■存在许多治疗银屑病的国际指南,并且大多数在分级证据质量方面存在差异,建议的力量,和剂量。我们审查的目的是比较英国出版的国际准则,加拿大,欧洲,和美国对中度至重度斑块状银屑病的治疗。
■我们对成人患者中至重度斑块状银屑病的全身疗法和光疗进行了文献综述。英国人,加拿大,欧洲,美国指南是我们审查中的主要比较者。为确定指南中未提及的相关支持性临床试验,我们在PubMed和EMBASE进行了文献检索。两位作者独立提取了适应症的数据,给药,功效,证据等级,以及每种疗法的临床推荐强度。
■针对肿瘤坏死因子和白细胞介素(IL)-12/23的单克隆抗体获得了治疗中度至重度斑块状银屑病的最强建议,由健壮的支持,高质量随机对照试验(RCTs)。较新的药物如IL-17和IL-23抑制剂在大多数指南中没有提及。传统疗法的RCT较少,与生物制剂的头对头比较很少,很难直接比较。在年长的特工中,甲氨蝶呤最强烈建议用于长期维持,环孢菌素建议用于短期控制耀斑。
■医生应根据药物耐受性个性化牛皮癣管理策略,功效,安全,患者合并症,药物的可用性,患者偏好。
UNASSIGNED: Many international
guidelines for management of psoriasis exist and most have variations in grading evidence quality, strength of recommendations, and dosing. The objective of our review is to compare international
guidelines published in the United Kingdom, Canada, Europe, and the United States for the management of moderate-to-severe plaque psoriasis.
UNASSIGNED: We conducted a literature review on systemic therapies and phototherapy for moderate-to-severe plaque psoriasis in adult patients. The British, Canadian, European, and American
guidelines served as the key comparators in our review. To identify relevant supporting clinical trials not referenced in the
guidelines, we conducted literature searches in PubMed and EMBASE. Two authors independently extracted data on indications, dosing, efficacy, evidence grade, and strength of clinical recommendation for each therapy.
UNASSIGNED: Monoclonal antibodies directed toward tumour necrosis factor and interleukin (IL)-12/23 received the strongest recommendations for treatment of moderate-to-severe plaque psoriasis, supported by robust, high-quality randomized controlled trials (RCTs). Newer agents such as IL-17 and IL-23 inhibitors are not referenced in most
guidelines. There are fewer RCTs for conventional therapies and few head-to-head comparisons with biologics, making it difficult to draw direct comparisons. Among older agents, methotrexate is most strongly recommended for long-term maintenance and cyclosporine is recommended for short-term control of flares.
UNASSIGNED: Physicians should individualize psoriasis-management strategies based on medication tolerance, efficacy, safety, patient comorbidities, availability of the medication, and patient preference.