Sanofi, Gentilly, France.
Sanofi, Reading, UK.
Br J Dermatol. 2024 Sep 18;191(4):548-555. doi: 10.1093/bjd/ljae207.
Prurigo nodularis (PN) is a pruritic skin disease characterized by multiple intensely itchy skin nodules in symmetrically distributed areas of the extremities. There are limited studies on the epidemiology and treatment pathways of PN, especially moderate-to-severe PN, from England.
To assess the epidemiology and treatment pathways of mild and moderate-to-severe PN in England.
This retrospective cohort study used data from the Clinical Practice Research Datalink and Hospital Episode Statistics in England. Adult patients (aged ≥ 18 years) with a PN-specific diagnosis code allocated any time between 1 April 2007 and 1 March 2019 (patient identification period) were selected. Patients were included if their first PN diagnostic code (index diagnosis date; IDD) was recorded during the identification period, with data available 6 months before and ≥ 12 months after the IDD. Patients were classified as having moderate-to-severe PN (MSPN) or mild PN (MiPN), based on the presence or absence of a prescription record, post-IDD, for either a systemic immunosuppressant or a gabapentinoid. Patients with MSPN and MiPN were matched 1 : 1 according to age, sex and IDD. Prevalence and incidence were calculated for each year from 2007 to 2019. Drugs prescribed post-IDD were analysed.
A total of 8933 patients (MSPN, n = 2498; MiPN, n = 6435) were included in the study; 2462 patients with MiPN and 2462 with MSPN were included for the comparative analysis. The presence of atopic dermatitis, asthma and eosinophilic oesophagitis were significantly higher (all P < 0.001) in patients with MSPN compared with those with MiPN. The overall prevalence of cases of PN increased during the study period. The incidence rate also showed a similar trend. The rates of prescription of potent and super-potent topical corticosteroids (TCS), topical calcineurin inhibitors, first- and second-generation antihistamines, oral and injectable systemic corticosteroids, methotrexate, antidepressants and tacrolimus were significantly higher (all P < 0.001) in patients with MSPN compared with those with MiPN.
The epidemiology of PN was consistent with that found in other European studies. Patients with MSPN received a significantly higher number of prescriptions for potent TCS and systemic drugs compared with patients with MiPN.
结节性痒疹（PN）是一种瘙痒性皮肤病，其特征为四肢对称分布的多个剧烈瘙痒性结节。目前，有关英国 PN 的流行病学和治疗途径的研究有限，尤其是中重度 PN。
评估英国轻度和中重度 PN 的流行病学和治疗途径。
这是一项回顾性队列研究，使用了来自英国临床实践研究数据库和医院病例统计数据库的数据。选择在 2007 年 4 月 1 日至 2019 年 3 月 1 日期间（患者识别期）任何时间被分配 PN 特定诊断代码的成年患者（年龄≥18 岁）。如果患者的第一个 PN 诊断代码（索引诊断日期；IDD）在识别期内记录，并且 IDD 之前和之后 6 个月内有数据，则将患者纳入研究。根据 IDD 后是否有记录处方，将患者分为中重度 PN（MSPN）或轻度 PN（MiPN），处方药物为全身性免疫抑制剂或加巴喷丁类药物。根据年龄、性别和 IDD，将 MSPN 和 MiPN 患者 1：1 匹配。计算 2007 年至 2019 年每年的患病率和发病率。分析 IDD 后开具的药物。
共纳入 8933 例患者（MSPN，n=2498；MiPN，n=6435）；2462 例 MiPN 患者和 2462 例 MSPN 患者纳入比较分析。与 MiPN 患者相比，MSPN 患者中特应性皮炎、哮喘和嗜酸性食管炎的发生率显著更高（均 P<0.001）。研究期间，PN 病例的总体患病率增加。发病率也呈现出类似的趋势。与 MiPN 患者相比，MSPN 患者中强效和超强效外用皮质类固醇（TCS）、外用钙调磷酸酶抑制剂、第一代和第二代抗组胺药、口服和注射用全身皮质类固醇、甲氨蝶呤、抗抑郁药和他克莫司的处方率显著更高（均 P<0.001）。
PN 的流行病学与其他欧洲研究一致。与 MiPN 患者相比，MSPN 患者接受了更多强效 TCS 和全身药物的处方。
