我是Richard Langley博士，一名皮肤病学教授，任职于加拿大新斯科舍省哈利法克斯的达尔豪斯大学，很高兴今天能在此回答问题，并通过镜头与大家会面。
我们探讨了SPROUT研究，该研究针对接受阿普米司特治疗的儿童银屑病患者。今日发布的一张壁报对这些儿童患者进行了分析，按病程分为三层：病程<2年、2~5年及>5年。研究旨在验证“早期治疗可改善患者预后”这一结论——这与针对司库奇尤单抗的 STEP-IN 研究、针对古塞奇尤单抗的GUIDE研究结果一致，两项研究均显示早期治疗能带来更好的疗效和更持久的应答。我们好奇阿普米司特（一种口服药物，安全性良好但疗效不及部分生物制剂）能否通过作用于组织驻留记忆细胞，影响或改变疾病，从而也实现“早期治疗获益”。研究结果显示，所有年龄组均存在差异：治疗开始时间越早（尤其在病程前1~2年内开始，而非单纯依据患者年龄），应答率越高。因此核心结论是“早期治疗至关重要，时机很关键”——多项研究数据（包括这项首次在儿科患者中开展的研究）均证实，即使是病程较短的儿童，早期治疗也能获益。
我的主旨演讲题目为“早期治疗：机遇之窗”，重点阐述了三点内容。第一，早期治疗至关重要，因为它能提高改善患者生活质量、预防终身累积损伤的概率。银屑病若长期未治疗，会导致抑郁症、自杀率升高，降低工作效率，并波及生活的方方面面。第二，早期治疗可影响合并症——新出现的数据表明，它能干预银屑病关节炎的发展，我们及其他团队的研究也显示，早期干预可提高患者生存率。第三，早期治疗可能具有疾病修饰潜力，能带来更优预后：更多患者实现皮肤清除，且缓解持续时间更长。
目前，银屑病治疗领域最大的未满足需求是，大量患者（即便中度至重度患者）未接受治疗。这背后的原因包括：患者难以接触到训练有素的皮肤科医生，以及存在处方阻力。第二个未满足需求是 “中度疾病”患者的治疗不足：这类患者皮损累及体表面积虽不广，但会影响手、足、头皮等关键部位；其中，手足综合征（一种高度异质性疾病，需个体化治疗方案）正逐渐成为重点问题，目前我们正制定相关方案以解决这一难题。此外，尽管存在有效的治疗方案，但患者可及性不足；现有治疗并非100%有效，掌跖银屑病、脓疱性疾病、特应性皮炎等亚型仍需更优的治疗选择。
当前最令人振奋的进展集中在人工智能（AI）领域：AI能加速分子研发，还可助力靶向治疗——不仅能针对单一靶点，还能开发双特异性、三特异性抗体。该领域将有令人期待的数据发布，其中不少来自中国，这体现了药物研发从“以美国为中心”向“全球化合作”的转变。要解决未满足需求，我们需在全球范围内建设分子研发专业能力，并以全球社区的形式开展合作，助力所有患者。
My name is Dr. Richard Langley. I am a professor of dermatology at Dalhousie University in Halifax, Nova Scotia, Canada, and I am delighted to be here today to answer questions and meet with you through the lens.
We discussed the SPROUT study, which focuses on pediatric psoriasis patients treated with apremilast. A poster released today analyzes these pediatric patients, stratified by disease duration: less than 2 years, 2 to 5 years, and more than 5 years. The study aimed to verify that early treatment leads to better patient outcomes—consistent with findings from the STEP-IN study (on secukinumab) and the GUIDE study, both of which showed early treatment results in better efficacy and more durable responses. We wondered if apremilast, an oral drug with good safety but lower efficacy than some biologics, could also deliver this ""early treatment benefit"" by impacting or modifying the disease via tissue-resident memory cells. Our findings revealed differences across all age groups: starting treatment earlier (especially within the first 1 to 2 years of disease onset, not necessarily based on patient age) led to superior response rates. Thus, the key message is that early treatment and timing matter—data from multiple studies, including this first one in pediatric patients, confirms that even children with shorter disease duration benefit from early treatment.
My keynote speech, titled ""Early Treatment: A Window of Opportunity,"" highlighted three key points. First, early treatment is crucial because it increases the chance of improving patients’ quality of life and preventing cumulative life impairment. Untreated psoriasis over time raises rates of depression, suicide, and reduces work productivity, affecting many aspects of life. Second, early treatment can influence comorbidities—emerging data shows it can interfere with the development of psoriatic arthritis, and research (including our own) demonstrates improved survival with early intervention. Third, early treatment may have disease-modifying potential, leading to better outcomes: more patients achieving clear skin and longer-lasting remission.
Currently, the biggest unmet need in psoriasis treatment is that many patients—even those with moderate to severe disease—do not receive treatment. This is due to factors like limited access to trained dermatologists and resistance to prescribing treatments. A second unmet need is the undertreatment of patients with ""moderate disease"": while their skin involvement is not extensive, it affects critical areas (hands, feet, scalp), and hand-foot syndrome (a highly heterogeneous subtype requiring unique approaches) is becoming a key concern, with ongoing work to develop targeted protocols. Additionally, while effective treatments exist, access remains limited; current treatments are not 100% effective, and subtypes like palmoplantar psoriasis, pustular disease, and atopic dermatitis still require better options.
The most exciting progress now lies in artificial intelligence (AI), which accelerates molecule development and enables targeted therapies—not just for single targets, but also bispecific and trispecific antibodies. Exciting data in this area is upcoming, much of it from China, reflecting a shift from U.S.-centric drug development to global collaboration. To address unmet needs, we must build molecular development expertise worldwide and work as a global community to help all patients."
