Politiek, K. (Klaziena) (2013) Systemic treatment of severe atopic dermatitis. Results from daily practice. thesis, Medicine.
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Abstract
Background: Atopic dermatitis is a disease with significant illness-related stress. Itch, sleeping problems, social stigma, occupational and recreational impact; a few random examples from the daily life problems of a patient with severe AD. AD is a disease of which prevalence has increased steadily during the past three decades and is the most common inflammatory skin disease. Topical and systemic treatment is often necessary to control the disease. In chronic and severe cases, systemic immunosuppressive treatment needs to be started to control the disease. This concerns cyclosporin A, azathioprine, and methotrexate of which the effectiveness has been documented in clinical trials. Also mycophenolate mofetil and mycophenolic acid sodium are reported to be effective in the treatment of AD. These systemic therapies are regularly used in the University Medical Centre Groningen (UMCG) for AD and therefore insight into effectiveness, frequency of prescription, adverse events and long-term follow-up is desired. Methods: All patients treated with systemic therapies for atopic dermatitis in the UMCG, where included. Patient charts between 1992 until 2013 were used. These patient data were recorded in an Access database, which contains items such as: patient characteristics, atopic characteristics, start/stop date, effectiveness rate, reason for stopping systemic treatment, subjective adverse events, laboratory assessment and blood pressure. Results: A total of 196 patients were enrolled in this retrospective study (mean age 41.2 years) of whom 188 patients used one or more systemic therapies. The median duration of first treatment episode of cyclosporin A was 308 days, which 86/159 had good response to treatment. An increase of > 30% of serum creatinine was found in 22/111 patients and 12/88 patients had to discontinued treatment due to rise of blood pressure. Older patients stopped significantly more due to these two main adverse events. Azathioprine had a shorter median duration of first treatment episode of 60 days. Good response to treatment was found in 19/51 patients. The main reason for discontinued treatment was in 20/48 patients due to adverse events, mainly gastro-intestinal symptoms. Methotrexate and mycophenolic acid sodium had a median treatment duration in first treatment episode of 91.0 and 127.5 days. These treatments showed good response in 9/26 and 6/19 patients respectively. Conclusion: Over the last 20 years, cyclosporin A is the most frequently prescribed systemic immunosuppressive therapy for AD. It was also the treatment with the most response to AD. During the treatment, mainly older people, were at risk for developing hypertension and nephrotoxicity. This contra-indication and also non-effectiveness of treatment can result in change to a compound of second choice. Particular methotrexate and mycophenolic acid sodium are safe and useful compounds. Azathioprine is mostly discontinued early due to adverse events. With regards to long term complications all analyzed compounds can, if good controlled, used relatively safe.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Schuttelaar, dr. M.L.A. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:54 |
| Last Modified: | 25 Jun 2020 10:54 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1513 |
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