生物制剂在儿童银屑病治疗中的应用进展

多数轻中度儿童银屑病通过外用药及光疗可控制病情,重度儿童银屑病需要考虑系统治疗.近年来,生物制剂在成人斑块型银屑病的应用显示出良好的效果及安全性,逐渐被国内外批准用于儿童中重度斑块型银屑病,本文就生物制剂在儿童银屑病的应用进展进行综述.     

儿童银屑病生物治疗与疫苗接种

银屑病是一种免疫介导的、反复发作的炎症性皮肤病。生物制剂是治疗中重度儿童斑块型银屑病的重要手段之一。循证医学证据表明生物制剂治疗儿童银屑病具有良好疗效和安全性，但同时也增加了感染的易感性。接种疫苗是预防感染的重要措施，但银屑病患者疫苗接种率明显低于正常人群，与担忧疫苗接种加重银屑病、银屑病影响对疫苗的免疫反应、系统治疗影响疫苗效果等疫苗犹豫相关。儿童作为国家免疫规划的主要对象，其生物治疗期间的疫苗接种问题已成为皮肤科医生面临的常见问题之一。本文综述儿童银屑病生物治疗与疫苗接种研究进展，供医患决策疫苗接种时参考。     

生物制剂在儿童银屑病治疗中的研究进展

儿童银屑病因其慢性、反复性特点,给部分患儿及家长带来沉重负担。遗传、异常的免疫应答、环境等因素的相互作用参与了银屑病的发生。儿童与成人的新陈代谢、皮肤吸收率和药物代谢等不同,因此如何在达到预期治疗疗效并且提高用药的安全性显得尤为重要。生物制剂在一些难治性儿童银屑病方面发挥了积极的作用,越来越广泛的应用于临床。本文就生物制剂在儿童银屑病治疗中的研究进展进行综述。     

中国儿童银屑病生物治疗专家共识（2021）

【摘要】 对于中重度儿童银屑病,若外用药治疗无法控制病情,临床则需要考虑系统治疗。儿童属于生物制剂应用的特殊人群,应用的剂量、疗效及安全性与成人不尽相同。为此,我国儿童银屑病诊疗领域部分专家依据国内外指南及共识、相关文献及临床经验,经过深入讨论,制定本共识。从生物制剂的应用原则、应用方法、疗效及安全性、疗程及停药时机、用药前筛查及用药过程中监测等方面提供指导性意见,希望为我国中重度儿童银屑病患者生物制剂的应用提供参考依据。     

妊娠期银屑病治疗进展

银屑病是一种免疫相关的慢性炎症性疾病。大部分女性患者在育龄期发展为银屑病。目前,传统药物和生物制剂在治疗银屑病方面取得了良好的效果,但它们均有可能导致妊娠不良事件的发生。本综述旨在讨论用于治疗妊娠期银屑病的主要药物包括传统药物和生物制剂的疗效以及安全性,以及既往报道的妊娠期银屑病的治疗的研究,为临床决策提供参考。     

影响生物制剂疗效的银屑病患者相关因素分析

生物制剂治疗银屑病的疗效已得到普遍认可,但仍有部分患者对生物制剂应答较差,可发生于生物制剂初始阶段,也可发生于生物制剂治疗中后期,提示患者个体间差异是影响生物制剂疗效的因素之一。本文就影响银屑病生物制剂疗效的患者因素及相应治疗对策进行总结,为银屑病患者生物制剂的选择及治疗方案的调整提供依据。     

儿童脓疱型银屑病治疗进展

儿童银屑病是一种常见的炎症性皮肤病,而儿童脓疱型银屑病(Childhood pustular psoriasis,CPP)较为少见,是一种发生于儿童的全身性炎症性伴皮肤功能障碍的银屑病类型。CPP顽固且易复发,对患儿及其父母生活质量及发展都影响颇大。对于CPP,皮肤的局部治疗是必不可少的基础,维甲酸类、甲氨蝶呤、环孢素、生物制剂等为系统治疗中的常用药物,脓疱型银屑病儿童通常对光疗有较好的反应。此文介绍了目前针对于儿童脓疱型银屑病的治疗共识与经验,为现在的治疗进展进行了概括。     

生物制剂治疗儿童银屑病的现状分析

银屑病是一种临床常见的慢性反复发作性炎症性皮肤病,发病率高,使得很多患者深受其害,其中,儿童患者亦占有相当大的比例。儿童患病不仅影响其身心健康,由于本病需长期使用外用及口服药物维持治疗,更是给家庭带来沉重的经济负担。因儿童特殊生理条件的限制,能够用于儿童银屑病治疗的药物选择更少,因此亟需安全、有效的药物来满足儿童银屑病的治疗。近年来,生物制剂的深入研究给银屑病患儿的治疗带来新的曙光。     

生物制剂在银屑病特殊人群中的应用

传统的治疗银屑病药物有一定的疗效,但由于其副作用的影响,临床应用在一定范围内受到了限制。生物制剂作为当前研究热点,相比传统药物具有更好的安全性和治疗效果。本文主要讨论目前我国药监局(NMPA)批准使用的银屑病治疗生物制剂在孕妇、哺乳期妇女、儿童、慢性感染患者、恶性肿瘤患者及疫苗接种患者等特殊人群中的应用。     

生物制剂在儿童及青少年银屑病中的应用进展

 银屑病是一种遗传和环境共同作用诱发的免疫介导的慢性、复发性、炎症性、系统性疾病，表现为鳞屑性红斑或斑块，病因涉及遗传、环境、免疫等因素。儿童及青少年银屑病的发病率不低，对其身心健康造成一定的影响。许多研究表明Th17细胞及IL-23/IL-17轴在银屑病的发病机制中起着重要作用，为银屑病的治疗提供重要的靶点。TNF-α拮抗剂、IL-12/IL-23拮抗剂及IL-17拮抗剂等生物制剂逐渐应用于儿童及青少年中、重度银屑病，显示出良好的疗效及安全性。由于儿童及青少年的生理特点，更应注重生物制剂的安全性。     

A favourable benefit/risk ratio with efalizumab: A review of the clinical evidence

Moderate to severe plaque psoriasis has traditionally been treated with agents that have toxicities associated with long-term use. Many patients therefore cannot be treated safely, conveniently or effectively with traditional therapies. Recent phase 3 clinical trials for efalizumab, a biological agent targeted specifically at the T-cell-based pathology of psoriasis, have demonstrated its short- and long-term efficacy and safety for the treatment of psoriasis. This article reviews results from 12-week, six-month, and three-year trials, focusing on the drug’s safety, efficacy, and therapeutic response time, as well as the phenomenon of rebound in non-responding patients. Efalizumab emerges as an important addition to the dermatological pharmacopeia for the long-term treatment of psoriasis.

     

A favourable benefit/risk ratio with efalizumab: a review of the clinical evidence

Moderate to severe plaque psoriasis has traditionally been treated with agents that have toxicities associated with long-term use. Many patients therefore cannot be treated safely, conveniently or effectively with traditional therapies. Recent phase 3 clinical trials for efalizumab, a biological agent targeted specifically at the T-cell-based pathology of psoriasis, have demonstrated its short- and long-term efficacy and safety for the treatment of psoriasis. This article reviews results from 12-week, six-month, and three-year trials, focusing on the drug's safety, efficacy, and therapeutic response time, as well as the phenomenon of rebound in non-responding patients. Efalizumab emerges as an important addition to the dermatological pharmacopeia for the long-term treatment of psoriasis.     

Severe infliximab‐induced psoriasis treated with adalimumab switching

Background Antitumor necrosis factor (anti‐TNF) agents are a well‐established treatment for various medical conditions, including psoriasis and psoriatic arthritis. However, anti‐TNF agents may themselves induce psoriasis in some patients. Methods The authors report two cases of patients with severe and refractory infliximab‐induced psoriasis. Results The patients had good clinical responses after switching to another TNF blocker. Conclusion For severe cases, infliximab withdrawal combined with conventional immunosuppressive psoriasis drugs or with adalimumab may be a therapeutic option.     

Erythrodermic Psoriasis Treated with Golimumab: A Case Report

Erythrodermic psoriasis (EP) is a very severe variant of psoriasis whose management poses a challenge to physicians, as currently available therapies often provide unsatisfactory results. Many biologics have been used to treat chronic plaque psoriasis, the most common form of psoriasis; however, their effectiveness for EP is poorly understood. A recently developed biologic, golimumab, has been extensively studied for the treatment of moderate-to-severe active rheumatoid arthritis, psoriatic arthritis, active ankylosing spondylitis, and chronic plaque psoriasis. However, no clinical trials have been performed for EP. Here, we report the case of a 32-year-old man who presented with severe psoriasis that previously failed to respond satisfactorily to methotrexate, cyclosporine, retinoid, narrow-band ultraviolet B phototherapy, and topical agents (i.e., steroids and calcipotriol). Skin lesions worsened progressively and developed into erythroderma. Psoriatic arthritis was also detected. Conventional therapies lacked efficacy. Therefore, we administered golimumab 50 mg. The skin lesions improved significantly according to the Psoriasis Area and Severity Index score after the first administration; lesions improved further throughout the treatment course. Although additional studies are required to fully evaluate the efficacy and safety of golimumab, this agent may be an alternative treatment strategy for some patients with recalcitrant EP.     

中国银屑病生物制剂治疗指南（2021）

【摘要】 生物制剂在银屑病治疗中的应用越来越广泛,在治疗中重度、难治性及特殊类型银屑病方面发挥了积极的作用。在我国获批上市并已用于治疗银屑病的生物制剂包括肿瘤坏死因子α抑制剂、白细胞介素12/23抑制剂和白细胞介素17A抑制剂三大类7种制剂,如何合理、有效、安全地使用生物制剂已经成为临床工作中备受关注的问题。为此,我国银屑病诊疗及相关领域专家依据国内外研究数据和临床经验,结合中国银屑病患者的特点,在深入讨论的基础上制订本指南,从生物制剂的应用原则与方法、疗效与安全性、患者的筛查与监测、常见问题与对策以及特殊人群应用的注意事项等方面,为临床医生提供具体的指导意见。     

Treatment of psoriasis with etanercept in a patient with a history of primary B-cell lymphoma

The use of immunobiologicals that suppress an overly active immune system in psoriasis carries with it the possibility of cancer development as a result of immunosuppression. Patients with a history of malignancy may be at risk for recurrence when treated with immunosuppressive agents. Moreover, autoimmune diseases, such as psoriasis, have been associated with an increased risk of lymphoma. Therefore, risk–benefit assessments must take into account the clinical severity and treatment of psoriasis. We describe a 59-year-old white man with a history of primary B-cell lymphoma, severe recalcitrant plaque-type psoriasis and psoriatic arthritis, who was started on etanercept for treatment of his psoriasis and psoriatic arthritis. The patient has a long history of remission of his lymphoma. After treatment, the patient experienced significant global improvement with essentially complete remission of the cutaneous lesions and arthritis, and had no recurrence of his lymphoma or other systemic complications while on etanercept after follow-up for > 3 years.     

Recommendations for incorporating biologicals into management of moderate to severe plaque psoriasis: individualized patient approaches

Psoriasis is a T-cell mediated skin disease that affects approximately 2% of the population worldwide. Despite the prevalence of the disease and long-standing efforts to develop strategies to treat it, there is a need for safe and effective therapies to treat psoriasis, particularly the more severe forms. Biological agents such as alefacept, efalizumab, etanercept, and infliximab have been recognized as a class of treatment distinct from other forms of therapy in the treatment algorithm of psoriasis. Recent national and international consensus meetings have developed statements that position biological agents as an important addition to the treatment armamentarium for moderate to severe psoriasis, along with phototherapy and traditional systemic agents. There has been consensus that treatment should be individualized to each patient’s needs and circumstances. Biological agents offer the hope of safe, effective, long-term management of moderate to severe psoriasis. As new agents receive approval from Health Canada, the available range of therapeutic options for treating this chronic disease will broaden. A Canadian Psoriasis Expert Panel recently convened in February 2005 to analyze, based on a series of clinical case scenarios, the indications, contraindications, and considerations for and against each of the four biological agents, derived from product labelling, where available, and from the efficacy and safety data from phase 3 and earlier clinical trials, as well as post-marketing reports. The Panel has formulated a set of recommendations for incorporating these biological agents into the current treatment paradigm of moderate to severe plaque psoriasis and has identified the preferred biological agents for each patient based on individual needs and circumstances.

     

Recommendations for incorporating biologicals into management of moderate to severe plaque psoriasis: individualized patient approaches

Psoriasis is a T-cell mediated skin disease that affects approximately 2% of the population worldwide. Despite the prevalence of the disease and long-standing efforts to develop strategies to treat it, there is a need for safe and effective therapies to treat psoriasis, particularly the more severe forms. Biological agents such as alefacept, efalizumab, etanercept, and infliximab have been recognized as a class of treatment distinct from other forms of therapy in the treatment algorithm of psoriasis. Recent national and international consensus meetings have developed statements that position biological agents as an important addition to the treatment armamentarium for moderate to severe psoriasis, along with phototherapy and traditional systemic agents. There has been consensus that treatment should be individualized to each patient's needs and circumstances. Biological agents offer the hope of safe, effective, long-term management of moderate to severe psoriasis. As new agents receive approval from Health Canada, the available range of therapeutic options for treating this chronic disease will broaden. A Canadian Psoriasis Expert Panel recently convened in February 2005 to analyze, based on a series of clinical case scenarios, the indications, contraindications, and considerations for and against each of the four biological agents, derived from product labelling, where available, and from the efficacy and safety data from phase 3 and earlier clinical trials, as well as post-marketing reports. The Panel has formulated a set of recommendations for incorporating these biological agents into the current treatment paradigm of moderate to severe plaque psoriasis and has identified the preferred biological agents for each patient based on individual needs and circumstances.     

Recommendations for incorporating biologicals into management of moderate to severe plaque psoriasis: individualized patient approaches

Psoriasis is a T-cell mediated skin disease that affects approximately 2% of the population worldwide. Despite the prevalence of the disease and long-standing efforts to develop strategies to treat it, there is a need for safe and effective therapies to treat psoriasis, particularly the more severe forms. Biological agents such as alefacept, efalizumab, etanercept, and infliximab have been recognized as a class of treatment distinct from other forms of therapy in the treatment algorithm of psoriasis. Recent national and international consensus meetings have developed statements that position biological agents as an important addition to the treatment armamentarium for moderate to severe psoriasis, along with phototherapy and traditional systemic agents. There has been consensus that treatment should be individualized to each patient’s needs and circumstances. Biological agents offer the hope of safe, effective, long-term management of moderate to severe psoriasis. As new agents receive approval from Health Canada, the available range of therapeutic options for treating this chronic disease will broaden. A Canadian Psoriasis Expert Panel recently convened in February 2005 to analyze, based on a series of clinical case scenarios, the indications, contraindications, and considerations for and against each of the four biological agents, derived from product labelling, where available, and from the efficacy and safety data from phase 3 and earlier clinical trials, as well as post-marketing reports. The Panel has formulated a set of recommendations for incorporating these biological agents into the current treatment paradigm of moderate to severe plaque psoriasis and has identified the preferred biological agents for each patient based on individual needs and circumstances.