Vermeulen F M, Gerbens L A A, Schmitt J, Deleuran M, Irvine A D, Logan K, Ouwerkerk W, Vestergaard C, Flohr C, Spuls P I
Department of Dermatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Meibergdreef 9, Amsterdam, the Netherlands.
Centre for Evidence-Based Healthcare, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany.
Br J Dermatol. 2020 Dec;183(6):1073-1082. doi: 10.1111/bjd.18959. Epub 2020 Mar 18.
For many years dermatologists have had access to few therapies for patients with moderate-to-severe atopic eczema (AE). New promising therapies are entering the market but conventional phototherapies and systemic therapies have more well-known safety profiles, lower costs and wider availability.
To provide insight into current prescribing practices of conventional phototherapy and systemic immunomodulatory therapies for adults with chronic AE, and the factors influencing these prescribing practices, before biologics and other novel therapeutics become routine clinical practice.
In this exploratory study dermatologists were invited to participate in an online survey via a mailing list of the European Academy of Dermatology and Venereology and national societies. Data were collected on participant characteristics (including clinical practice data), the use of phototherapies and systemic therapies, and factors influencing their use.
From 30 European countries, 238 out of 361 dermatologists willing to participate (65·9%) completed the survey, with 229 meeting the inclusion criteria. For phototherapy (prescribed by 84·7%), most preferred narrowband ultraviolet B as first line (80·9%) and psoralen plus ultraviolet A as second (21·6%). For systemic therapy (prescribed by 95·2%) ciclosporin (54·1%), oral corticosteroids (32·6%) and methotrexate (30·7%) were used first line. Dermatologists relied mostly on personal experience for prescribing phototherapy and systemic therapy. Azathioprine and mycophenolic acid were prescribed by only 135 (59·0%) and 85 (37·1%) participants in total, mostly due to a lack of personal experience.
This study provides insight into prescribing practices for conventional phototherapy and systemic therapy in Europe and shows that off-label therapies are also preferred as first-line choice of systemic therapy.
多年来，皮肤科医生可用于中重度特应性皮炎（AE）患者的治疗方法很少。新的有前景的疗法正在进入市场，但传统光疗和全身疗法具有更知名的安全性、更低的成本和更广泛的可及性。
在生物制剂和其他新型疗法成为常规临床实践之前，深入了解成人慢性AE患者传统光疗和全身免疫调节疗法的当前处方实践，以及影响这些处方实践的因素。
在这项探索性研究中，通过欧洲皮肤病与性病学会和各国学会的邮件列表邀请皮肤科医生参与在线调查。收集了参与者特征（包括临床实践数据）、光疗和全身疗法的使用情况以及影响其使用的因素的数据。
来自30个欧洲国家，361名愿意参与的皮肤科医生中有238名（65.9%）完成了调查，其中229名符合纳入标准。对于光疗（84.7%的医生开具），大多数人首选窄谱中波紫外线（NB-UVB）作为一线治疗（80.9%），补骨脂素加紫外线A（PUVA）作为二线治疗（21.6%）。对于全身治疗（95.2%的医生开具），一线使用环孢素（54.1%）、口服糖皮质激素（32.6%）和甲氨蝶呤（30.7%）。皮肤科医生在开具光疗和全身治疗处方时大多依赖个人经验。硫唑嘌呤和霉酚酸分别只有135名（59.0%）和85名（37.1%）参与者开具，主要是因为缺乏个人经验。
本研究深入了解了欧洲传统光疗和全身治疗的处方实践，并表明超说明书用药疗法也作为全身治疗的一线选择而受到青睐。
