Lebwohl M, Thaçi D, Warren R B
Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany.
J Eur Acad Dermatol Venereol. 2021 Feb;35 Suppl 1(Suppl 1):35-41. doi: 10.1111/jdv.17053.
The majority of patients with psoriasis vulgaris (chronic plaque psoriasis) can be treated successfully with short-term topical therapies. However, long-term management of psoriasis with topicals is challenging and tends to take a reactive approach to disease relapse, rather than a proactive approach aimed at maintaining disease remission. Patients are often dissatisfied with the delay in treatment response and inconvenience of applying topical treatments, and therefore frequently discontinue treatment leading to poor outcomes. Relapse is common, particularly with reactive management, as underlying residual disease can remain following initial skin clearance; some patients find that their disease at relapse may be worse than their initial symptoms. This can have a detrimental effect on patient quality of life (QoL) and increase the risk of psoriasis-associated depression. A long-term proactive management approach, with maintenance treatment following initial treatment success, could help sustain disease remission and improve clinical and QoL outcomes for patients. Treatment with fixed-dose calcipotriol 50 µg/g betamethasone dipropionate 0.5 mg/g cutaneous foam (Cal/BD foam) is effective in the short term, providing a fast onset of action and improvements in disease at 4 weeks. Results from the Phase III PSO-LONG study demonstrated that long-term proactive management was superior to reactive management in prolonging time to first relapse, reducing number of relapses and increasing days in remission in adults with psoriasis vulgaris. Furthermore, Cal/BD foam was well tolerated in PSO-LONG. No new safety concerns were identified over 52 weeks; the safety profile was consistent with that described previously. Given this, Cal/BD foam should be considered when prescribing topicals for the long-term proactive management for patients with psoriasis.
大多数寻常型银屑病(慢性斑块状银屑病)患者可通过短期局部治疗获得成功治疗。然而,使用局部药物对银屑病进行长期管理具有挑战性,并且往往采取应对疾病复发的被动方法,而不是旨在维持疾病缓解的主动方法。患者通常对治疗反应延迟和局部治疗应用不便感到不满,因此经常停止治疗,导致治疗效果不佳。复发很常见,尤其是采用被动管理时,因为初始皮肤清除后潜在的残留疾病可能仍然存在;一些患者发现他们复发时的病情可能比初始症状更严重。这可能会对患者的生活质量(QoL)产生不利影响,并增加银屑病相关抑郁症的风险。一种长期的主动管理方法,即在初始治疗成功后进行维持治疗,可能有助于维持疾病缓解,并改善患者的临床和生活质量结果。使用固定剂量的卡泊三醇50µg/g倍他米松二丙酸酯0.5mg/g皮肤泡沫(Cal/BD泡沫)进行治疗在短期内有效,起效迅速,4周时疾病有所改善。III期PSO-LONG研究的结果表明,在延长寻常型银屑病成人患者首次复发时间、减少复发次数和增加缓解天数方面,长期主动管理优于被动管理。此外,Cal/BD泡沫在PSO-LONG研究中耐受性良好。在52周内未发现新的安全问题;安全性概况与先前描述的一致。鉴于此,在为银屑病患者开长期主动管理的局部药物处方时,应考虑使用Cal/BD泡沫。