Nowaczyk Joanna, Makowska Karolina, Rakowska Adriana, Sikora Mariusz, Rudnicka Lidia
Department of Dermatology, Medical University of Warsaw, Warsaw, Poland.
Dermatol Ther (Heidelb). 2020 Jun;10(3):387-399. doi: 10.1007/s13555-020-00370-2. Epub 2020 Apr 8.
Cyclosporine is commonly used in treatment for alopecia areata. It can be administered as a monotherapy or in combination with systemic corticosteroids, with various outcomes.
Efficacy of cyclosporine with and without systemic corticosteroids for alopecia areata was evaluated by a systematic review. Cochrane, EBSCOhost, Pubmed, Scopus and Web of Science databases were searched. Only studies published before January 2020 were included.
A total of 2104 studies were initially examined, of which 14 were eligible for the systematic review. Among 340 reported cases, 213 had focal, multifocal or ophiasis form of alopecia areata, 60 were diagnosed with alopecia totalis and 67 with alopecia universalis. The mean response rate in the whole group of patients at the end of treatment was 65.00% (221/340; range 25-100%). Hair regrowth rate was higher in the group with cases of alopecia areata limited to scalp (124/165; mean 75.15%; range 40-100%) than in the cases with alopecia totalis (30/46; mean 65.22%; range 25-100%) or alopecia universalis (24/52; mean 46.15%; range 25-100%). The combined therapy with systemic corticosteroids was superior to the monotherapy (152/219; mean 69.41%; 0-80% vs. 69/121; mean 57.02%; range 6.67-100%) and had a lower recurrence rate (39/108; mean 36.11% vs. 34/46; mean 73.91%, respectively). The combined treatment with methylprednisolone was significantly more effective when compared to the cyclosporine monotherapy (124/183; mean 67.76%; range 0-80% vs. 69/121; mean 57.02%; range 6.67-100%). The mean time of treatment was 6.75 months (range 2-36).
Limitations of our study were the retrospective character of included studies, differences in doses of prescribed drugs, and duration of the treatment and follow-up times.
Cyclosporine in combination with oral systemic corticosteroids is more effective than in monotherapy for severe alopecia areata.
环孢素常用于斑秃的治疗。它可以作为单一疗法使用，也可以与全身性皮质类固醇联合使用，疗效各异。
通过系统评价评估环孢素单独或联合全身性皮质类固醇治疗斑秃的疗效。检索了Cochrane、EBSCOhost、Pubmed、Scopus和Web of Science数据库。仅纳入2020年1月之前发表的研究。
最初共检索到2104项研究，其中14项符合系统评价的纳入标准。在340例报告病例中，213例为局限性、多灶性或匐行性斑秃，60例诊断为全秃，67例为普秃。治疗结束时，全组患者的平均有效率为65.00%（221/340；范围25%-100%）。局限于头皮的斑秃患者组的毛发再生率（124/165；平均75.15%；范围40%-100%）高于全秃患者组（30/46；平均65.22%；范围25%-100%）或普秃患者组（24/52；平均46.15%；范围25%-100%）。联合全身性皮质类固醇治疗优于单一疗法（152/219；平均69.41%；0%-80% 对比 69/121；平均57.02%；范围6.67%-100%），且复发率更低（分别为39/108；平均36.11% 对比 34/46；平均73.91%）。与环孢素单一疗法相比，联合甲泼尼龙治疗显著更有效（124/183；平均67.76%；范围0%-80% 对比 69/121；平均57.02%；范围6.67%-100%）。平均治疗时间为6.75个月（范围2-36个月）。
本研究的局限性在于纳入研究的回顾性特征、所开药物剂量的差异、治疗持续时间以及随访时间。
对于重度斑秃，环孢素联合口服全身性皮质类固醇比单一疗法更有效。
