生物制剂治疗的银屑病患者中抗组胺药难治性慢性瘙痒：阿瑞匹坦与抗组胺药加倍剂量的真实世界数据。

Antihistamines-refractory chronic pruritus in psoriatic patients undergoing biologics: aprepitant vs antihistamine double dosage, a real-world data.

机构信息

Department of Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.

Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.

出版信息

J Dermatolog Treat. 2022 May;33(3):1554-1557. doi: 10.1080/09546634.2020.1840502. Epub 2020 Oct 28.

DOI:10.1080/09546634.2020.1840502

PMID:33084462

Abstract

BACKGROUND

Psoriasis-related pruritus (PRP) in patients under systemic treatment is challenging. The risk to switch anti-psoriatic drugs and to lose response to previous therapy is high, thus dermatologists prefer to add an anti-pruritic agent.

OBJECTIVES

To evaluate the effect of anti-histamines and aprepitant in treating PPR of psoriatic patients undergoing systemic anti-psoriatic therapies.

METHODS

A pilot observational open-label study was performed on responsive psoriatic patients with PPR under treatment. Initial therapy included oral rupatadine (10 mg/day for 30 days). In case of the Epworth Sleepiness Scale (ESS) was above 14, patients were switched to aprepitant (80 mg/day for 7 days), otherwise, rupatadine dosage was increased (20 mg/day for 7 days). Clinical evaluation was performed at the baseline (T0) and after 7 days (T7).

RESULTS

We enrolled 40 patients with PPR, 20 in each group. Age, gender, Psoriatic arthritis (PsA) and the itch - VAS, were matched. At T7, aprepitant displayed higher improvements than rupatadine (itch - VAS = 4 [3-5] vs 8.5 [8-9], < .01, DLQI = 14 [13-16] vs. 18 [16-21], < .01 and ESS = 5 [4-7] vs 15 [14-16], < .01). Doubling the rupatadine dosage from 10 mg to 20 mg/day only slightly improve itch (itch - VAS = 9 [8-10] vs 9 [8-9], = .03), conversely no modifications in the quality of life (DLQI = 18 [17-20] vs 18 [17-21], = .73) and increased sleepiness (ESS = 10 [9-11] vs 15 [14-16], < .01).

CONCLUSIONS

Aprepitant may be a valid alternative in PPR patients with ESS >14 under antihistamines.

摘要

背景

接受系统治疗的银屑病患者相关瘙痒（PRP）具有挑战性。转换抗银屑病药物和失去对先前治疗反应的风险很高，因此皮肤科医生更倾向于添加止痒剂。

目的

评估抗组胺药和阿瑞匹坦治疗接受系统抗银屑病治疗的银屑病患者 PRP 的效果。

方法

对接受治疗的有 PRP 的反应性银屑病患者进行了一项试点观察性开放标签研究。初始治疗包括口服芦帕他定（10mg/天，持续 30 天）。如果 Epworth 嗜睡量表（ESS）>14，患者则转换为阿瑞匹坦（80mg/天，持续 7 天），否则芦帕他定剂量增加（20mg/天，持续 7 天）。在基线（T0）和 7 天后（T7）进行临床评估。

结果

我们纳入了 40 例 PRP 患者，每组 20 例。年龄、性别、银屑病关节炎（PsA）和瘙痒 - VAS 相匹配。在 T7 时，阿瑞匹坦的改善优于芦帕他定（瘙痒 - VAS=4[3-5] 对 8.5[8-9]，<.01，DLQI=14[13-16] 对 18[16-21]，<.01 和 ESS=5[4-7] 对 15[14-16]，<.01）。将芦帕他定的剂量从 10mg 加倍至 20mg/天仅略微改善瘙痒（瘙痒 - VAS=9[8-10] 对 9[8-9]，=.03），但生活质量（DLQI=18[17-20] 对 18[17-21]，=.73）和嗜睡（ESS=10[9-11] 对 15[14-16]，<.01）无变化。