■头皮牛皮癣很难控制。治疗银屑病的唯一批准的口服酪氨酸激酶2和磷酸二酯酶4抑制剂是deucravitinib和apremilast。这项研究的目的是利用随机对照试验的数据探讨它们对头皮牛皮癣的疗效。
■我们搜索了Medline,Scopus,WebofScience,CENTRAL和ClinicalTrials.gov至2023年8月4日。为了确定偏见的风险,使用修订后的偏倚风险评估工具2.0.进行逆方差随机效应荟萃分析。利用Q和I2统计量评估异质性。预先确定的结果包括头皮皮肤清除的参与者比例(头皮医生的全球评估[ScPGA]为0/1),银屑病头皮严重程度指数(PSSI)的平均变化,皮肤病生活质量指数(DLQI)的平均改善。
■十个RCT符合纳入标准。与安慰剂相比,apremilast(RR2.41,95%CI2.08至2.79,Tau2=0,I2=0)和deucravitinib(RR3.86,95%CI3.02至4.94,Tau2=0,I2=0)在16周时诱导ScPGA为0/1更有效。此外,deucravitinib比apremilast更有效(RR1.70,95%CI1.44~2.00,Tau2=0,I2=0).无法对其余结果进行分析。
■阿普雷米司特和德克拉伐替尼对头皮银屑病有效。Deucravitinib可能更有效地清除头皮。
Psoriasis of the scalp is challenging to manage. The only approved oral tyrosine kinase 2 and phosphodiesterase 4 inhibitors for psoriasis are deucravacitinib and apremilast. The aim of this study was to explore their efficacy for scalp psoriasis utilizing data from randomized controlled trials.
We searched Medline, Scopus, Web of Science, CENTRAL, and ClinicalTrials.gov up to August 4, 2023. To determine risk of bias, the revised Risk of Bias assessment tool 2.0 was used. Inverse variance random effects meta-analyses were executed. Heterogeneity was assessed utilizing Q and I2 statistics. Pre-determined outcomes included the proportion of participants with cleared scalp skin (Scalp Physician\'s Global Assessment [ScPGA] of 0/1), mean change in Psoriasis Scalp Severity Index (PSSI), and mean improvement in Dermatology Life Quality Index (DLQI).
Ten RCTs fulfilled inclusion criteria. Both apremilast (RR = 2.41, 95% CI = 2.08-2.79, Tau2 = 0, I2 = 0) and deucravacitinib (RR = 3.86, 95% CI = 3.02-4.94, Tau2 = 0, I2 = 0) were more effective in inducing ScPGA of 0/1 at 16 weeks compared to placebo. Furthermore, deucravacitinib was more effective than apremilast (RR = 1.70, 95% CI = 1.44-2.00, Tau2 = 0, I2 = 0). An analysis could not be executed for the rest of the outcomes.
Apremilast and deucravacitinib are effective for scalp psoriasis. Deucravacitinib may be more efficient in clearing the scalp.