Fivenson D P, Breneman D L, Rosen G B, Hersh C S, Cardone S, Mutasim D
Department of Dermatology, Henry Ford Hospital, Detroit, Mich.
Arch Dermatol. 1994 Jun;130(6):753-8.
The combination of nicotinamide and tetracycline has been anecdotally reported to be effective in the treatment of bullous pemphigoid. We conducted a randomized, open-labeled trial comparing the combination of 500 mg of nicotinamide, three times daily, and 500 mg of tetracycline four times daily, with prednisone therapy in 20 patients with bullous pemphigoid. The study was divided between an 8-week acute phase with fixed drug dosages and a 10-month follow-up phase in which study medications were tapered based on patient response.
Eighteen of 20 patients enrolled in the study were treated, two patients were unavailable for follow-up. Twelve patients were treated with the combination of nicotinamide and tetracycline and six patients were treated with prednisone. There were five complete responses, five partial responses, one nonresponder, and one patient with disease progression in the nicotinamide and tetracycline group compared with one complete response and five partial responses in the prednisone group. There were no statistically significant differences in response parameters between the two groups. All five patients in the nicotinamide and tetracycline group receiving long-term follow-up remained disease free during medication tapering, while three patients in the prednisone group had repeated disease flare-ups with steroid tapering. Adverse effects in the nicotinamide and tetracycline group included gastrointestinal upset (two patients) and transient renal failure (one patient). In the prednisone group, there was one occurrence each of hypertension, erosive gastritis, multiple decubitus ulcers, osteomyelitis, deep venous thrombosis, and death related to sepsis. Two patients required insulin therapy for hyperglycemia.
The combination of nicotinamide and tetracycline appears to be a useful alternative to systemic steroids in the treatment of bullous pemphigoid.
有坊间报道称烟酰胺与四环素联合使用对大疱性类天疱疮的治疗有效。我们进行了一项随机、开放标签试验，比较每日三次服用500毫克烟酰胺和每日四次服用500毫克四环素的联合用药方案与泼尼松治疗20例大疱性类天疱疮患者的疗效。该研究分为一个为期8周的急性期，期间药物剂量固定，以及一个为期10个月的随访期，在此期间根据患者反应逐渐减少研究药物的用量。
纳入研究的20例患者中有18例接受了治疗，2例患者无法进行随访。12例患者接受烟酰胺与四环素联合治疗，6例患者接受泼尼松治疗。烟酰胺与四环素组有5例完全缓解、5例部分缓解、1例无反应者和1例疾病进展患者，而泼尼松组有1例完全缓解和5例部分缓解。两组之间的反应参数无统计学显著差异。烟酰胺与四环素组接受长期随访的所有5例患者在逐渐减少用药期间均未出现疾病复发，而泼尼松组有3例患者在逐渐减少类固醇用量时疾病反复复发。烟酰胺与四环素组的不良反应包括胃肠道不适（2例患者）和短暂性肾衰竭（1例患者）。泼尼松组分别出现1例高血压、糜烂性胃炎、多处褥疮溃疡、骨髓炎、深静脉血栓形成以及与败血症相关的死亡。2例患者因高血糖需要胰岛素治疗。
烟酰胺与四环素联合使用似乎是治疗大疱性类天疱疮时系统性类固醇的一种有用替代方案。
