Farhi David, Dupin Nicolas
Service de dermatologie et de vénéréologie, Pavillon Tarnier, Hôpital Cochin, AP-HP, Université René Descartes, F-75006 Paris, France.
Presse Med. 2009 May;38(5):832-43. doi: 10.1016/j.lpm.2008.07.023. Epub 2009 Mar 17.
Psoriasis impairs significantly the quality of life. Systemic treatments have inconstant efficiency and dose-dependant toxicity. Since 2004, four biologic therapies - infliximab, etanercept, éfalizumab and adalimumab - are approved in Europe for the treatment of moderate to severe psoriasis, with failure, intolerance or contra-indication to at least 2 "classical" systemic treatments, including phototherapy, methotrexate and ciclosporin. The estimated rate of patients reaching PASI75 at month 3 are as follow: about 80% under infliximab (classical W0-W2-W6 regimen); about 33% and 50% under etanercept, respectively, 25 and 50mg, twice weekly; about 25% under éfalizumab (1mg/kg, weekly); about 70% under adalimumab (40mg, every other week). The 12-month efficiency of biologic therapies in psoriasis is poorly documented. The long term (5-year or more) safety of biologic therapies is not documented. New biologic therapies are under investigation in the treatment of psoriasis: ustekinumab (CNTO-1275), ABT-874, certolizumab (CDP-870), golimumab (CNTO-148). Ustekinumab is approved in Europe since January 2009.
银屑病严重损害生活质量。全身治疗的疗效不稳定且存在剂量依赖性毒性。自2004年以来，四种生物疗法——英夫利昔单抗、依那西普、依法利珠单抗和阿达木单抗——在欧洲被批准用于治疗中度至重度银屑病，适用于对至少两种“经典”全身治疗（包括光疗、甲氨蝶呤和环孢素）无效、不耐受或有禁忌的患者。在第3个月达到银屑病面积和严重程度指数改善75%（PASI75）的患者估计比例如下：接受英夫利昔单抗治疗（经典的0周-2周-6周方案）的患者约为80%；接受依那西普治疗的患者，分别使用25毫克和50毫克剂量、每周两次，比例约为33%和50%；接受依法利珠单抗治疗（1毫克/千克，每周一次）的患者约为25%；接受阿达木单抗治疗（40毫克，每隔一周一次）的患者约为70%。生物疗法对银屑病的12个月疗效记录较少。生物疗法的长期（5年或更长时间）安全性尚无记录。新的生物疗法正在银屑病治疗中进行研究：优特克单抗（CNTO - 1275）、ABT - 874、赛妥珠单抗（CDP - 870）、戈利木单抗（CNTO - 148）。优特克单抗自2009年1月起在欧洲获得批准。
