Abstract
Background.Therapy of psoriasis in children is an urgent problem of dermatology and paediatrics. The present-day knowledge of the disease pathogenesis defines the focus of therapeutic interventions causing rapid relief of disease symptoms, prevention of complications and the achievement of a complete skin resurfacing from psoriatic lesions as well as long-term retention of the effect. These requirements are largely met by therapy with genetically engineered biological drugs.Our aim wasto study the clinical efficacy and safety of treating children suffering from moderate and severe psoriasis with genetically engineered biological drugs.Patients and Methods.The study included children with moderate and severe psoriasis. Four groups were formed: in the first and second groups, the children were treated with ustekinumab and etanercept, respectively, without prior methotrexate, in the third group — with ustekinumab after methotrexate, in the fourth group — with etanercept after methotrexate. The efficacy of therapy with ustekinumab and etanercept was evaluated using the PASI and CDLQI indices, their impact on the quality of life of patients was studied, the adverse events were registered.Results.The study involved 98 children aged from 6 to 17 years: 23 children in the first group, 26 — in the second group, 24 — in the third group, and 25 — in the fourth group. The arithmetic mean of the PASI index during the initial examination ranged from 23.7 ± 1.27 in patients of the second group to 31.9 ± 1.68 in the first group. The minimum value of the index was 10.5, the maximum one — 58.5. The CDLQI index at the first visit ranged from 14.8 ± 0.95 in patients of the fourth group to 17.0 ± 0.99 in the first group, which showed no statistically significant differences.Conclusion.Genetically engineered biological therapy with ustekinumab and etanercept is an effective and safe method for treating moderate and severe psoriasis in childhood, but ustekinumab compared to etanercept leads to a more pronounced decrease in the PASI index.Nikolay N. Murashkin — receiving research funding from pharmaceutical companies Jansen, Eli Lilly. Receiving fees for scientific advice from Galderma, Pierre Fabre, Bayer, Astellas, Libriderm.Eduard T. Ambarchian — receiving research funding from pharmaceutical company Eli Lilly. Receiving fees for scientific advice from Jansen, Libriderm.
Highlights
Therapy of psoriasis in children is an urgent problem of dermatology and paediatrics
The present-day knowledge of the disease pathogenesis defines the focus of therapeutic interventions causing rapid relief of disease symptoms, prevention of complications and the achievement of a complete skin resurfacing from psoriatic lesions as well as long-term retention of the effect. These requirements are largely met by therapy with genetically engineered biological drugs
Four groups were formed: in the first and second groups, the children were treated with ustekinumab and etanercept, respectively, without prior methotrexate, in the third group — with ustekinumab after methotrexate, in the fourth group — with etanercept after methotrexate
Summary
Терапия псориаза у детей является актуальной проблемой дерматологии и педиатрии. Современные данные о патогенезе заболевания диктуют направленность терапевтических мероприятий, обусловливающих быстрое купирование симптомов болезни, профилактику осложнений и достижение полного очищения кожного покрова от псориатических высыпаний, а также длительное удержание эффекта. Генноинженерная биологическая терапия препаратами устекинумаб и этанерцепт является эффективной и безопасной методикой лечения среднетяжелых и тяжелых форм псориаза в детском возрасте, однако устекинумаб в сравнении с этанерцептом приводит к более выраженному снижению индекса PASI. Сравнительная оценка эффективности и безопасности ингибиторов TNFα и IL12/23 в терапии псориаза у детей. Путем таргетного блокирования функции одного или нескольких медиаторов воспаления отдельные биологические препараты продемонстрировали высокие показатели эффективности и безопасности в клинических исследованиях, посвященных терапии псориаза в детском возрасте [7, 8]. В рамках научно-исследовательской работы ФГАУ «Национальный медицинский исследовательский центр здоровья детей» Минздрава России «Оптимизация общих подходов к диагностике, лечению и реабилитации хронических дерматозов у детей» было проведено сравнительное исследование эффективности и безопасности ингибиторов TNFα и IL12/23 в терапии псориаза у детей. Цель исследования — изучить эффективность и безопасность ингибиторов TNFα и IL12/23 в терапии псориаза у детей. Методы регистрации исходов У всех пациентов был проведен сбор анамнеза заболевания, включая сведения о дебюте и стаже болезни, особенностях клинического течения, частоте инфекционных заболеваний за последний год, а также
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