阿达木单抗联合阿维A治疗5例儿童泛发性脓疱型银屑病回顾性分析

【摘要】 目的 回顾性分析阿达木单抗联合阿维A治疗儿童泛发性脓疱型银屑病的临床疗效及安全性。方法 选取2019年10月至2020年8月就诊于天津市儿童医院皮肤科的5例泛发性脓疱型银屑病患儿,入院予口服0.5 mg·kg-1·d-1阿维A,待相关检查结果回报后,第0周（首剂）、第1周及此后每2周给予皮下注射阿达木单抗20/40 mg,日本皮肤科协会（JDA）评分改善50％后阿维A减量至0.3 mg·kg-1·d-1,改善75％后停用阿维A,于阿达木单抗治疗0、1、2、4、8、12、24周时观察并记录患者病情,治疗过程中监测不良反应。结果 5 例患者均接受至少40周疗程的药物治疗,2周时3例达JDA50;4周时4例达JDA75,1例JDA100;8周时5例均达到JDA100。至2021年6月,5例患儿均已接受至少40周随访,期间病情未见反复,均未出现感染或恶性肿瘤等严重不良反应。结论 阿达木单抗联合阿维A治疗儿童泛发性脓疱型银屑病起效较快,安全性较高。

Adalimumab combined with acitretin in the treatment of five children with generalized pustular psoriasis: a retrospective clinical observation

【Abstract】 Objective To evaluate the clinical efficacy and safety of adalimumab combined with acitretin in the treatment of childhood generalized pustular psoriasis. Methods Five children with generalized pustular psoriasis were collected from Department of Dermatology, Tianjin Children′s Hospital from October 2019 to August 2020. After admission, the patients received oral acitretin at a dose of 0.5 mg·kg-1·d-1. After relevant laboratory examinations, these patients additionally received subcutaneous injections of 20- or 40-mg adalimumab at weeks 0 （the initial dose）, 1, and every 2 weeks thereafter; when patients obtained a 50% improvement in the Japanese Dermatology Association （JDA） severity index score, the dose of acitretin would be reduced to 0.3 mg·kg-1·d-1, and acitretin would be discontinued after a 75% improvement. The disease condition was evaluated at weeks 0, 1, 2, 4, 8, 12 and 24 after the start of adalimumab treatment, and adverse reactions were monitored during treatment. Results All the 5 patients received drug treatment for at least 40 weeks. After 2-week treatment, 3 patients achieved a 50% reduction in JDA severity index score（JDA50）; after 4-week treatment, 4 achieved JDA75, and 1 achieved JDA100; after 8-week treatment, all the 5 patients achieved JDA100. By June 2021, all the 5 children received follow-up for at least 40 weeks, no recurrence was observed during the treatment period, and no infections, malignant tumors or other serious adverse reactions occurred. Conclusion Adalimumab combined with acitretin shows rapid onset of action and high safety in the treatment of childhood generalized pustular psoriasis.