Department of Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Respiratory Disease, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
J Eur Acad Dermatol Venereol. 2018 Aug;32(8):1336-1342. doi: 10.1111/jdv.14896.
Although atopic dermatitis (AD) is a very common skin disease, data on the percentage of patients with really difficult-to-treat AD are scarce. From socio-economic perspective, it is important to have more insight into these numbers, as new very effective, but expensive, treatment options will be available in the near future for difficult-to-treat AD. Estimating the number of patients with AD using oral immunosuppressive drugs can give an impression of the percentage of difficult-to-treat patients in the total AD population.
To give an overview of the use of oral immunosuppressive drugs in patients with AD in the Netherlands.
Prescription data of oral immunosuppressive drugs in the Netherlands were extracted from a pharmaceutical database (NControl) containing data of 557 million prescriptions and 7.2 million patients. An algorithm, based on the WHO Anatomical Therapeutic Chemical (ATC) codes, was used to identify patients with AD. The prescription of oral immunosuppressive drugs in patients with AD between 1 January 2012 and 1 January 2017 was evaluated.
Based on the algorithm, 65 943 patients with AD were selected. 943 patients with AD (1.4%) used cyclosporine A, methotrexate, azathioprine or mycophenolic acid. Methotrexate was most commonly used, followed by azathioprine and cyclosporine A. A switch in medication was rarely seen. In the evaluation period, a decrease in the prescription of cyclosporine A was seen, together with an increase in the prescription of methotrexate. In 31% of the patients who stopped treatment, the discontinuation took place within the first months of treatment.
In this study population, 1.4% of the patients with AD used oral immunosuppressive drugs for their eczema in a 5-year period. Methotrexate was the most commonly used systemic drug in the Netherlands for the treatment of AD.
尽管特应性皮炎（AD）是一种非常常见的皮肤病，但关于真正难以治疗的 AD 患者的比例的数据却很少。从社会经济学的角度来看，了解这些数据非常重要，因为在不久的将来，针对难以治疗的 AD，将会有新的非常有效但昂贵的治疗选择。估计使用口服免疫抑制剂治疗 AD 的患者数量，可以让我们对 AD 患者总体中难以治疗的患者的比例有一个大致的了解。
概述荷兰使用口服免疫抑制剂治疗 AD 的情况。
从包含 5.57 亿张处方和 720 万患者数据的制药数据库（NControl）中提取荷兰口服免疫抑制剂的处方数据。根据世界卫生组织（WHO）解剖治疗化学（ATC）代码开发了一个算法，用于识别 AD 患者。评估了 2012 年 1 月 1 日至 2017 年 1 月 1 日期间 AD 患者使用口服免疫抑制剂的情况。
根据该算法，选择了 65943 名 AD 患者。943 名 AD 患者（1.4%）使用环孢素 A、甲氨蝶呤、硫唑嘌呤或霉酚酸。最常使用的是甲氨蝶呤，其次是硫唑嘌呤和环孢素 A。很少看到药物转换。在评估期间，环孢素 A 的处方减少，同时甲氨蝶呤的处方增加。在停止治疗的 31%的患者中，停药发生在治疗的最初几个月内。
在本研究人群中，5 年内有 1.4%的 AD 患者使用口服免疫抑制剂治疗其湿疹。在荷兰，甲氨蝶呤是治疗 AD 最常用的系统药物。
