off-label biologic regimens in psoriasis a systematic review of efficacy and safety of dose escalation, reduction, and interrupted biologic therapy标示外生物治疗银屑病的疗效和安全性的系统评价剂量增加,减少,打断了生物疗法.pdfVIP

Off-Label Biologic Regimens in Psoriasis: A Systematic Review of Efficacy and Safety of Dose Escalation, Reduction, and Interrupted Biologic Therapy 2 1 Elizabeth A. Brezinski , April W. Armstrong * 1 Department of Dermatology, University of California Davis, Sacramento, California, United States of America, 2 School of Medicine, University of California Davis, Sacramento, California, United States of America Abstract Objectives: While off-label dosing of biologic treatments may be necessary in selected psoriasis patients, no systematic review exists to date that synthesizes the efficacy and safety of these off-label dosing regimens. The aim of this systematic review is to evaluate efficacy and safety of off-label dosing regimens (dose escalation, dose reduction, and interrupted treatment) with etanercept, adalimumab, infliximab, ustekinumab, and alefacept for psoriasis treatment. Data Sources and Study Selection: We searched OVID Medline from January 1, 1990 through August 1, 2011 for prospective clinical trials that studied biologic therapy for psoriasis treatment in adults. Individual articles were screened for studies that examined escalated, reduced, or interrupted therapy with etanercept, adalimumab, infliximab, ustekinumab, or alefacept. Data Synthesis: A total of 23 articles with 12,617 patients matched the inclusion and exclusion criteria for the systematic review. Data were examined for primary and secondary efficacy outcomes and adverse events including infections, malignancies, cardiovascular events, and anti-drug antibodies. The preponderance of data suggests that continuous treatment with anti-TNF agents and anti-IL12/23 agent was ne