治疗“高影响部位”银屑病,哪些药物的表现突出

当银屑病发生在生殖器、头皮、掌跖(手心脚心)等 “高影响部位” 时,银友往往面临更大的生理不适和心理压力。所谓 “高影响部位”,并非仅以皮损面积衡量,而是结合部位特殊性对患者生活的影响程度定义。即便皮损面积不大,也可能给患者带来远超普通部位的困扰,易让患者产生自卑心理、生活质量急剧下降。近日,国际银屑病理事会(IPC)汇总了十几项针对这些特殊部位的药物临床试验结果,为临床治疗提供了参考方向。今天就来拆解这些研究,看看哪些药物在“高影响部位”治疗中表现突出。

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依奇珠单抗(Ixekizumab):用于中重度生殖器银屑病患者16周治疗后,73%患者达到 SPGA 0(完全清除)或 1(几乎清除)”,而安慰剂组仅 8% [1]阿普米司特(Apremilast):治疗中度至重度生殖器银屑病患者,39.6%的患者在第16周时达到改良 sPGA-G 0 或 1,且该评估评分较基线降低≥2分;而接受安慰剂治疗的患者中这一比例为 19.5% [2]

古塞奇尤单抗(Guselkumab):用于非脓疱型掌跖银屑病患者治疗16周时,35.9%的患者达到掌跖银屑病面积和严重程度指数75(ppPASI75),即症状改善75%,而接受安慰剂治疗的患者中这一比例为 28.2% [3]

●阿达木单抗(Adalimumab):用于中重度手足慢性斑块型银屑病患者治疗16周时,31%的患者达到手足整体评估 75(hfPGA75),而接受安慰剂治疗的患者中这一比例仅为 4% [4]

●司库奇尤单抗(Secukinumab):用于掌跖银屑病患者治疗16周时,接受300mg司库奇尤单抗治疗的患者中,33.3%达到掌跖研究者整体评估(ppIGA)0 级 / 1 级,且该评估评分较基线降低≥2 分;接受150mg司库奇尤单抗治疗的患者中这一比例为22.1%;而接受安慰剂治疗的患者中这一比例仅为 1.5% [5]

利生奇珠单抗(Risankizumab)用于伴有非脓疱型掌跖受累的中重度斑块型银屑病患者治疗16周时,接受150mg利生奇珠单抗治疗的患者中,33.3%达到掌跖研究者整体评估(ppIGA)0 级 / 1 级,且该评估评分较基线降低≥2 分;而接受安慰剂治疗的患者中这一比例为 16.1% [6]

●阿普斯特(Apremilast):用于中重度头皮斑块型银屑病患者治疗16周时,43%的患者达到头皮医师整体评估(ScPGA)0 级或 1 级,且该评估评分较基线降低≥2 分;而接受安慰剂治疗的患者中这一比例为 13.7% [7]

●司库奇尤单抗(Secukinumab):用于中重度头皮银屑病患者治疗12周时,57%的患者 达到头皮研究者整体评估(IGA-scalp)0 级或 1 级,而接受安慰剂治疗的患者中这一比例仅为 6% [8]

●氘可来昔替尼(Deucravacitinib):用于头皮银屑病患者治疗24周时,57.6%的患者达到静态医师整体评估(sPGA)0 级或 1 级,而接受安慰剂治疗的患者中这一比例仅为 5.3% [9]

●古塞奇尤单抗(Guselkumab):用于体表面积(BSA)较低但高影响部位受累的银屑病患者治疗16周时,74%的患者达到研究者整体评估(IGA)0 级或 1 级,而接受安慰剂治疗的患者中这一比例仅为 12% [10]

●古塞奇尤单抗(Guselkumab):用于面部(FP)和生殖器(GP)银屑病患者治疗12周时,83.3%的面部银屑病患者达到面部静态医师整体评估(sPGA)0 级或 1 级;76.5%的生殖器银屑病患者达到面部静态医师整体评估(sPGA)0 级(完全清除)或 1 级(几乎清除) [11]

看完这些研究数据,可能有银友会问:“我能根据这些研究结果自己选择用药吗?”其实,这些国际研究结果的价值,更多体现在“提供参考方向”。虽然这些国际研究给出了积极的疗效数据,但每位银友的病情、过敏史、基础疾病都不同,所以您不能根据研究结果自己选择药物。建议大家与主治医生沟通,明确告知部位特殊性与自身需求,以便获得安全有效的治疗。

–THE END–

1.Ryan C, Menter A, Guenter , et al. Efficacy and safety of ixekizumab in a randomized, double-blinded, placebo-controlled phase IIIb study of patients with moderate-to-severe genital psoriasis Br J Dermatol.2.Merola JF, ParishLC, Guenter L, et al. Efficacy and safety of apremilast in patients with moderate-to-severe genital psoriasis: Results from DISCREET, a phase 3 randomized, double-blind, placebo-controlled trial J Am Acad Dermatol. 2024;90:485-493.

3.Passeron T, Carrascosa JM, Warren RB, et al. A Phase IIIb, Multicentre, Interventional, Randomised Placebo-Controlled Clinical Trial Investigating the Efficacy and Safety of Guselkumab for the Treatment of Nonpustular Palmoplantar Psoriasis (G-PLUS). Dermatologic Therapy Volume 2023, Article ID 9967747

4.Leonardo C, Langley RG, Papp K, et al Adalimumab for treatment of moderate to severe chronic plaque psoriasis of the hands and feet: efficacy and safety results from REACH, a randomized, placebo-controlled, double-blind trial. Arch Dermatol.

5.Gottlieb A, Sullivan J, van Doorn M, et al. Secukinumab shows significant efficacy in palmoplantar psoriasis: Results from GESTURE, a randomized controlled trial. J Am Acad Dermatol 2017 ;76:70-80.

6.Lebwohl M, Bukhalo M, Stein Gold L, et al. randomized phase 3b study evaluating the safety and efficacy of risankizumab in adult patients with moderate-to- severe plaque psoriasis with non- pustular palmoplantar involvement J Am Acad Dermatol 2024;91:1150-7

7.Van Voorhees AS, SteinGold L, Lebwohl M, et al. Efficacy and safety of apremilast in patients with moderate to severe plaque psoriasis of the scalp: Results of a phase 3b, multicenter, randomized, placebo-controlled, double-blind study. J Am Acad Dermatol. 2020 ;83:96-103.

8.Bagel J, Calis Duffin K, Moore A, et al. The effect of secukinumab on moderate-to-severe scalp psoriasis: Results of a 24-week, randomized, double-blind, placebo-controlled phase 3b study. J Am Acad Dermatol 2017;77:667-74.

9.Lebwohl M, et al. EADV 2024, FC04.07

10.Presented by L Stein Gold at Fall Clinical Dermatology Conference; October 24-27, 2024; Wynn Las Vegas, NV, USA

11.Bonifati C, Lembo S, Richetta AG, et al. Effectiveness of guselkumab in patients with facial and/or genital psoriasis: Interim analysis results at Week 12 from the GULLIVER study. J Eur Acad Dermatol Venereol. 2025;39(Suppl 1):7-14.

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