Efficacy And Safety Of Systemic Drugs In The Treatment Of Pustular Psoriasis:A Systematic Review And Single Rate Meta-Analysis

Pustular psoriasis can be divided into generalized pustular psoriasis(GPP)and localized pustular psoriasis(LPP),which includes palmoplantar pustulosis(Palmoplantaris)and acrodermatitis continua Hallopeau.Because of the differences between generalized pustular psoriasis and limited pustular psoriasis in terms of lesion area,degree of impact on patients,criteria for evaluating drug efficacy,and response to drug therapy,this study was conducted in 2 parts.The first part: Efficacy and safety of systemic drugs in the treatment of generalized pustular psoriasis: A Systematic Review and single rate Meta-Analysis,and the second part: Efficacy and safety of systemic drugs in the treatment of localized pustular psoriasis: A Systematic Review and single rate Meta-Analysis.After searching the domestic and international literature,it was found that the overall literature meeting the inclusion criteria was low and of low quality,and the literature in patients with localized pustular psoriasis only included palmoplantar pustulosis,and no literature related to acrodermatitis continua Hallopeau was included in this paper.Therefore,the title was changed to Efficacy and safety of systemic drugs in the treatment of palmoplantar pustulosis:A Systematic Review and single rate Meta-Analysis.Part Ⅰ.Efficacy and safety of systemic drugs in the treatment of generalized pustular psoriasis: A Systematic Review and single rate Meta-AnalysisObjective The purpose of this paper is to compile,analyze and evaluate the efficacy and safety of traditional drugs(acitretin,cyclosporine,methotrexate)and biological agents(TNF-α antagonists,IL-12/23 antagonists,IL-23 antagonists,IL-17A/RA antagonists)for the treatment of pustular psoriasis with a comprehensive search of national and international databases,by increasing the sample size of the study.Methods A search strategy was developed to systematically evaluate the final included literature for efficacy,recurrence,and adverse effects,and a meta-analysis of the efficiency of drug treatment for pustular psoriasis was performed using stata17.0 software.Results 1.Traditional drug therapy for GPP:(1)The efficiency of acitretin,cyclosporine and methotrexate in treating GPP at 8-12 weeks was 95%,94% and 87%,respectively,with No statistically significant efficiency among the three drugs(P>0.05);(2)Acitretin takes effect in 1-2 weeks;cyclosporine takes effect in 1 week;methotrexate takes effect in 1.5-3 weeks,with cyclosporine taking effect at the fastest rate;(3)Adverse reactions of acitretin may include dryness,elevated liver enzymes,lipid abnormalities,nail abnormalities,hair loss;cyclosporine may include elevated blood pressure,abnormal liver and kidney function,abnormal blood routine,abnormal urine routine;methotrexate may include abnormal blood routine,abnormal liver and kidney function,abnormal urine routine,tumor;(4)Acitretin,cyclosporine,and methotrexate can all relapse after stopping the drug.2.Biological agents for GPP(only 2 classes of biological agents were included in the literature):(1)short-term(12-16W)treatment of GPP,IL-17A/RA antagonists were superior to TNF-α antagonists(P<0.05),58% and 85%,respectively;long-term(≥24W),67% and 85%,respectively,with no difference in efficacy;(2)TNF-α antagonists for GPP,1-3 days onset of action;IL-17A/RA antagonists for GPP,1-4 days onset of action;(3)TNF-α antagonists were observed to cause adverse effects such as infection,abnormal immune index,infusion reaction,aggravation of skin lesions,fever,elevated blood pressure,abnormal liver function,malaise,and loss of vascular access;IL-17A/RA antagonists were observed to cause infection,injection site reaction,aggravation of skin lesions,skin manifestations,periarthritis,positive anti-drug antibodies,infusion reactions,abnormal blood count,and serious adverse reactions with tumors;(4)Only TNF-α antagonists mentioned that they could relapse after discontinuation of the drug.Conclusion 1.Acitretin,cyclosporine and methotrexate are effective in the treatment of GPP,with acitretin taking effect in 1-2 weeks,cyclosporine in 1 week,and methotrexate in 1.5-3 weeks,with cyclosporine taking effect most rapidly,and all three can be relapsed after discontinuation.2.The short-term(12-16 weeks)efficacy of IL17A/RA antagonists and TNF-α antagonists in the treatment of GPP was 85% and 55%,respectively,and the efficacy of IL17A/RA antagonists was better than that of TNF-α antagonists;the long-term(≥24 weeks)efficacy was 85% and 67%,respectively.There was no difference in efficacy between them and they both had rapid onset of action.3.Both traditional drugs and biologics have multiple adverse reactions,with acitretin being more common for dryness,cyclosporine and methotrexate being more common for liver and kidney damage,and biologics being most common for infections overall,with nasopharyngitis being the most common.Part Ⅱ.Efficacy and safety of systemic drugs in the treatment of palmoplantar pustulosis:A Systematic Review and single rate Meta-AnalysisObjective The purpose of this paper is to compile,analyze,and evaluate the efficacy and safety of traditional drugs(acitretin,cyclosporine,methotrexate)and biological agents(TNF-α antagonists,IL-12/23 antagonists,IL-23 antagonists,IL-17A/RA antagonists)for the treatment of Localized pustular psoriasis through a comprehensive search of national and international databases and by increasing the sample size of the study.Methods Located pustular psoriasis was divided into palmoplantar pustulosis and acrodermatitis continua hallopeau.A search strategy was developed to systematically evaluate the efficacy,recurrence,and adverse effects of the final included literature.stata17.0 software was used to calculate the efficiency meta-analysis of drug treatment for restricted pustular psoriasis.Results It was found that the overall literature meeting the inclusion criteria was small and of low quality.Only palmoplantar pustulosis was found in patients with located pustular psoriasis,and no literature related to acrodermatitis continua Hallopeau was included in this paper.The results obtained with the above-mentioned condition limitations were as follows.1.Traditional medication for PPP(only acitretin is included in the literature):(1)The efficiency of acitretin is 88% at 8-12 weeks for PPP;(2)Acitretin at a dose of 20-30 mg/d most patients can observe an onset of effect in 1-2 weeks,with control of skin lesions in 6-8 weeks;(3)Adverse effects such as dryness symptoms,elevated triglycerides and cholesterol,elevated transaminases,myalgia,arthralgia,abnormal blood count,mild headache,facial skin flushing,thinning,and blistering can be observed with Acitretin for PPP;(4)Relapse can occur both during treatment and after discontinuation of the drug.2.Biological agents for PPP:(1)Efficiency meta-analysis(only IL-12/23 antagonists were included): IL-12/23 antagonist ustekinumab had an efficiency of 45% for short-term(12-16 weeks)treatment of PPP;(2)Biologic agents for PPP failed to extract the onset of action time;(3)IL-12/23 antagonist ustekinumab was observed to have adverse effects such as infection,injection site reaction,headache with fatigue,and IL-23 antagonist guselkizumab was observed to have adverse effects such as infection,skin manifestations such as eczema,urticaria,etc.,injection site erythema,joint pain,anti-drug antibody positivity,aggravation of skin lesions,and serious adverse effects such as tumor;4)Only IL-12/23 antagonist ustekinumab mentioned that relapse could occur both during and after discontinuation of drug therapy.Conclusion 1.The efficiency of acitretin is 88% at 8-12 weeks for PPP,with onset of action at 1-2 weeks,and recurrence can occur both during treatment and after discontinuation of the drug.2.The efficiency of IL-12/23 antagonist ustekinumab is 45% at 8-12 weeks for PPP,with recurrence occurring during and after discontinuation of drug therapy.3.Acitretin and the IL-12/23 antagonist ustekinumab are associated with a variety of adverse effects,the former with dryness and the latter with infection,mostly nasopharyngitis.