课程介绍
我的团队其实在中国开始有古塞奇尤单抗的时候，算是最早进行了一个中国真实世界的研究。真实世界早期的研究也显示了古塞奇尤单抗在中国人群中的起效速度快、皮损的清除率高、停药复发的时长更长。这是我们中国人群的早期数据。接下来我们做了一些基础实验，包括在上游的树突状细胞、中性粒细胞、Treg细胞对Th17细胞的影响。我们做了这一些研究。同时也结合了古塞奇尤单抗在治疗斑块状银屑病前后炎症细胞的改变和改善情况以及Treg细胞的稳定情况。同时又回到临床来观察我们使用古塞奇尤单抗治疗前后皮损中这些炎症细胞的改变情况。
我们团队也在这方面也发了很多篇文章，也出了一些小小的成果。这次EADV发表了4篇关于中国人群（使用）古塞奇尤单抗的研究，还是非常振奋的。因为这个也是一个真实世界研究。它包括了早期干预，怎么能够更加有效？其中最重要的是谈到了更早的干预、更年轻的干预、体重更轻的干预、未经过生物制剂治疗一线使用古塞奇尤单抗的治疗，那么它的起效更快、更好，同时它的停药复发的时长更长。我们注意到了它的停药时间，在中国数据里面，48周，大概将近一年，停药以后大概超过一年，50%（的患者）才出现复发。这个是一个非常好的数据，也显示了古塞奇尤单抗具有很好的停药复发时长，大概是达到了可以打1年、停1年的情况。好像是打一年送一年这种感觉。第一，有一些病人如果他通过多种生物制剂的治疗，比如他已经使用了肿瘤坏死因子、IL-17等生物制剂反复治疗，那么使用古塞奇尤单抗可能就不能轻易停药。我们叫经治的患者，他毕竟已经使用了生物制剂，这时候不要轻易停药。第二，如果体重是明显超重的，比如说100公斤以上的，如果他及早地停药，可能复发的几率呢就要更高一点。超重和代谢综合征都是银屑病的共病，其实它们都是银屑病后期的共病，这跟药物治疗的不敏感性密切相关。所以这部分病人还是需要长期的规范治疗。
Actually, my team was among the first to conduct a real-world study in China when guselkumab was first available in the country. Early real-world studies have also shown that in the Chinese population, guselkumab has a rapid onset of action, high skin clearance rates and a longer time to relapse after discontinuation. This is the early data from our Chinese population. Next, we conducted some basic experiments, including the effects of upstream dendritic cells, neutrophils, and Treg cells on Th17 cells. We have conducted these studies. It also takes into account the changes and improvement of inflammatory cells and the stability of Treg cells before and after the treatment of plaque psoriasis with guselkumab. At the same time, we returned to the clinical field to observe the changes of these inflammatory cells in the skin lesions before and after our treatment with guselkumab.
Our team has also published a number of articles in this field, and has achieved some results. Four studies on the use of guselkumab in the Chinese population were presented at the EADV conference. It is very encouraging. Because this is also a real-world study. It includes early intervention. How can it be more effective? Among them, the most important points mentioned were earlier intervention, intervention at a younger age, intervention in individuals with lower body weight, and the use of guselimumab as a first-line treatment without prior exposure to biologics. It was noted that these approaches lead to faster and better efficacy. At the same time, the recurrence time after drug withdrawal is longer. We noticed its withdrawal time. In the Chinese data, 48 weeks, about a year, and about a year after drug withdrawal, only 50% of patients experienced a recurrence. This is a very good result. It also shows that guselkumab has a long duration of relapse after drug withdrawal. It has roughly reached the stage where treatment can be stopped for one year after one year of treatment. It also feels like a "one year of treatment, one year (free) included" kind of deal. First, in some patients who have been treated with multiple biologics repeatedly, such as tumor necrosis factor (TNF) inhibitors and IL-17 inhibitors, discontinuing guselkumab may not be advisable. These patients are referred to as biologic experienced. First, since they have already been exposed to biologics, treatment should not be stopped lightly. Second, in patients who are significantly overweight, for example over 100 kg, if such patients discontinue treatment prematurely, they may face a higher risk of relapse. Obesity and metabolic syndrome are common comorbidities of psoriasis. In fact, they are all comorbidities of psoriasis in the later stage. This is closely related to the insensitivity to drug treatment. So these patients still need long-term standardized treatment.
