环孢素、阿达木单抗、司库奇尤单抗治疗甲银屑病的疗效及安全性比较

Efficacy and safety of cyclosporin,adalimumab and secukinumab in the treatment of nail psoriasis

目的观察环孢素、阿达木单抗、司库奇尤单抗治疗甲银屑病的临床疗效及安全性。方法选择我院门诊就诊的甲银屑病患者共计91例,随机分为环孢素组(30例)、阿达木单抗组(31例)、司库奇尤单抗组(30例),比较三组患者在治疗前、治疗12周、治疗24周后的甲银屑病程度指数(NAPSI)、皮肤病生活质量评分(DLQI),观察临床有效率以及不良反应发生率。结果三组患者治疗前NAPSI评分、DLQI评分对比无显著差异(P>0.05)。治疗12周后,阿达木单抗组及司库奇尤单抗组NAPSI评分低于环孢素组(32.16±13.82、32.37±10.97比42.20±16.66,P<0.05),NAPSI评分平均改善率高于环孢素组[(37.34±13.00)%、(35.42±9.61)%比(20.38±8.15)%,P<0.05]。治疗24周后,阿达木单抗组及司库奇尤单抗组NAPSI评分明显低于环孢素组(17.81±14.72、19.27±9.90比31.17±15.14,P<0.05),NAPSI评分平均改善率高于环孢素组[(66.86±22.97)%、(61.86±15.68)%比(42.84±15.29)%,P<0.05],DLQI评分低于环孢素组(4.71±4.52、6.30±5.04比10.43±8.50,P<0.05),治疗后DLQI评分差值大于环孢素组(-6.23±5.70、-5.90±3.83比-3.20±4.92,P<0.05),临床有效率高于环孢素组(64.52%、60.00%比23.33%,P<0.05)。阿达木单抗组与司库奇尤单抗组在治疗12、24周后的NAPSI评分及其改善率,治疗24周后的DLQI评分及其差值,以及临床有效率比较,均无统计学差异(均P>0.05)。三组间不良反应发生率无统计学差异(P=0.784)。结论环孢素、阿达木单抗、司库奇尤单抗均可改善甲银屑病患者的生活质量,对甲银屑病有一定疗效,安全性均在耐受范围。阿达木单抗、司库奇尤单抗较环孢素疗效更佳,而阿达木单抗与司库奇尤单抗之间无明显差异。

Objective To assess the clinical efficacy and safety of cyclosporin,adalimumab and secukinumab in the treatment of nail psoriasis.Methods Ninety-one patients with nail psoriasis from our hospital were randomly divided into cyclosporin group(30 cases),adalimumab group(31 cases)and secukinumab group(30 cases).The nail psoriasis severity index(NAPSI)and dermatology life quality index(DLQI)in the three groups were compared before and after 12-and 24-week treatments.Clinical effectiveness and adverse reactions were observed.Results Before the treatment,there were no significant differences in NAPSI and DLQI scores among the three groups(P>0.05).After 12 weeks of the treatment,the NAPSIs in the adalimumab and the secukinumab groups were lower than that in cyclosporin group(32.16±13.82,32.37±10.97 vs 42.20±16.66,P<0.05);The average improvement rates of NAPSI in both the adalimumab and the secukinumab groups were higher than that in the cyclosporin group[(37.34±13.00)%,(35.42±9.61)%vs(20.38±8.15)%,P<0.05].After 24 weeks of the treatment,the NAPSIs in the adalimumab and the secukinumab groups were significantly lower than that in the cyclosporin group(17.81±14.72,19.27±9.90 vs 31.17±15.14,P<0.05);The average improvement rates of NAPSI in the adalimumab and the secukinumab groups were higher than that in the cyclosporin group[(66.86±22.97)%,(61.86±15.68)%vs(42.84±15.29)%,P<0.05].DLQI in both the adalimumab and the secukinumab groups were lower than that in the cyclosporin group(4.71±4.52,6.30±5.04 vs 10.43±8.50,P<0.05).The changes in DLQIs were more dramatic in the adalimumab and the secukinumab groups than in the cyclosporin group(-6.23±5.70 and-5.90±3.83 vs-3.20±4.92,P<0.05).The effective rates in both the adalimumab and secukinumab groups were higher than that in the cyclosporin group(64.52%and 60.00%vs 23.33%,P<0.05).However,neither NAPSIs nor improvement rates differed significantly between the adalimumab and secukinumab groups after 12-or 24-week treatments.Likewise,DLQIs were similar in the adalimumab and secukinumab groups after 24-week treatments(P>0.05).There were no significant differences in adverse reactions among the three groups(P=0.784).Conclusions Cyclosporin,secukinumab and adalimumab are effective and safe for nail psoriasis.Both secukinumab and adalimumab are more effective than cyclosporin,while the efficacies of secukinumab and adalimumab are comparable.