今年的 EADV 大会盛况空前，各个场馆都十分热闹，一些受关注的话题相关会场常常座无虚席。我主要从事银屑病亚专业的日常诊疗工作，因此格外关注银屑病相关的几个会场，每次都会尽量参与听课，了解大会带来的银屑病临床诊疗最新进展。
我认为今年大会的核心热点，是各国专家都提及的银屑病治疗现状 —— 治疗手段丰富且疗效显著。大家普遍关注的问题是，患者治疗后能否实现疾病改善与缓解，而在这一状态下，后期对患者的干预和治疗尤为关键。一方面，早期干预对患者后续疾病稳定和预防复发帮助很大；另一方面，早期干预能让部分患者阻止疾病进展，减少对其生命周期的长期影响。这次会议非常贴近临床实际，契合临床需求，为我们更好地为银屑病患者选择治疗方案提供了指导，最终助力患者在整个生命周期中保持较健康的生活状态。
根据这两天的学习，我发现 GUIDE 研究长达四年的临床观察数据，尤其是近期披露的部分结果，带来了新的认知。熟悉该研究的专家应该了解，接受古塞奇尤单抗治疗后，患者疗效十分突出，我们将这类患者归为超级应答者人群。数据分析显示，这些超级应答者多为短病程患者。
在最新临床研究中，这类患者有了新的定义：除了可能达到超级应答，短病程患者的临床症状还可能长期维持在低严重程度水平。研究发现，病程小于两年的患者，其 PASI 评分严重程度多在 2 或 3 分以下，对日常生活影响极小，而这类患者往往都是短病程人群。
还有一组我格外关注的数据的是 GUIDE 研究第四部分披露的结果：有一群患者停药后，临床改善效果可维持三年，几乎一直保持 PASI 评分小于 5 分的状态。临床上，银屑病患者 PASI 评分小于 5 分对日常生活基本无明显影响，而这部分患者的特征十分特殊 ——13 例患者中近 11 例为超级短病程，病程在 15 个月以内。
这对临床实践的启示是，对于病程不超过两年（尤其是 15 个月以内）的患者，接受生物制剂治疗（特别是 IL-23 抑制剂古塞奇尤单抗），治疗 68 周后，临床改善效果可维持三年。此外，研究显示这部分患者绝大多数没有系统治疗史，仅将古塞奇尤单抗作为首个尝试的系统治疗药物。综上，这类患者的核心特征为：病程极短（15 个月以内）、治疗后临床严重程度小于 5 分、治疗前未接受过系统治疗。因此，为这类患者选择首个系统治疗药物时，优先选用 IL-23 抑制剂，能带来长期获益。
通过参与本次 EADV 大会，我了解到已有专家提出银屑病可被治愈的观点，目标是到 2035 年实现完全治愈。但在我看来，部分患者若能针对性评估其病史、病程严重程度，个性化选择合适的生物制剂，可实现疾病缓解甚至长期缓解，达到类似治愈的状态。不过仍有很多患者不在这一范畴内，比如一些难治、严重的病例，我已与同行及当地专家在会议中进行了讨论。
我们发现，小腿、头皮等顽固部位往往是患者复发或疗效应答不足的关键区域，要实现这些部位的治愈，还需进一步探索并跟踪患者疗效。此外，银屑病已远超单纯的皮肤问题，今年不少专家都提到，这类皮肤疾病不仅局限于皮肤本身，还需关注皮肤外的健康状况，深入了解共病之间的关系及机制。因此，探索银屑病患者的共病情况并做好控制，无论是对患者全生命周期的影响，还是系统疾病对皮肤的作用，都值得后续持续关注与研究，以实现对患者的更优管理。
This year’s EADV conference is unprecedented in its scale and excitement, with all venues bustling with activity. Sessions focused on topics of widespread interest are often packed to capacity. As my main focus is on the sub-specialty of psoriasis in daily clinical diagnosis and treatment, I paid particular attention to the psoriasis-related sessions and tried to attend them every time to learn about the latest clinical developments in psoriasis treatment presented at the conference.
I believe the core focus of this year’s conference, as addressed by experts from various countries, is the current state of psoriasis treatment—there are numerous treatment options available, and the therapeutic effects are remarkable. A common concern among everyone is whether patients can achieve disease improvement and remission after treatment. When in this state, post-treatment interventions and management for patients become particularly crucial. On one hand, early intervention greatly helps stabilize the disease and prevent relapse in the later stage; on the other hand, it allows some patients to halt disease progression and reduce its long-term impact on their lifespan. This conference is highly grounded in clinical practice and aligns well with clinical needs, providing guidance for us to better select treatment plans for psoriasis patients, ultimately helping them maintain a relatively healthy lifestyle throughout their lives.
Based on what I’ve learned over the past two days, I found that the four-year clinical observation data of the GUIDE study, especially the recently disclosed results, have brought new insights. Experts familiar with this research may know that after treatment with Guselkumab, patients achieve exceptionally impressive efficacy, and we classify these patients as a group of super responders. Data analysis shows that most of these super responders have a short disease course.
In the latest clinical studies, this group of patients has been given a new definition: in addition to possibly reaching a super response, patients with a short disease course may also maintain clinical symptoms at a long-term low level of severity. The study found that for patients with a disease duration of less than two years, their PASI score severity is mostly below 2 or 3 points, which has minimal impact on daily life—and these patients are usually those with a short disease course.
Another set of data that I paid close attention to is the results disclosed in the fourth part of the GUIDE study: a group of patients maintained clinical improvement for three years after stopping medication, almost consistently maintaining a PASI score below 5 points. Clinically, a PASI score below 5 for psoriasis patients has basically no significant impact on daily life, and this group of patients has very unique characteristics—among the 13 patients, nearly 11 had an extremely short disease course of within 15 months.
This revelation for clinical practice is that for patients with a disease duration of no more than two years (especially within 15 months), receiving biologic treatment (particularly the IL-23 inhibitor Guselkumab) can maintain clinical improvement for three years after 68 weeks of treatment. Additionally, the study shows that the vast majority of these patients have no history of systemic treatment and only regard Guselkumab as their first attempt at systemic therapy. In summary, the core characteristics of this group of patients are: an extremely short disease course (within 15 months), clinical severity below 5 points after treatment, and no prior systemic treatment. Therefore, when choosing the first systemic treatment drug for these patients, prioritizing the IL-23 inhibitor can bring long-term benefits.
By attending this year’s EADV conference, I learned that some experts have proposed that psoriasis can be cured, with the goal of achieving complete cure by 2035. However, in my opinion, if some patients can undergo targeted assessment of their medical history and disease severity, and personalized selection of appropriate biologics, they can achieve disease remission or even long-term remission, reaching a state similar to cure. Nevertheless, there are still many patients who do not fall into this category, such as those with refractory and severe cases, which I have discussed with colleagues and local experts during the conference.
We found that resistant areas such as the lower legs and scalp are often key sites for patient relapse or insufficient treatment response. To achieve cure in these areas, further exploration and follow-up of patient outcomes are needed. In addition, psoriasis has far exceeded being a mere skin problem. Many experts mentioned this year that such skin diseases are not limited to the skin itself; we also need to pay attention to health beyond the skin and gain a deeper understanding of the relationships and mechanisms between comorbidities. Therefore, exploring comorbidities in psoriasis patients and effectively controlling them—whether regarding the impact on the patient’s entire lifespan or the effect of systemic diseases on the skin—deserves continuous attention and research in the future to achieve better management of patients.
