Research Centre for Pharmaceutical Care and Pharmaco-economics, Katholieke Universiteit Leuven, Onderwijs en Navorsing 2, Herestraat 49, Leuven, Belgium.
Respir Med. 2010 May;104(5):615-25. doi: 10.1016/j.rmed.2010.01.006. Epub 2010 Feb 16.
This review aims to compare continuous with on-demand pharmacotherapy of allergic rhinitis by focusing on pharmacodynamic, pharmacokinetic, safety, effectiveness, cost and cost-effectiveness considerations. A working party of experts reviewed and discussed the literature and guidelines, and conducted a qualitative analysis of the Summary of Product Characteristics of specific medicines. With respect to medicines, the working party limited itself to antihistamines, nasal corticosteroids and leukotriene antagonists. Based on a review of the evidence from a multidisciplinary perspective, this article makes pharmacotherapeutic recommendations that are easy, functional and applicable to daily practice in primary care. The pharmacotherapeutic evidence for continuous versus on-demand treatment of allergic rhinitis was limited. Clearly, for corticosteroids, their mechanism of action in allergic rhinitis of reducing allergic inflammation requires continuous therapy at least for the duration of symptoms. For H(1)-antihistamines, some trials suggest that continuous treatment is preferable but more studies are needed to confirm this conclusion. For both H(1)-antihistamines and nasal corticosteroids safety data indicate that continuous treatment may be given without fears of adverse consequences, although a distinction can be made between the first and the second generation antihistamines. With regard to the cost and cost-effectiveness implications of continuous therapy versus on-demand therapy, more studies are necessary before definitive conclusions may be made.
这篇综述旨在通过关注药效学、药代动力学、安全性、有效性、成本和成本效益等方面，比较变应性鼻炎的按需与连续药物治疗。一个专家组审查并讨论了文献和指南，并对特定药物的产品特性摘要进行了定性分析。就药物而言，专家组将自己局限于抗组胺药、鼻用皮质类固醇和白三烯拮抗剂。基于多学科角度的证据审查，本文提出了易于、实用和适用于初级保健日常实践的药物治疗建议。变应性鼻炎连续与按需治疗的药物治疗证据有限。显然，对于皮质类固醇，其在减轻变应性炎症方面的作用机制至少需要在症状持续期间进行连续治疗。对于 H1-抗组胺药，一些试验表明连续治疗可能更好，但需要更多的研究来证实这一结论。对于 H1-抗组胺药和鼻用皮质类固醇，安全性数据表明，连续治疗可以使用，而不必担心不良反应，但第一代和第二代抗组胺药之间可以有所区别。关于连续治疗与按需治疗的成本和成本效益影响，在得出明确结论之前，还需要进行更多的研究。
