Levell N J, Shuster S, Munro C S, Friedmann P S
University Department of Dermatology, Newcastle upon Tyne, UK.
Acta Derm Venereol. 1995 Jan;75(1):65-9. doi: 10.2340/00015555756569.
We set out to show that the assumption is incorrect that continuous treatment with cyclosporin is necessary in psoriasis, as this tenet forms a basis for current recommended treatment regimens. Sixty patients with mild to moderate plaque psoriasis were allocated at random to treatment with oral cyclosporin 5 mg/kg/day (30 patients) or topical dithranol and ultraviolet B therapy (30 patients) for up to 16 weeks until clear (median time 6 weeks cyclosporin and 8 dithranol), and the times to relapse compared. The patients were seen monthly for up to 8 months, and the severity and the extent of psoriasis were assessed. Relapse, defined as return of psoriasis to 50% of the area at the start of the trial or patient demand for further treatment, was not significantly different between the groups (hazard ratio 1.11, 95% CI 0.55-2.32). No patients suffered a rebound of severe disease and none relapsed in the first 8 weeks after stopping treatment. The relapse rate was higher following cyclosporin from 8 to 28 weeks after treatment and following dithranol from 28 to 34 weeks. The patients with arthritis had a higher median joint severity score at relapse than prior to treatment with cyclosporin. At the end of 8 months, 5 patients treated with dithranol and 8 patients with cyclosporin remained clear, 75% and 67% having relapsed. We conclude that rapid relapse does not occur after clearance of mild to moderate plaque psoriasis with cyclosporin and the relapse rate was no different from dithranol treatment.
我们着手证明，银屑病持续使用环孢素治疗是必要的这一假设是错误的，因为这一原则构成了当前推荐治疗方案的基础。60例轻至中度斑块状银屑病患者被随机分配接受口服环孢素5mg/kg/天治疗（30例患者）或外用蒽林及紫外线B治疗（30例患者），最长治疗16周直至皮疹清除（环孢素治疗组中位时间为6周，蒽林治疗组为8周），然后比较两组的复发时间。患者每月就诊，最长随访8个月，评估银屑病的严重程度和范围。复发定义为银屑病面积回到试验开始时的50%或患者要求进一步治疗，两组之间复发率无显著差异（风险比1.11，95%可信区间0.55 - 2.32）。没有患者出现严重疾病反跳，且在停止治疗后的前8周内无人复发。环孢素治疗后8至28周以及蒽林治疗后28至34周复发率较高。有关节炎的患者复发时的中位关节严重程度评分高于使用环孢素治疗前。8个月末，接受蒽林治疗的5例患者和接受环孢素治疗的8例患者皮疹仍未复发，两组的复发率分别为75%和67%。我们得出结论，轻至中度斑块状银屑病患者使用环孢素清除皮疹后不会迅速复发，且复发率与蒽林治疗无异。
