Department of Dermatology, University of Graz, Graz, Austria.
J Eur Acad Dermatol Venereol. 2012 Aug;26 Suppl 5:19-20. doi: 10.1111/j.1468-3083.2012.04607.x.
The use of biologic agents has greatly improved psoriasis treatment. However, some individuals fail to respond to treatment or loose initial efficacy, and it may be difficult to find the optimal treatment for these patients. We present a patient with long-standing, moderate-severe plaque psoriasis, who had received UVB therapy as well as classical systemic therapies without sufficient response previously. Alefacept only gave a moderate response with quick recurrence after the end of treatment. Adalimumab was working for some time, but finally the patient experienced a slow loss of efficacy and was especially hampered by severe involvement of his hands. This caused him great distress as his work involved a high level of customer contact. The decision was taken to change therapy to ustekinumab. After one injection of ustekinumab psoriasis was greatly improved and it was almost completely resolved after the second injection, and arthritis was no longer active. The efficacy of ustekinumab treatment could be maintained up to now; there is only minimal disease activity and the patient is extremely satisfied. In conclusion, the decision to change to another biologic with different mode of action proved to be successful, and it helped the patient to forget his disease for most of the time and to fulfil the responsibilities of his job.
生物制剂的应用极大地改善了银屑病的治疗效果。然而，有些患者对治疗无反应或初始疗效丧失，为这些患者找到最佳治疗方法可能颇具难度。我们报告了一位患有长期、中度至重度斑块型银屑病的患者，他之前曾接受过 UVB 治疗和传统的全身治疗，但反应不佳。阿法赛普治疗仅获得了中度反应，治疗结束后很快复发。阿达木单抗治疗一段时间后，最终患者出现疗效缓慢下降的情况，手部严重受累尤其使他感到困扰，因为他的工作需要与大量客户接触。因此，决定将治疗方案改为乌司奴单抗。乌司奴单抗注射一次后，银屑病得到了极大改善，第二次注射后几乎完全消退，关节炎也不再活跃。迄今为止，乌司奴单抗的治疗效果得以维持；疾病活动度仅轻微，患者非常满意。总之，改用作用机制不同的另一种生物制剂的决策被证明是成功的，这使患者在大部分时间里忘记了自己的疾病，能够履行工作职责。
