Pearce Daniel J, Higgins Kristen B, Stealey Katherine H, Balkrishnan Rajesh, Crane Martin M, Camacho Fabian, Fleischer Alan B, Feldman Steven R
Department of Dermatology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1071, USA.
J Dermatolog Treat. 2006;17(5):288-93. doi: 10.1080/09546630600920041.
Patients with moderate-to-severe psoriasis frequently require systemic treatment and these medications may be associated with adverse effects. Little is known about the frequency of these events when systemic agents are used in true clinical practice.
To determine the frequency of adverse events associated with various systemic psoriasis therapies.
A retrospective chart review of 753 patients treated in an academic dermatology practice was performed to identify the frequency of adverse events. Poisson regression was used to estimate the odds of significant events for each systemic therapy; UVB-treated patients served as a control population.
Methotrexate seemed to be the most prescribed medication. Adverse events were noted with all forms of systemic psoriasis therapy. The highest event rate was seen with oral retinoids, though most of these were considered minor (64%). Cyclosporine had the highest significant adverse event rate (0.9 events/patient). For 'significant' adverse events, oral agents had an adjusted odds ratio>6 compared to standard UVB therapy. The highest risk was for cyclosporine (OR = 20.3); however, the estimate was imprecise (95% confidence interval [4.3, 96.6]).
Traditional psoriasis therapies are associated with significant adverse events in some patients despite toxicity-sparing approaches such as combination therapy. Clinicians need to be aware of screening for adverse events in order to best ensure the safety of their patients and to maximize the efficacy of a given agent. There is still a need for the development of safe and effective treatments for patients with moderate-to-severe psoriasis.
中重度银屑病患者常常需要进行系统治疗，而这些药物可能会有不良反应。在实际临床应用中使用全身用药时，对于这些不良反应发生的频率了解甚少。
确定与各种系统性银屑病治疗相关的不良事件的发生频率。
对在一家学术性皮肤科诊所接受治疗的753例患者进行回顾性病历审查，以确定不良事件的发生频率。采用泊松回归来估计每种全身治疗发生严重事件的几率；接受紫外线B（UVB）治疗的患者作为对照人群。
甲氨蝶呤似乎是最常开具的药物。所有形式的系统性银屑病治疗均出现了不良事件。口服维甲酸类药物的事件发生率最高，不过其中大多数被认为是轻微的（64%）。环孢素的严重不良事件发生率最高（0.9次/患者）。对于“严重”不良事件，与标准UVB治疗相比，口服药物的调整优势比>6。环孢素的风险最高（优势比=20.3）；然而，该估计并不精确（95%置信区间[4.3, 96.6]）。
尽管采用了联合治疗等降低毒性的方法，但传统的银屑病治疗在一些患者中仍会导致严重不良事件。临床医生需要注意筛查不良事件，以便最好地确保患者安全并使给定药物的疗效最大化。对于中重度银屑病患者，仍然需要开发安全有效的治疗方法。
