Mocanu Madalina, Toader Mihaela-Paula, Rezus Elena, Taranu Tatiana
Dermatology Clinic, Railways University Hospital Iasi, 'Grigore T. Popa' University of Medicine and Pharmacy, 700506 Iasi, Romania.
Rheumatology Clinic, University Rehabilitation Hospital, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.
Exp Ther Med. 2019 Dec;18(6):4987-4992. doi: 10.3892/etm.2019.8008. Epub 2019 Sep 16.
Non-adherence to psoriasis treatment has an important impact in controlling chronic disease evolution and the occurrence of systemic comorbidities. Biologic therapy represents a revolutionary treatment, many of the undesirable psychological and socio-economical consequences of conventional topical or systemic therapies being avoided. Nevertheless, the discontinuation of biological therapy may occur due to facts related to the patient, to the lack of good communication between the patient and the physician or to the adverse or paradoxical reactions. We studied the non-adherence reasons to anti-TNFα agents (Infliximab, Adalimumab, Etanercept) used for treating 84 cases with moderate-severe psoriasis. The results of our study over the past 10 years showed a 76.2% adherence rate, lowest in patients treated with Etanercept (70.9%). Relative to the anti-TNF agent used, the highest adherence rate was recorded in Adalimumab (80.8%), followed by Infliximab (76.5%) and Etanercept (70.9%). We have noticed differences between the rates of adhesion to therapy with different anti-TNFα agents, but with no statistical significance. The main adverse effects that occurred during anti-TNFα therapy were: local reaction to the drug, mild infectious events, allergic reactions, cardiotoxicity, alopecia areata, pancreatitis, eosinophilia, thrombocytopenia. Anti-TNF therapy was discontinued in one case of endocarditis, one case with tuberculous laryngitis and another one with polydiscitis (Adalimumab), a case of colon cancer and one of pregnancy (Etanercept) and one paradoxical reaction (Infliximab).
不坚持银屑病治疗对控制慢性病进展及全身性合并症的发生具有重要影响。生物疗法是一种革命性的治疗方法，避免了传统局部或全身疗法许多不良的心理和社会经济后果。然而，生物疗法的中断可能由于与患者相关的因素、患者与医生之间缺乏良好沟通或不良或矛盾反应而发生。我们研究了84例中重度银屑病患者使用抗TNFα药物（英夫利昔单抗、阿达木单抗、依那西普）治疗的不依从原因。我们过去10年的研究结果显示依从率为76.2%，使用依那西普治疗的患者依从率最低（70.9%）。相对于所使用的抗TNF药物，阿达木单抗的依从率最高（80.8%），其次是英夫利昔单抗（76.5%）和依那西普（70.9%）。我们注意到不同抗TNFα药物治疗的依从率存在差异，但无统计学意义。抗TNFα治疗期间发生的主要不良反应有：药物局部反应、轻度感染事件、过敏反应、心脏毒性、斑秃、胰腺炎、嗜酸性粒细胞增多、血小板减少。抗TNF治疗因1例心内膜炎、1例结核性喉炎、1例多椎间盘炎（阿达木单抗）、1例结肠癌和1例妊娠（依那西普）以及1例矛盾反应（英夫利昔单抗）而中断。
