| Objective: To evaluate the efficacy,safety and economic value of IL-17 A inhibitors of Secukinumab and Ixekizumab by evidence-based medicine(EBM).Methods: A comprehensively extensive search of Pubmed,Embase,Cochrane Library and China knowledge Network(CNKI)and other medical databases,the search deadline is October 2020.The clinical randomized controlled trial(RCT)of IL-17 A inhibitors in the treatment of moderate and severe plaque psoriasis was searched,and the thesis interrelated to this research were picked according to the inclusion norm.The documents was moved and the involved data were shift out.The main efficacy indicators were psoriatic lesion area and severity index(psoriasis area and severity index,PASI)score of 90% and complete clearance rate(PASI 90,PASI 100).Secondary efficacy indicators mainly include PASI 50.The main safety index was at least one adverse event(AEs),and the secondary safety index included immunogenicity,candida albicans infection rate and neutropenia≥3 grade.And use Review Manager5.3 software for statistical analysis.According to the findings of Meta analysis,the populations who required remedy during the long therapeutic procedure with the two IL-17 A inhibitors was computed,as well as the analysis of cost-effectiveness was make to get economic comment.Results: This article totally includes 16 studies,of which 9 studies in Secukinumab group and 6 in Ixekizumab,amounting to 5336 sick persons in Secukinumab group and 5536 in Ixekizumab.There was no significant statistical discrepancy in the index of sex,course,body weight and average PASI score between the two groups at a baseline level.Meta analysis showed that the acquisition rate of PASI 50 treated with Secukinumab in 2 weeks was 35%,[95%CI:0.27-0.42].After 12 weeks of treatment,the proportion of PASI 90 reached 64% [95%CI:0.57-0.70],in which the efficacy of 300 mg dose was better than that of 150mg(RR:1.37 [95%CI:1.23-1.52]).After 52 weeks of treatment,the rates of reaching PASI 90,PASI 100 were 67% [95%CI:0.57-0.76],42%[95%CI:0.32-0.51],respectively.During 12 weeks of remedy,compared to placebos,the combined value RR of the adverse event occurred at least one was1.15[95%CI:1.04-1.27].Over the course of 52 weeks of remedy,the incidence rates of anti-antibodies,candida albicans and grade 3 neutropenia and above were1%[95%CI:0.00-0.01],2%[95%CI:0.02-0.04] and 1%[95%CI:0.00-0.01].After 12 weeks of treatment with Ixekizumab,72% of PASI 90 was obtained[95%CI:0.66-0.77],in which the efficacy of administration every 2 weeks was better than that of once every four weeks(RR:1.10 [95%CI:1.04-1.17]).After 52 weeks of treatment,the rates of reaching PASI90,PASI100 were73% [95%CI:0.67-0.78],52%[95%CI:0.46-0.58],respectively.During twelve weeks of remedy,the combined value RR of the adverse event occurred at least one was 1.20 [95%CI:1.11-1.30] by the comparison of placebos,and the discrepancy was dramatically statistic(P < 0.0001).Over the course of 52 weeks of treatment,the incidence rates of anti-antibodies,candida albicans and grade 3 neutropenia and above were 13%[95%CI:0.11-0.14],1%[95%CI:0.01-0.01],0%[95%CI: 0.00-0.01].Cost-effectiveness analysis was used in economic evaluation,which showed that the number of patients who needed treatment,the ratio of titer to cost and cost-effectiveness were 1.49 and 1.37,114531.34￥and 96613.70￥,114336.64￥and96623.36￥ respectively.Conclusions: Both Secukinumab and Ixekizumab can effectively and quickly exert clinical efficacy,and maintain a high level for a long time,with low incidence of adverse events and stable immunogenicity.Ixekizumab has better cost-effectiveness and is recommended when traditional drugs are ineffective. |
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