Abstract：
OBJECTIVE: To compare the tolerability and effectiveness of two different classes of biological DMARDs [IL-17 and IL-23(p19) inhibitors, IL-17i and IL-23(p19)i] relative to TNF inhibitors (TNFi) regarding the drug survival rates and treatment outcomes in patients with PsA.
METHODS: We emulated a target trial on comparative effectiveness using observational data from a prospective cohort study based on the Parker Institute\'s PsA cohort (the PIPA cohort). All patients underwent interview and a clinical examination programme at baseline and at follow-up visits at 4 and 12 months. The primary endpoint, drug survival, was assessed up to 12 months from baseline. We estimated hazard ratios from proportional hazards model and used propensity score adjustment in an attempt to deconfound and emulate a random treatment assignment.
RESULTS: We included a total of 109 patients in the intention-to-monitor population at baseline initiating either TNFi (75 patients), IL-17i (26 patients) or IL-23(19)i (8 patients). Hazard ratios in the propensity adjusted model comparing IL-17i and IL-23(p19)i with TNFi were 1.36 (95% CI 0.59-3.14) and 0.56 (95% CI 0.10-3.24), respectively. TNFi and IL-17i had comparable effects regarding response rates and changes in clinical outcomes after 12 months, whereas IL-23(p19)i tended to perform better overall.
CONCLUSIONS: No decisive differences between drugs were observed at group level regarding drug survival and clinical outcomes after 12 months. TNFi, IL-17i and IL-23(p19)i may all be considered equally effective in the treatment of patients with PsA, advocating for investigating more in personalized treatment strategies.
METHODS: We emulated a target trial on comparative effectiveness using observational data from a prospective cohort study based on the Parker Institute\'s PsA cohort (the PIPA cohort). All patients underwent interview and a clinical examination programme at baseline and at follow-up visits at 4 and 12 months. The primary endpoint, drug survival, was assessed up to 12 months from baseline. We estimated hazard ratios from proportional hazards model and used propensity score adjustment in an attempt to deconfound and emulate a random treatment assignment.
RESULTS: We included a total of 109 patients in the intention-to-monitor population at baseline initiating either TNFi (75 patients), IL-17i (26 patients) or IL-23(19)i (8 patients). Hazard ratios in the propensity adjusted model comparing IL-17i and IL-23(p19)i with TNFi were 1.36 (95% CI 0.59-3.14) and 0.56 (95% CI 0.10-3.24), respectively. TNFi and IL-17i had comparable effects regarding response rates and changes in clinical outcomes after 12 months, whereas IL-23(p19)i tended to perform better overall.
CONCLUSIONS: No decisive differences between drugs were observed at group level regarding drug survival and clinical outcomes after 12 months. TNFi, IL-17i and IL-23(p19)i may all be considered equally effective in the treatment of patients with PsA, advocating for investigating more in personalized treatment strategies.
摘要：
目的：比较两种不同类型的生物学抗病药物（bDMARDs；白细胞介素（IL）-17和IL-23（p19）抑制剂）相对于肿瘤坏死因子抑制剂（TNFi）的耐受性和有效性。银屑病关节炎（PsA）患者的药物生存率和治疗结果。
方法：我们使用基于ParkerInstitute的PsA队列-PIPA队列的前瞻性队列研究的观察数据，对比较有效性的目标试验进行了模拟。所有患者在基线和随访4个月和12个月时接受访谈和临床检查计划。主端点，药物生存,从基线开始评估长达12个月。我们从比例风险模型中估计了风险比，并使用了倾向评分调整来尝试去发现和模仿随机治疗分配。
结果：我们纳入了在基线开始TNFi的意向监测人群中总共109名患者（75名患者），IL17i（26名患者），或IL23（19）i（8名患者）。在比较IL-17i和IL-23（p19）i与TNFi的倾向调整模型中，风险比分别为1.36（95％CI0.59-3.14）和0.56（95％CI0.10-3.24），分别。12个月后，TNFi和IL-17i在缓解率和临床结果变化方面具有相当的效果，而IL-23（p19）i总体表现更好。
结论：在12个月后的药物生存和临床结局方面，在组水平上没有观察到药物之间的决定性差异。TNFi,IL-17i,和IL-23（p19）i都可以被认为在治疗PsA患者中同样有效，倡导在个性化治疗策略中进行更多调查。
方法：我们使用基于ParkerInstitute的PsA队列-PIPA队列的前瞻性队列研究的观察数据，对比较有效性的目标试验进行了模拟。所有患者在基线和随访4个月和12个月时接受访谈和临床检查计划。主端点，药物生存,从基线开始评估长达12个月。我们从比例风险模型中估计了风险比，并使用了倾向评分调整来尝试去发现和模仿随机治疗分配。
结果：我们纳入了在基线开始TNFi的意向监测人群中总共109名患者（75名患者），IL17i（26名患者），或IL23（19）i（8名患者）。在比较IL-17i和IL-23（p19）i与TNFi的倾向调整模型中，风险比分别为1.36（95％CI0.59-3.14）和0.56（95％CI0.10-3.24），分别。12个月后，TNFi和IL-17i在缓解率和临床结果变化方面具有相当的效果，而IL-23（p19）i总体表现更好。
结论：在12个月后的药物生存和临床结局方面，在组水平上没有观察到药物之间的决定性差异。TNFi,IL-17i,和IL-23（p19）i都可以被认为在治疗PsA患者中同样有效，倡导在个性化治疗策略中进行更多调查。
