两组治疗前后银屑病皮损面积和严重程度指数(PASI)数据。结果司库奇尤单抗组治疗第4、8、12周后PASI评分分别为11.78±5.63、6.63±3.67、3.34±2.48;依奇珠单抗组治疗第4、8、12周后PASI评分分别为10.27±5.64、5.10±3.02、2.53±2.11;司库奇尤单抗组治疗第4、8、12周后PASI评分下降值分别为:10.22±5.14、15.37±4.94、18.66±4.62;依奇珠单抗组治疗第4、8、12周后PASI评分下降值分别为:14.00±4.04、19.17±2.86、21.74±3.17。司库奇尤单抗组治疗第4、8、12周后PASI评分下降率分别为:(46.6±21.5)%、(69.6±16.5)%、(84.8±11.0)%;依奇珠单抗组治疗第4、8、12周后PASI评分下降率分别为:(59.0±19.2)%、(79.8±9.9)%、(90.1±6.7)%。部分患者使用司库奇尤单抗治疗仍有局部皮疹顽固不退,在换用依奇珠单抗后皮疹清除。结论司库奇尤单抗和依奇珠单抗治疗中重度寻常型银屑病短期疗效相当。依奇珠单抗在部分皮疹治疗抵抗时更具治疗优势。治疗过程中出现湿疹样皮炎,可能与Th1/Th2炎症轴偏移有关。

Objective To explore and compare the efficacy and safety of Secukinumab and Ixekizumab in the treatment of moderate to severe plaque psoriasis.Methods A randomized controlled study was used to enroll 20 patients with moderate to severe plaque psoriasis in the outpatient clinic of Shanghai Dermatology Hospital from June 2019 to December 2020, and patients were randomly assigned to two treatment groups, the Secukinumab treatment group and the Ixekizumab treatment group.The efficacy and safety of the drugs in two groups were evaluated after 4, 8 and 12 weeks of medication.The t test was used to compare the measurement data between the two groups, and the Fisher exact test was used to compare the count data between the two groups. The area and severity index(PASI) data of psoriasis before and after treatment in the two groups were analyzed.Results The PASI scores after the 4, 8, and 12 weeks of treatment in the Secukinumab group were 11.78±5.63, 6.63±3.67, 3.34±2.48, respectively;in the Ixekizumab group 10.27±5.64, 5.10±3.02, 2.53±2.11, respectively.The decrease of PASI scores after the 4, 8 and 12 weeks of treatment in the Secukinumab group were 10.22±5.14,15.37±4.94,18.66±4.62, respectively;in the Ixekizumab group were 14.00±4.04, 19.17±2.86, 21.74 ±3.17, respectively.The decline rates of PASI scores after 4, 8 and 12 weeks of treatment in Secukinumab group were:(46.6±21.5)%,(69.6±16.5)%,(84.8±11.0)%, respectively;the rate in the Ixekizumab group were(59.0±19.2)%,(79.8±9.9)%,(90.1±6.7)%, respectively.In some patients, some lesions still persisted after therapy of Secukinumab, but cleared after switching to Ixekizumab.Conclusion The short-term curative effect of Secukinumab and Ixekizumab in the treatment of moderate to severe psoriasis vulgaris is equivalent.Ixekizumab has more therapeutic advantages when some lesions are resistant to treatment.Eczema-like dermatitis occurrs during treatment, which may be related to the deviation of Th1/Th2 inflammation axis.