Risk of Serious Infections in Patients with Psoriasis on Biologic Therapies: A Systematic Review and Meta-Analysis

被引：60

作者：

Yiu, Zenas Z. N. ^{[1
,2
]}

Exton, Lesley S. ^{[3
]}

Jabbar-Lopez, Zarif ^{[4
]}

Mustapa, M. Firouz Mohd ^{[3
]}

Samarasekera, Eleanor J. ^{[5
]}

Burden, A. David ^{[6
]}

Murphy, Ruth ^{[7
,8
]}

Owen, Caroline M. ^{[9
]}

Parslew, Richard ^{[10
]}

Venning, Vanessa ^{[11
]}

Ashcroft, Darren M. ^{[2
]}

Griffiths, Christopher E. M. ^{[1
]}

Smith, Catherine H. ^{[12
]}

Warren, Richard B. ^{[1
]}

机构：

[1] Univ Manchester, Manchester Acad Hlth Sci Ctr, Salford Royal NHS Fdn Trust, Dermatol Ctr, Manchester M6 8HD, Lancs, England

[2] Univ Manchester, Manchester Pharm Sch, Ctr Pharmacoepidemiol & Drug Safety, Manchester, Lancs, England

[3] British Assoc Dermatologists, London, England

[4] Newcastle Tyne Hosp NHS Fdn Trust, Royal Victoria Infirm, Dept Dermatol, Newcastle Upon Tyne, Tyne & Wear, England

[5] Royal Coll Phys London, Natl Clin Guideline Ctr, London, England

[6] Western Infirm & Associated Hosp, Dept Dermatol, Glasgow, Lanark, Scotland

[7] Univ Sheffield, Teaching Hosp, Sheffield, S Yorkshire, England

[8] Sheffield Childrens Hosp, Sheffield, S Yorkshire, England

[9] East Lancashire Hosp NHS Trust, Royal Blackburn Hosp, Dept Dermatol, Blackburn, Lancs, England

[10] Royal Liverpool & Broadgreen Univ Hosp Trust, Dept Dermatol, Liverpool, Merseyside, England

[11] Oxford Univ Hosp Fdn Trust, Dept Dermatol, Oxford, England

[12] Guys & St Thomas NHS Fdn Trust, St Johns Inst Dermatol, London, England

来源：

JOURNAL OF INVESTIGATIVE DERMATOLOGY | 2016年 / 136卷 / 08期

基金：

美国国家卫生研究院;

关键词：

RANDOMIZED CONTROLLED-TRIAL; PLACEBO-CONTROLLED TRIAL; INTERLEUKIN-12/23; MONOCLONAL-ANTIBODY; CHRONIC PLAQUE PSORIASIS; TO-SEVERE PSORIASIS; PHASE-III TRIAL; DOUBLE-BLIND; DISEASE CHARACTERISTICS; RHEUMATOID-ARTHRITIS; INFLIXIMAB INDUCTION;

D O I：

10.1016/j.jid.2016.03.035

中图分类号：

R75 [皮肤病学与性病学];

学科分类号：

100206 ;

摘要：

A comprehensive evaluation of the risk of serious infections in biologic therapies for psoriasis is lacking. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and prospective cohort studies reporting serious infections in people taking any licensed biologic therapy for psoriasis compared with those taking placebo, nonbiologic therapy, or other biologic therapies. The quality of the studies was assessed using Grading of Recommendations Assessment, Development and Evaluation criteria. No significant heterogeneity was detected in data from 32 RCTs (n = 13,359 participants) and one cohort study (n = 4,993 participants). In adults, low-to very-low-quality RCT data showed no significant difference between any biologic therapy and placebo at weeks 12-16 (overall pooled Peto odds ratio = 0.71, 95% confidence interval = 0.36-1.41) and weeks 20-30 (odds ratio = 2.27, 95% confidence interval = 0.45-11.49). No significant differences were found in any of the other comparisons in underpowered RCT data. Prospective cohort study data of low quality suggests that only adalimumab (adjusted hazard ratio [adjHR] = 2.52, 95% confidence interval = 1.47-4.32) was associated with a significantly higher risk of serious infection compared with retinoid and/or phototherapy in adults. No association between biologic therapies and serious infections in patients with psoriasis who were eligible for RCTs was detected. Further observational studies are needed to inform the uncertainty around this risk in the real world.

引用

页码：1584 / 1591

页数：8

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