Umezawa Yoshinori, Hayashi Mitsuha, Kikuchi Sota, Fukuchi Osamu, Yanaba Koichi, Ito Toshihiro, Asahina Akihiko, Saeki Hidehisa, Nakagawa Hidemi
Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan.
Department of Dermatology, Nippon Medical School, Tokyo, Japan.
J Dermatol. 2015 Jul;42(7):731-4. doi: 10.1111/1346-8138.12903. Epub 2015 May 11.
Patients with psoriasis undergoing hemodialysis have additional difficulties in treatment compared with general patients. Conventional treatments such as cyclosporin, retinoids and methotrexate are not widely administrated due to the chances of an increase in adverse effects and the possibility of risk to patient survival. Recently, biologic treatments have been recognized as having sufficient efficacy for severe psoriasis with low incidence of organ toxicities. For this reason, biologic treatments may be more preferable for patients on hemodialysis; however, there is not sufficient evidence. We have treated three patients with psoriasis with ustekinumab for 1 year, who had been undergoing hemodialysis. They were previously treated with conventional treatments before ustekinumab treatments; however, they did not respond to these treatments sufficiently. Following treatment with ustekinumab, rapid and maintained improvement in psoriasis was observed. Over the course of treatments, two of the three patients encountered no adverse events during their first year of treatment. The other patient discontinued ustekinumab due to elevated levels of C-reactive protein. These findings suggest that ustekinumab may be an appropriate treatment for patients undergoing hemodialysis who are suffering from psoriasis. However, the risk of developing infection remains higher than in general patients.
与普通患者相比，接受血液透析的银屑病患者在治疗上存在更多困难。环孢素、维甲酸和甲氨蝶呤等传统治疗方法由于不良反应增加的可能性以及对患者生存构成风险的可能性，并未得到广泛应用。近年来，生物治疗已被认为对重度银屑病具有足够的疗效，且器官毒性发生率较低。因此，生物治疗可能更适合接受血液透析的患者；然而，目前尚无充分证据。我们对3例接受血液透析的银屑病患者使用优特克单抗治疗了1年。在使用优特克单抗治疗之前，他们曾接受过传统治疗；然而，他们对这些治疗反应不佳。使用优特克单抗治疗后，观察到银屑病迅速且持续改善。在治疗过程中，3例患者中有2例在治疗的第一年未出现不良事件。另1例患者因C反应蛋白水平升高而停用优特克单抗。这些发现表明，优特克单抗可能是治疗患有银屑病的血液透析患者的一种合适疗法。然而，发生感染的风险仍高于普通患者。
