关键词: 银屑病, 生物制剂, 难治部位, 治疗抵抗

Abstract: 【Abstract】 Objective To investigate difficult-to-treat sites in patients with psoriasis receiving biological therapy. Methods Clinical data were retrospectively collected from 73 adult patients with psoriasis in the database of Psoriasis Center, National Clinical Research Center for Skin and Immune Diseases from June 2020 to September 2021, who had received sufficient and standardized treatment with biological agents for ≥ 24 weeks, and were still treated with biological agents at the time of enrolment into this study with the psoriasis area and severity index （PASI） score being 1 - 5 at the time of enrolment into the database of Psoriasis Center. Distribution of psoriatic lesions resistant to biological therapy were analyzed, and differences in refractory sites were compared between different biologics. Chi-square test or Fisher′s exact test was used to analyze differences in the anatomical distribution of residual skin lesions after treatment with different biologics, McNemar test to compare the anatomical distribution of skin lesions before and after biological therapy, and Kruskal-Wallis H test to analyze the association between PASI scores for residual skin lesions and dermatology life quality index （DLQI） scores. Results After ≥ 24 weeks of sufficient and standardized biological therapy in the 73 patients, refractory skin lesions mostly involved the lower limbs （46 cases, 63.01%）, followed by the scalp （36 cases, 49.32%） and upper limbs （27 cases, 36.99%）; proportions of patients with residual skin lesions on the face and neck, trunk, upper limbs, lower limbs, hands and feet significantly decreased after biological therapy compared with those before treatment （paired χ2 = 5.14, 7.69, 9.90, 4.17 and 6.13, P = 0.016, 0.003, 0.001, 0.031 and 0.008, respectively）, while there was no significant difference in the proportions of patients with skin lesions on the scalp and genital areas before and after treatment （both P > 0.05）. No significant difference in the anatomical distribution of residual skin lesions was observed between the 13 patients receiving treatment with tumor necrosis factor inhibitors （adalimumab, infliximab, or tumor necrosis factor receptor-antibody fusion protein） and 59 receiving treatment with interleukin-17 （IL-17） inhibitors （secukinumab or ixekizumab） （all P > 0.05）. There was no significant difference in the anatomical distribution of residual skin lesions in the 13 patients before and after the treatment with tumor necrosis factor inhibitors （all P > 0.05）; in the 59 patients treated with IL-17 inhibitors, the proportions of patients with residual skin lesions on the trunk, upper limbs, hands and feet significantly decreased after treatment （paired χ2 = 4.90, 9.09 and 7.11, P = 0.021, 0.001 and 0.004, respectively）, while there was no significant difference in the distribution of skin lesions on the scalp, face and neck, lower limbs and genital area before and after treatment （all P > 0.05）. Among the 73 patients, the PASI scores for lesions on the upper and lower limbs and the total PASI scores were all associated with the DLQI scores （H = 7.52, 12.61, 6.75, respectively, all P < 0.05）, and were significantly higher in the patients with DLQI scores of > 10 points than in those with DLQI scores of ≤ 5 points （all P < 0.05）. Conclusions Biological therapy-resistant psoriatic lesions were mostly located on the scalp, and refractory skin lesions mostly involved the lower limbs, scalp and upper limbs. No significant difference in the anatomical distribution of residual skin lesions was observed between patients treated with tumor necrosis factor inhibitors and IL-17 inhibitors, but IL-17 inhibitors may result in lesion clearance at more anatomical sites compared with tumor necrosis factor inhibitors.

Key words: Psoriasis, Biological agents, Difficult-to-treat body regions, Resistance to treatment