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Patients taking guselkumab had the highest probability of achieving two major clinical thresholds in the treatment of palmoplantar pustulosis (PPP).

According to a recent meta-analysis, a 100 mg dosage of guselkumab, an IL-23 inhibitor, fared best among the seven treatment courses included in the investigation. The two main outcomes of the analysis were overall change in PPP Area and Severity Index (PPPASI) score and achievement of the PPPASI-50 clinical response threshold. Seven randomized controlled trials collectively encompassing 567 patients were ultimately included.

Guselkumab at the 100 mg dosage had the highest probability of attaining the outcomes versus placebo (mean difference -8.00; 95% CI 4.88-11.11), while the achievement of PPPASI-50 response did not reveal any significant differences (OR 3.79, 95% CI 0.51-28.37).

The analysis, conducted by a team of researchers based in Tokyo, Japan, appears in the . The following excerpts have been edited for length and clarity.

What was the impetus for this investigation?

Optimal management of PPP means early diagnosis and management with safe and effective therapies. Biologics such as IL-23 inhibitors have emerged recently as effective treatment options. To date, however, few studies have made direct comparisons among available PPP treatments.

This systematic review and network meta-analysis was conducted to determine the optimal therapy and to compare reported measures of efficacy in clinical trials of systemic treatments for PPP.

Which medications were included in the analysis?

Seven randomized controlled trials were identified for inclusion in the study, collectively encompassing these treatment options:

• Alitretinoin
• Maxacalcitol
• Guselkumab, 100 mg
• Guselkumab, 200 mg
• Anakinra
• Spesolimab, 300 mg
• Spesolimab, 900 mg

What were the key findings of the analysis?

At a dosage level of 100 mg, guselkumab had the highest probability of helping patients achieve the clinical thresholds established in the analysis.

Guselkumab at 200 mg was second among the medications analyzed in reaching the proposed outcomes (mean difference -4.71, 95% CI 2.12-7.30), while there was no significant difference in achievement of PPPASI-50 response (OR 2.34, 95% CI 0.48-11.43).

No clear reason emerged for the lack of volume dependence between guselkumab 100 mg and guselkumab 200 mg. One possibility, researchers posited, was that higher doses of guselkumab may cause infection flare-ups and other reactions, which may worsen skin lesions.

What are the clinical takeaways?

These findings can help guide clinical decision-making when considering medication options for patients with PPP.

In addition to treatments with topical therapies and biologics, clinicians should be mindful of effective treatments such as smoking cessation, dental care, and tonsillectomy.