不同剂量阿维A治疗寻常性斑块状银屑病成本-效果分析

阿维A是第二代芳香维A酸类药物,多用于红皮病型和脓包型等严重型银屑病的治疗,为了寻找安全、有效、经济的治疗方法,笔者运用药物经济学原理和方法,对不同剂量的阿维A治疗寻常性斑块状银屑病所产生的相对经济-效果进行评价,为临床合理用药提供参考.     

阿维A联合百癣夏塔热片治疗寻常型银屑病的临床观察

目的观察阿维A联合百癣夏塔热片治疗寻常型银屑病的临床疗效。方法 76例银屑病患者分为阿维A联合百癣夏塔热片治疗组和单纯应用阿维A对照组,用PASI计分法评价银屑病病情严重程度及临床疗效。结果治疗组有效率明显高于对照组(P<0.01),且平均起效时间亦快于对照组。结论阿维A联合百癣夏塔热片治疗寻常型银屑病的起效时间及近期疗效均优于单用阿维A治疗,联合应用可以减少阿维A的疗程用量而减少不良反应,值得进一步研究。     

阿维A联合润燥止痒胶囊治疗寻常型银屑病的疗效观察

目的观察阿维A联合润燥止痒胶囊治疗寻常型银屑病疗效。方法将寻常型银屑病94例随机分为两组,治疗组50例给予阿维A20mg/d加润燥止痒胶囊2.0g,tid治疗,同时外用氯倍他索乳膏,对照组44例给予阿维A 20mg/d治疗,同时外用氯倍他索乳膏于皮损处,共治疗4周。结果两组有效率经统计学处理,差异无显著性(χ2=0.016,P>0.05),两组复发率差异有显著性(χ2=4.615,P<0.05)。结论阿维A联合润燥止痒胶囊治疗寻常型银屑病可以明显降低复发率。     

阿维A联合复方氟美松治疗寻常性银屑病随机双盲研究

目的：研究阿维A联合复方氟美松治疗寻常型银屑病的临床疗效及安全性。方法：采用随机双盲对照的分析方法,将入选患者随机分为治疗组和对照组,治疗组接受阿维A胶囊和复方氟美松软膏联合治疗,对照组应用复方氨肽素和氯倍他索软膏联合治疗。结果：治疗组临床治愈率和有效率优于对照组,不良反应发生率差异无统计学意义（P〉0．05）。结论：阿维A联合复方氟美松治疗寻常型银屑病安全有效。     

阿维A联合窄谱UVB照射治疗寻常型银屑病疗效观察

目的观察口服阿维A胶囊,联合窄谱UVB照射治疗寻常型银屑病的临床治疗效果。方法将收住入院确诊的寻常型银屑病55例设治疗组合对照组。结果治疗组口服阿维A胶囊联合窄谱UVB照射治疗效果明显,且能缩短疗程,延长复发时间。结论窄谱UVB照射联合口服阿维A胶囊治疗寻常型银屑病疗效确切,安全,不良反应少,近期效果和远期效果均优于对照组。     

强力宁联合小剂量阿维A治疗银屑病120例临床研究观察

目的：探讨强力宁联合小剂量阿维A治疗银屑病的临床疗效。方法：选取2014年7月～2016年1月在我院接受治疗的寻常型银屑病患者120例为研究对象,分为强力宁联合阿维A组及强力宁联合小剂量阿维A组,每组60例。比较治疗前后两组临床疗效、肝肾功能、血脂及用药不良反应情况。结果：强力宁联合小剂量阿维A组治疗总有效率为73.3%,显著高于强力宁联合阿维A组（P<0.05）,差异有统计学意义。治疗过程中不良反应发生率为6.6%,显著低于强力宁联合阿维A组（P<0.05）。结论：强力宁联合小剂量阿维A治疗寻常型银屑病疗效好,毒副作用少,值得临床推广。     

阿维A联合甲氨蝶呤治疗难治性泛发性脓疱型银屑病的疗效观察

目的：探讨阿维A联合甲氨蝶呤治疗难治性泛发性脓疱型银屑病的疗效及安全性。方法169例难治性泛发性脓疱型银屑病患者,采用数字表法随机分为阿维A组、甲氨蝶呤组以及阿维A与甲氨蝶呤联合治疗组,观察不同治疗方法的临床疗效与安全性。结果联合治疗组的总有效率为96．55％,明显高于阿维A组的83．93％以及甲氨蝶呤组的80．00％（χ2＝5．210、7．603,均P＜0．05）。联合治疗组不良反应发生率为41．38％,显著高于阿维A组的21．43％（χ2＝5．251,P＜0．05）。结论阿维A联合甲氨蝶呤治疗难治性泛发性脓疱型银屑病的临床疗效显著,安全性好,值得在临床中推广应用。     

美能联合阿维A治疗寻常型银屑病疗效观察

目的:观察美能联合阿维A治疗银屑病的治疗效果。方法:120例寻常型银屑病患者分成治疗组和对照组。治疗组口服美能100mg/次,日三次,同时阿维A胶囊口服。对照组单纯口服阿维A胶囊。结果:治疗组的有效率95%,对照组的有效率85%,两组比较差异有显著性(P<0.05)。结论:美能联合阿维A治疗银屑病不失为一种好的联合用药治疗方法。     

阿维A联合窄谱中波紫外线照射治疗寻常型银屑病疗效观察

目的观察阿维A联合窄谱中波紫外线（NB—UVB）照射治疗寻常型银屑病的临床疗效及影响因素。方法单独采用NB—UVB照射或联合口服阿维A治疗银屑病256例,并以银屑病面积和严重指数（PASI）评价疗效,分析性别、皮肤类型、临床亚型及分期对疗效的影响。结果窄谱中波紫外线照射治疗银屑病有效,联合口服阿维A后疗效可显著提高,缩短疗程,疗效相关因素分析表明,进行期优于静止期（P〈0．05）,点滴型优于斑块型（P〈0．05）,Ⅲ型皮肤优于Ⅳ型皮肤（P〈0．05）,但男性略优于女性（P〉0．05）。结论NB—UVB照射治疗寻常型银屑病疗效好,不良反应小,结合口服阿维A能显著增加疗效,其疗效可能与寻常型银屑病亚型、分期及患者皮肤类型有关。     

复方甘草酸苷联合阿维A治疗泛发性寻常型银屑病的效果观察

目的：探讨复方甘草酸苷联合阿维A治疗泛发性寻常型银屑病的临床效果。方法：将2011年1月～2013年1月我院收治的184例泛发性寻常型银屑病患者的临床资料进行回顾性分析。结果：观察组92例泛发性寻常型银屑病患者,经复方甘草酸苷联合阿维A治疗,总有效率为89.13%,明显高于对照组,P<0.05,差异具有统计学意义。结论：复方甘草酸苷联合阿维A治疗泛发性寻常型银屑病的临床疗效确切,不良反应少,值得推广。     

Clinical pharmacokinetics and drug metabolism of tazarotene: a novel topical treatment for acne and psoriasis.

Tazarotene (AGN 190168) is a new acetylenic retinoid which is effective for the topical treatment of patients with stable plaque psoriasis and mild to moderate acne vulgaris. Topical gel application provides direct delivery of tazarotene into the skin. At 10 hours after a topical application of 0.1% tazarotene gel to the skin of healthy individuals and patients with psoriasis, approximately 4 to 6% of the dose resided in the stratum corneum and 2% of the dose distributed to the viable epidermis and dermis. Tazarotene is rapidly hydrolysed by esterases to its active metabolite, tazarotenic acid. Tazarotenic acid does not accumulate in adipose tissue, but undergoes further metabolism to its sulfoxide and to other polar metabolites and is rapidly eliminated via both urinary and faecal pathways with a terminal half-life of about 18 hours. Percutaneous absorption is similar between healthy individuals and patients with facial acne, leading to plasma concentrations below 1 microg/L. The systemic bioavailability of tazarotene (measured as tazarotenic acid) is low, approximately 1% after single and multiple topical applications to healthy skin. In patients with psoriasis under typical conditions of use, systemic bioavailability increased during the initial 2 weeks of treatment from 1% (single dose) to 5% or less (steady state). The increased bioavailability is probably related to decreases in plaque elevation and scaling due to successful treatment, resulting in a less effective skin penetration barrier to tazarotene. Steady-state concentrations of tazarotenic acid are achieved within 2 weeks of topical treatment in both healthy and psoriatic skin types. The large variability in plasma concentrations observed in patients with psoriasis is probably because of the large differences in lesional skin condition, the amount of drug applied and the surface area of application. There was no significant drug accumulation in the body with long term treatment of patients with psoriasis. Topical administration of tazarotene requires dosages much smaller than those usually required for oral retinoids, such as isotretinoin, acitretin and etretinate, and it delivers the drug directly into the target skin tissues. The low systemic absorption and rapid systemic elimination of tazarotene and tazarotenic acid results in limited systemic exposure. Thus, topical tazarotene has a low potential for systemic adverse effects and is effective in the treatment of patients with acne and psoriasis.     

Pharmacokinetics of tazarotene and acitretin in psoriasis

Introduction: Psoriasis is a prevalent cutaneous condition with severe physical and psychological manifestations. Since the advent of biologics, clinical outcomes in psoriasis have improved. However, retinoids are useful in the correct clinical context. Tazarotene and acitretin are currently the only US Food and Drug Administration approved retinoids for treatment of psoriasis. Both topical tazarotene and oral acitretin act on retinoic acid receptors and retinoid-X-receptors, resulting in altered gene expression of inflammatory cytokines and inhibition of keratinocyte proliferation.

Areas covered: This article provides an in-depth pharmacologic and clinical review on the use of tazarotene and acitretin in psoriasis. The PubMed database was searched using combinations of keywords: acitretin, bioavailability, dosing, efficacy, etretinate, interactions, mechanism, pharmacodynamics, pharmacokinetics, pharmacogenetics, psoriasis, safety, tazarotene, tolerability, and toxicity.

Expert opinion: Tazarotene and acitretin are effective treatments for psoriasis. Benefits include lack of immunosuppression and success treating inflammatory psoriasis. When combined with other topical and systemic agents, both retinoids improve clinical efficacy while lowering the treatment threshold. However, topical adherence and bothersome side effects can limit retinoid use. Acitretin and tazarotene both improve outcomes through a unique mechanism that especially benefits subsets of patients, despite side effects and limitations.     

A review of acitretin for the treatment of psoriasis

Background: Acitretin is an oral retinoid that is approved for the treatment of psoriasis. It is unique compared to other systemic therapies for psoriasis such as methotrexate and cyclosporine in that it is not immunosuppressive. It is, therefore, safe for use in psoriasis patients with a history of chronic infection such as HIV, hepatitis B, hepatitis C or malignancy who have a contraindication to systemic immunosuppressive therapy and require systemic therapy because topical therapy is inadequate and they are unable to commit to phototherapy. Acitretin is one of the treatments of choice for pustular psoriasis. Even though acitretin is less effective as a monotherapy for chronic plaque psoriasis, combination therapy with other agents, especially UVB or psoralen plus UVA phototherapy, can enhance efficacy. Objective: To provide an updated review of the safety and efficacy of acitretin in the treatment for psoriasis. Methods: Literature review of journal articles from 2008 to 2009 since the last review of acitretin evaluated medical literature from 2005 to 2008. Results/conclusion: Acitretin is an effective systemic therapy for psoriasis and is generally well tolerated at low doses for long-term use. If monotherapy with acitretin is inadequate, it can be used in combination with other treatments, particularly UVB phototherapy, to increase efficacy.     

阿维A联合迪银片治疗寻常性银屑病的疗效观察

目的：分析本院收治的寻常性银屑病患者的临床资料,探讨阿维A联合迪银片治疗寻常性银屑病的临床效果。方法：选取2007年5月~2009年4月在本院门诊治疗的银屑病患者96例,将患者随机平均分为两组,对照组进行阿维A治疗,观察组加用迪银片治疗。结果：观察组患者经过8周的治疗后,基本愈合18例（37.50%）、显效23例（47.92%）、好转7例（14.58%）、无效0例（0.0%）,与对照组相比,在基本愈合、显效和总有效率方面差异均有统计学意义（P〈0.05）。结论：阿维A联合迪银片治疗寻常性银屑病,基本愈合率能够显著提高,有效提高显著疗效,相比单一服用阿维A胶囊具有良好的临床效果,副作用较轻,具有推广价值。     

他扎罗汀凝胶与卡泊三醇软膏治疗斑块型银屑病的比较

目的 :观察他扎罗汀凝胶治疗斑块型银屑病的疗效与安全性 ,并与卡泊三醇软膏比较。方法 :71例斑块型银屑病病人分为 2组 ,他扎罗汀组 36例 ,每晚外涂 1次 ;卡泊三醇组 35例 ,早、晚各外涂1次 ,2组疗程均为 12wk。结果 :2组的总有效率分别为 83%和 79% ,差异无显著意义 (P >0 .0 5 )。结论 :他扎罗汀凝胶治疗斑块型银屑病安全有效 ,与卡泊三醇相仿     

阿维A与复方氨肽素治疗寻常型银屑病的比较

目的:评价阿维A和复方氨肽素治疗寻常型银屑病的临床疗效及安全性。方法:寻常型银屑病病人74例。阿维A组29例,其中重型16例,轻型13例,治疗中前4wk予阿维A 30 mg·d~(-1),后8 wk予20 mg·d~(-1),口服,共12wk。复方氨肽素组45例,其中重型20例,轻型25例,给予复方氨肽素15片·d~(-1)口服,共12wk。结果:在重型病人治疗中,阿维A组和复方氨肽素组的有效率分别为75%和35%,2组比较有非常显著差异(P＜0．01)。在轻型病人治疗中,阿维A组和复方氨肽素组的有效率分别为85%和48%,2组比较无明显差异(P＞0．05)。阿维A组起效较复方氨肽素组快(P＜0．01)。阿维A组不良反应发生率97%,高于复方氨肽素组67%(P＜0．01)。结论:阿维A治疗寻常型银屑病,尤其是重型疗效更高、起效更快;对于轻型,疗效与复方氨肽素相仿。而复方氨肽素使用安全性高于阿维A。     

Schools of pharmacology: retinoid update

The most widely used retinoids include topical tretinoin (Retin-A), adapalene (Differin), topical tazarotene (Tazorac), isotretinoin (Accutane), and acitretin (Soriatane). This article will review new uses and developments in tazarotene (its failure to secure FDA approval in oral form for psoriasis), adapalene (its new 0.3% gel form and use in rosacea), alitretinoin (its use in photoaging), bexarotene (its use for psoriasis and chronic hand dermatitis), isotretinoin (the IPledge program, its use for neuroblastoma and branded formulation pharmacological superiority to generics), and retinoic acid metabolism-blocking agents (RAMBAs) (liarazole use for ichthyosis and psoriasis).     

Acitretin. A review of its pharmacology and therapeutic use.

Acitretin (etretin), a second generation monoaromatic retinoid for use in the treatment of severe psoriasis and other dermatoses, is the major active metabolite of etretinate and possesses a similar therapeutic index; i.e. a similar ratio of clinical efficacy to adverse effects. When used alone at a maintenance dosage of 30 to 50mg daily, acitretin is effective in the treatment of psoriasis, causing a reduction in the severity of scaling, erythema and induration. Efficacy appears to be further enhanced by combination with psoralen-ultraviolet A photochemotherapy (PUVA) or ultraviolet B irradiation (UVB). These combinations reduce the time to lesion clearance and reduce the total radiation dose, improving overall safety. Comparative studies have confirmed the equivalence of acitretin and etrtinate with regard to efficacy and toxicity. Adverse reactions are dose-related and generally typical of hypervitaminosis A. Alopecia and mucocutaneous symptoms such as cheilitis and drying of the mucous membranes are particularly prevalent. Hypertriglyceridaemia and elevation of cholesterol levels also occur. Examination of the pharmacokinetic profile of acitretin reveals its main advantage over etretinate. Acitretin is less lipophilic than etretinate, and its lack of sequestration into 'deep' fatty storage sites is reflected in a comparatively short terminal elimination half-life of 50 to 60 hours, compared with 120 days for etretinate. Due to its teratogenic potential, acitretin is strictly contraindicated in women of childbearing potential unless effective contraceptive measures are employed. Etretinate has been identified in plasma samples of some patients treated with acitretin. Thus, acetretin has an established place in the treatment of keratinising disorders, although its use in women of child-bearing potential must be accompanied by effective contraceptive measures, with a further 2-year contraceptive period after therapy completion.