Department of Dermatology, Tufts Medical Center, Boston, MA, USA.
Clin Exp Rheumatol. 2013 Jul-Aug;31(4 Suppl 78):S63-70. Epub 2013 Oct 4.
Psoriasis is a chronic immune-mediated inflammatory disease of unknown etiology. Unlike other chronic inflammatory diseases receiving continuous treatment, psoriasis has traditionally been treated intermittently secondary to concern for cumulative toxicity of conventional systemic therapies. However, the development of targeted anti-inflammatory biologic agents allowed for continuous therapy for most patients. Herein, we review the literature for intermittent versus continuous use of widely available therapies for moderate-to-severe psoriasis: phototherapy, topical corticosteroids, conventional systemic therapies and biologic agents. These data support continuous treatment in biologic therapy, such as etanercept, adalimumab, infliximab, and ustekinumab. Intermittent therapy with biologic agents leads to decreased efficacy and sometimes increased side effects. When conventional systemic therapy is used continuously, it is more efficacious; however the data support intermittent use of methotrexate and cyclosporine due to cumulative toxicities. Psoriasis severity may wax and wane, but it is a chronic disease requiring continuous treatment for optimal control of inflammatory activity and to minimise cutaneous involvement.
银屑病是一种病因不明的慢性免疫介导的炎症性疾病。与其他接受持续治疗的慢性炎症性疾病不同，由于担心传统全身治疗的累积毒性，银屑病的治疗历来是间歇性的。然而，靶向抗炎生物制剂的发展使大多数患者能够进行持续治疗。在此，我们回顾了中度至重度银屑病广泛应用的治疗方法（光疗、局部皮质类固醇、传统全身治疗和生物制剂）间歇与连续使用的文献。这些数据支持生物治疗（如依那西普、阿达木单抗、英夫利昔单抗和乌司奴单抗）的持续治疗。生物制剂的间歇治疗会降低疗效，有时还会增加副作用。当连续使用传统全身治疗时，其疗效更高；然而，由于累积毒性，数据支持间断使用甲氨蝶呤和环孢素。银屑病的严重程度可能会时轻时重，但它是一种慢性疾病，需要持续治疗以最佳控制炎症活动并最小化皮肤受累。
