| Objective: To systematically evaluate the clinical efficacy and safety of anti-IL-17 antibody for the treatment of moderate-to-severe plaque psoriasis.Methods: PubMed(Medline),Cochrane Library,EBSCO,EMbase,CBM,CNKI,VIP,Wangfang detabase were searched by computer from January 2000 to November 2017 to identify eligible randomized controlled trials(RCT)that treated moderate-to-severe plaque psoriasis with anti-IL-17 antibody(secukinumab,Brodalumab,ixekizumab)strictly followed the inclusion and exclusion criteria for screening literature and data extraction,and assessed their qualities by the Cochrane risk of bias tool and Jadad.The RevMan(version 5.3,The Cochrane Collaboration)software was used for all statistical analyses,a sensitivity analysis also was performed.Results: A total of 15 RCTs were included,6 about secukinumab,5 about Brodalumab,and 4 about ixekizumab.The methodological qualities of the included literature were high.(1)Twelve RCTs reported the results of anti-IL-17 antibody versus placebo for the treatment of plaque psoriasis on the PASI indicator.Meta-analysis results showed that,Anti-IL-17 antibody group’s PASI75 index(RR=15.67,95%CI 13.10 to 18.75,P<0.000 01),PASI90 index(RR=32.78,95%CI 25.75 to 41.73,P<0.000 01),PASI100 index(RR=71.23,95%CI 46.12 to 110.00,P<0.000 01)were significantly higher than placebo group’s and the differences were statistically significant.In terms of safety,the incidence of total adverse events(AE)in the anti-IL-17 antibody group was significantly higher than that in the placebo group(RR=1.19,95%CI 1.14 to 1.23),P<0.00001],and the difference was statistically significant.The incidence of serious adverse events(SAE)and the rate of discontinuation due to AE were similar between two groups,with no statistically significant difference(P>0.05).The incidences of common adverse events such as nasopharyngitis,injection site reaction(ISR),diarrhea,and headache in anti-IL-17 antibody group were significantly higher than placebo group,the differences were statistically significant(P<0.05).(2)Thirteen RCTs reported the results of high-dose anti-IL-17 versus low-dose for the treatment for plaque psoriasis on PASI.Meta-analysis showed that the PASI75 index of high dose group of anti-IL-17 antibody(RR=1.16,95%CI 1.10 to 1.22),P<0.00001),PASI90 index(RR=1.28,95%CI 1.17 to 1.40)P <0.000 01),PASI100 index(RR = 1.52,95% CI 1.30 to 1.78,P <0.000 01)were significantly higher than the low-dose group’s,the differences were statistically significant.In terms of safety,the incidence of total AE,incidence of SAE,and rate of discontinuation due to AE in the high-dose anti-IL-17 group’s was comparable to those of which the low-dose group’s(P>0.05);The incidence of ISR in common adverse events was significantly higher than that in low-dose group’s,and the difference was statistically significant(P=0.05).(3)Seven RCTs reported the results of the PASI index in the treatment of plaque psoriasis with an anti-IL-17 antibody-contrast drug(etanercept,ustekinumab).Meta-analysis results showed that the anti-IL-17 antibody group’s PASI75 index(RR=1.40,95%CI 1.22 to 1.60,P<0.000 01),PASI90 index(RR=1.90,95%CI 1.51 to 2.39,P<0.000 01),PASI100 index(RR=2.92,95%CI 2.07 to 4.11,P <0.000 01)were significantly higher than the positive drug group’s,the differences were statistically significant.The subgroup’s analysis showed that the PASI index in the low-dose brodalumab group(140mg group)was comparable to that of ustekinumab(RR=1.06,95%CI 0.97 to 1.16,P=0.22),and the difference was not statistically significant.In terms of safety,the incidence of total AE,incidence of SAE,and incidence rate of discontinuation due to AE in the anti-IL-17 antibody group were comparable to those of which in the positive drug group,with no statistically significant difference(P>0.05);the incidence of joint pain in common adverse events was significantly higher than the positive drug group’s,the difference was statistically significant(P<0.05).Conclusion:(1)The efficacy of anti-IL-17 antibody for the treated moderate and severe plaque psoriasis is significant,and their adverse reactions are mild,common adverse reactions are nasopharyngitis,injection site reactions,diarrhea,headache.(2)The clinical efficacy of anti-IL-17 antibody high-dose is better than low doses and safety is comparable.(3)The anti-IL-17 antibody has better clinical efficacy than etanercept and is comparable in safety.(4)The anti-IL-17 antibody high-dose group had better clinical efficacy compared with ustekinumab and is comparable in safety.the clinical efficacy of brodalumab 140 mg is comparable to that of ustekinumab.Due to the short time to market for anti-IL-17 antibodies and the limited number of documents included,the analysis results of this study may be affected.Therefore,more high-quality,large-sample randomized controlled trials are needed to further confirm. |
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