纳武利尤单抗相关银屑病的文献分析

Literature analysis of nivolumab-associated psoriasis

目的 分析探讨纳武利尤单抗相关银屑病的临床特点与规律,为临床合理用药提供参考。方法检索中国知网、万方数据库、维普数据库、PubMed及Embase数据库,检索时间为2015年3月1日至2022年5月31日,对纳武利尤单抗相关银屑病的病例报道进行统计分析。结果 共纳入29篇文献32例患者,其中男性25例,女性7例,平均年龄为(63.8±11.8)岁,其中50~80岁占27例(84.4%);新发银屑病21例,原有银屑病加重11例;绝大部分发生在用药后180 d(84.4%)或10剂(75.0%)之内,中位潜伏期为84 d,平均潜伏期为(93.4±95.0)d,其中新发患者平均潜伏期为(106.4±104.8)d,加重患者为(67.4±63.9)d;临床分型以寻常型银屑病为主(23例,71.9%),中度居多(22例,68.8%);银屑病发生后,14例(43.8%)停药,16例(50.0%)未停药,所有患者经临床处理后,18例(56.2%)基本恢复,14例(43.8%)好转。停药的14例患者中,5例恢复用药,其中4例未见银屑病复发,1例恶化。结论 临床需警惕纳武利尤单抗相关银屑病的发生,用药期间应加强皮疹、关节疼痛等相关症状监测,尽早识别和诊断,必要时接受规范且个体化的治疗,以降低银屑病不良影响,最大化纳武利尤单抗的临床应用。

Objective To analyze the clinical characteristics and regularity of psoriasis associated with nivolumab,and provide reference for clinical rational drug use.Methods CNKI,Wanfang database,VIP databsese,PubMed and Embase were searched from March 1,2015 to May 31,2022,and statistical analysis was conducted on the case reports of psoriasis associated with nivolumab.Results A total of 32 patients from 29 papers were included.Among them,there were 25 males and 7 females,with an average age of(63.8±11.8) years,and 27 patients(84.4%) were between 50 and 80 years old.Twenty-one cases were new onset of psoriasis and 11 cases were aggravated psoriasis.Most of them occurred within 180 days(84.4%) or 10 doses(75.0%) after treatment.The median latency period was 84 days,and the average latency period was(93.4±95.0) days,with aggravated patients(67.4±63.9) days and new patients(106.4 ± 104.8) days.Psoriasis vulgaris was the main clinical type(23 cases,71.9%),and most were moderate(22 cases,68.8%).After the occurrence of psoriasis,14 cases(43.8%) discontinued the drug,16 cases(50.0%) continued.All patients were clinically treated.After treatment,18 cases(56.2%) basically recovered,and 14 cases(43.8%) improved.Among the 14 drug withdrawal-patients,5 resumed medication,of which 4 cases didn't observe psoriasis recurrence and 1 case worsened.Conclusion Clinicians need to be vigilant about the occurrence of psoriasis associated with nivolumab.During medication use,we should strengthen the monitoring of rash,joint pain and other related symptoms,identify and diagnose as soon as possible,administer standardized and individualized treatment when necessary,so as to reduce the adverse impact of psoriasis and maximize the clinical application of nivolumab.