Hiệu quả và độ an toàn của các chất ức chế IL-23 trong điều trị viêm khớp psoriasis: một phân tích tổng hợp dựa trên các thử nghiệm lâm sàng ngẫu nhiên

Springer Science and Business Media LLC - Tập 71 Số 4 - Trang 505-515 - 2023
Xiaojing Huang1, Haojie Shentu2, Yujing He3, Haijia Lai2, Chunsen Xu4, Meiling Chen5, Haowei Zhu1
1Emergency Medical Center, Ningbo Yinzhou No. 2 Hospital, 998 North Qianhe Road, Yinzhou District, Ningbo, Zhejiang, 315100, China
2School of Medical Imaging, Hangzhou Medical College, Zhejiang, Hangzhou, China
3The Second Clinical Medical College, Zhejiang Chinese Medical University, Zhejiang, Hangzhou, China
4School of Nursing, Hangzhou Medical College, Zhejiang, Hangzhou, China
5The Public Health College, Zhejiang Chinese Medical University, Zhejiang, Hangzhou, China

Tóm tắt

Tóm tắtTrong những năm gần đây, việc sử dụng các chất ức chế interleukin (IL) 23 trong điều trị viêm khớp psoriasis (PsA) đã trở thành chủ đề của nhiều nghiên cứu. Bằng việc kết hợp đặc hiệu với tiểu đơn vị p19 của IL-23, các chất ức chế IL-23 ngăn chặn các con đường tín hiệu hạ lưu và ức chế các phản ứng viêm. Mục tiêu của nghiên cứu này là đánh giá hiệu quả lâm sàng và độ an toàn của các chất ức chế IL-23 trong điều trị PsA. Các cơ sở dữ liệu PubMed, Web of Science, Thư viện Cochrane và EMBASE đã được tìm kiếm từ thời điểm khởi đầu đến tháng 6 năm 2022 cho các thử nghiệm ngẫu nhiên có đối chứng (RCTs) nghiên cứu việc sử dụng IL-23 trong liệu pháp PsA. Kết quả chính được quan tâm là tỷ lệ đáp ứng American College of Rheumatology 20 (ACR20) tại tuần thứ 24. Chúng tôi đã bao gồm sáu RCTs (3 nghiên cứu về guselkumab, 2 nghiên cứu về risankizumab và 1 nghiên cứu về tildrakizumab) với tổng cộng 2971 bệnh nhân PsA trong phân tích tổng hợp của chúng tôi. Chúng tôi phát hiện rằng nhóm chất ức chế IL-23 cho thấy tỷ lệ đáp ứng ACR20 cao hơn một cách có ý nghĩa so với nhóm giả dược (rủi ro tương đối = 1,74, khoảng tin cậy 95%: 1,57–1,92; P < 0,001; I2 = 40%). Không có sự khác biệt thống kê về nguy cơ xảy ra các biến cố bất lợi (P = 0,07) và biến cố bất lợi nghiêm trọng (P = 0,20) giữa nhóm chất ức chế IL-23 và nhóm giả dược. Đáng chú ý, tỷ lệ transaminase tăng cao trong nhóm chất ức chế IL-23 cao hơn nhóm giả dược (rủi ro tương đối = 1,69; 95%CI 1,29–2,23; P < 0,001; I2 = 24%). Trong điều trị PsA, các chất ức chế IL-23 vượt trội hơn rõ rệt so với can thiệp giả dược trong khi vẫn duy trì một hồ sơ an toàn thuận lợi.

Từ khóa


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