Garritsen F M, Roekevisch E, van der Schaft J, Deinum J, Spuls P I, de Bruin-Weller M S
Department of Dermatology, Academic Medical Center Amsterdam, The Netherlands.
Department of Dermatology, University Medical Center Utrecht, The Netherlands.
J Eur Acad Dermatol Venereol. 2015 Oct;29(10):1905-12. doi: 10.1111/jdv.13064. Epub 2015 Mar 9.
There is a lack of information on the use oral immunosuppressive drugs in atopic dermatitis (AD) daily practice.
A 10-years overview of the use of oral immunosuppressive drugs in patients with severe AD.
Medical charts of patients with AD, who received oral immunosuppressive drugs at the Academic Medical Center Amsterdam and in the University Medical Center Utrecht between January 2001 and January 2011, were analysed. Particular attention was paid to patient characteristics, prior treatment, prescribed oral immunosuppressive drugs, the order of use, doses and treatment durations and reasons for discontinuation of treatment.
Of 334 patients [53% male, mean age at start of an oral immunosuppressive drug 36.9 years (SD 13.6)] with AD received oral immunosuppressive treatment of which 102 (31%) participated in clinical trials. Cyclosporine A (CyA) was given in 80% of the patients, mycophenolate mofetil or enteric-coated mycophenolate (MMF/EC-MPS) in 31%, azathioprine (AZA) in 14%, methotrexate (MTX) in 11%, systemic glucocorticosteroids in 7% and systemic tacrolimus in 5%. In these academic centra, CyA was the first choice oral immunosuppressive in 252 patients. Reasons for discontinuation of oral immunosuppressive drugs were controlled AD disease, ineffectiveness and adverse events.
Various types of oral immunosuppressive drugs have been used over the past 10 years for the treatment of severe AD with a prominent first choice for CyA. Adverse events and ineffectiveness were frequent reasons for discontinuation. A prospective database of patients using oral immunosuppressive treatments in daily practice will give more insight in the effectiveness and safety and may help to formulate future recommendations.
在特应性皮炎（AD）的日常临床实践中，关于口服免疫抑制药物使用情况的信息较为匮乏。
对重度AD患者口服免疫抑制药物的使用情况进行为期10年的概述。
分析了2001年1月至2011年1月期间在阿姆斯特丹学术医疗中心和乌得勒支大学医学中心接受口服免疫抑制药物治疗的AD患者的病历。特别关注患者特征、既往治疗情况、所开具的口服免疫抑制药物、使用顺序、剂量、治疗持续时间以及停药原因。
334例AD患者[男性占53%，开始使用口服免疫抑制药物时的平均年龄为36.9岁（标准差13.6）]接受了口服免疫抑制治疗，其中102例（31%）参与了临床试验。80%的患者使用了环孢素A（CyA），31%的患者使用了霉酚酸酯或肠溶型霉酚酸（MMF/EC - MPS），14%的患者使用了硫唑嘌呤（AZA），11%的患者使用了甲氨蝶呤（MTX），7%的患者使用了全身性糖皮质激素，5%的患者使用了全身性他克莫司。在这些学术中心，252例患者将CyA作为首选的口服免疫抑制剂。停用口服免疫抑制药物的原因包括AD病情得到控制、治疗无效以及出现不良事件。
在过去10年中，多种类型的口服免疫抑制药物被用于治疗重度AD，其中CyA是首选药物。不良事件和治疗无效是停药的常见原因。建立一个日常临床实践中使用口服免疫抑制治疗患者的前瞻性数据库，将有助于更深入了解其有效性和安全性，并可能有助于制定未来的治疗建议。
