德国汉堡大学医学中心Kristian Reich课题组比较了Guselkumab与Secukinumab治疗中重度银屑病的疗效。2019年9月7日，《柳叶刀》发表了这一成果。

据悉，白细胞介素23（IL-23）和白细胞介素17A（IL-17A）抗体可有效治疗中重度银屑病。ECLIPSE项目旨在比较IL-23p19抑制剂Guselkumab和IL-17A抑制剂Secukinumab治疗中重度银屑病的疗效。

这项临床3期、多中心、双盲、随机、比较对照试验在9个国家（澳大利亚、加拿大、捷克共和国、法国、德国、匈牙利、波兰、西班牙和美国）的142个门诊临床点进行。2017年4月27日至2018年9月20日，共招募了1048名患者，年龄在18岁及以上，患有中重度斑块型银屑病，适用于光疗或全身治疗。参与者被随机分配接受Guselkumab治疗（534名）或Secukinumab治疗（514名）。PASI 90反应定义为银屑病面积和严重程度指数基线下降90%及以上。

治疗48周时，Guselkumab组中有451例（84%）患者达到PASI 90反应，显著高于Secukinumab组（360例，70%）。Guselkumab组在治疗第12周和第48周均达到PASI 75反应的患者有452例（85%），Secukinumab组中有412例（80%），差异不显著。两组中不良反应、感染和严重不良事件的发生率相差无几。

总而言之，基于48周时的PASI 90反应率，Gthemelkumab与Secukinumab相比在治疗中重度银屑病方面显示出优异的长期疗效，值得临床推广。

附：英文原文

Title: Guselkumab versus secukinumab for the treatment of moderate-to-severe psoriasis (ECLIPSE): results from a phase 3, randomised controlled trial

Author: Kristian Reich, April W Armstrong, Richard G Langley, Susan Flavin, Bruce Randazzo, Shu Li, Ming-Chun Hsu, Patrick Branigan, Andrew Blauvelt

Issue&Volume: Volume 394 Number 10201

Abstract:

Background

Antibodies targeting interleukin (IL)-23 and IL-17A effectively treat moderate-to-severe psoriasis. ECLIPSE is the first comparator study of an IL-23p19 inhibitor, guselkumab, versus an IL-17A inhibitor, secukinumab. The primary objective of this study was to show superiority of clinical response at week 48 for guselkumab versus secukinumab.

Methods

In this phase 3, multicentre, double-blind, randomised, comparator-controlled trial at 142 outpatient clinical sites in nine countries (Australia, Canada, Czech Republic, France, Germany, Hungary, Poland, Spain, and the USA), eligible patients were aged 18 years or older, had moderate-to-severe plaque-type psoriasis, and were candidates for phototherapy or systemic therapy. Eligible patients were randomly assigned with permuted block randomisation using an interactive web response system to receive either guselkumab (100 mg at weeks 0 and 4 then every 8 weeks) or secukinumab (300 mg at weeks 0, 1, 2, 3, and 4, and then every 4 weeks). The primary endpoint, the proportion of patients in the intention-to-treat population who achieved 90% reduction or more from baseline of Psoriasis Area and Severity Index (PASI 90 response) at week 48, and major secondary endpoints (the proportions of patients in the guselkumab group and in the secukinumab group who achieved a PASI 75 response at both weeks 12 and 48, a PASI 90 response at week 12, a PASI 75 response at week 12, a PASI 100 response at week 48, an Investigator's Global Assessment [IGA] score of 0 [cleared] at week 48, and an IGA score of 0 or 1 [minimal] at week 48) were to be tested in a fixed sequence to control type I error rate. Safety was evaluated in patients who received one or more doses of study drug from week 0 to 56. The study is registered with ClinicalTrials.gov, NCT03090100.

Findings

This study was done between April 27, 2017, and Sept 20, 2018. 1048 eligible patients were enrolled and, of these, 534 were assigned to receive guselkumab and 514 to receive secukinumab. The proportion of patients with a PASI 90 response at week 48 was greater in the guselkumab group (451 [84%]) than in the secukinumab group (360 [70%]; p<0·0001). Although non-inferiority (margin of 10 percentage points) was established for the first major secondary endpoint (452 [85%] of patients in the guselkumab group vs 412 [80%] of patients in the secukinumab group achieving a PASI 75 response at both weeks 12 and 48), superiority was not established (p=0·0616). Consequently, formal statistical testing was not done for subsequent major secondary endpoints. Proportions of patients with adverse events, infections, and serious adverse events were similar between the two treatments and, in general, safety findings were consistent with registrational trial observations.

Interpretation

Guselkumab showed superior long-term efficacy based on PASI 90 at week 48 when compared with secukinumab for treating moderate-to-severe psoriasis. This finding could assist health-care providers in their decision making process when selecting a biologic for treating moderate-to-severe psoriasis. 

DOI: 10.1016/S0140-6736(19)31773-8

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31773-8/fulltext