A Randomized, Open-Label, Multicenter Trial of Topical Tacrolimus for the Treatment of Pruritis in Patients with Atopic Dermatitis
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background: Pruritis caused by atopic dermatitis (AD) is not always well controlled by topical corticosteroid therapy, but use of tacrolimus often helps to soothe such intractable pruritis in clinical settings. Objective: To determine the anti-pruritic efficacy of topical tacrolimus in treating AD in induction and maintenance therapy. Methods: Prior to the study, patients were randomly allocated into two groups,induction therapy followed by tacrolimus monotherapy maintenance, and induction therapy followed by emollientonly maintenance. In the induction therapy, the patients were allowed to use topical tacrolimus and emollients in addition to a low dose (＜10 g/week) of topical steroids. Patients showing relief from pruritis were allowed to proceed to maintenance therapy. Recurrence of pruritis in maintenance therapy was examined as a major endpoint. Results: Two-thirds of patients (44/68; 64.7%) showed relief from pruritis after induction therapy. Pruritis recurred in 23.8% (5/21) of the tacrolimus monotherapy group and in 100% (21/21) of the emollient group during maintenance period, a difference that was statistically significant. Conclusion:Use of topical tacrolimus is effective in controlling pruritis of AD compared to emollient.
Abstract
Background: Pruritis caused by atopic dermatitis (AD) is not always well controlled by topical corticosteroid therapy, but use of tacrolimus often helps to soothe such intractable pruritis in clinical settings. Objective: To determine the anti-pruritic efficacy of topical tacrolimus in treating AD in induction and maintenance therapy. Methods: Prior to the study, patients were randomly allocated into two groups,induction therapy followed by tacrolimus monotherapy maintenance, and induction therapy followed by emollientonly maintenance. In the induction therapy, the patients were allowed to use topical tacrolimus and emollients in addition to a low dose (＜10 g/week) of topical steroids. Patients showing relief from pruritis were allowed to proceed to maintenance therapy. Recurrence of pruritis in maintenance therapy was examined as a major endpoint. Results: Two-thirds of patients (44/68; 64.7%) showed relief from pruritis after induction therapy. Pruritis recurred in 23.8% (5/21) of the tacrolimus monotherapy group and in 100% (21/21) of the emollient group during maintenance period, a difference that was statistically significant. Conclusion:Use of topical tacrolimus is effective in controlling pruritis of AD compared to emollient.
참고문헌 (21)
- Takeuchi M, "Increase of adult atopic dermatitis (AD) in recent Japan", Environ Dermatol, 7, pp.133~136 (2000)
- Yamamoto S, "Prevalence and exacerbation factors of atopic dermatitis", Skin Allergy Frontier, 1, pp.85~90 (2003)
- Ikoma A, "The neurobiology of itch", Nat Rev Neurosci, 7, pp.535~547 (2006)
- Rossi R, "Cutaneous innervation and the role of neuronal peptides in cutaneous inflammation: a minireview", Eur J Dermatol, 8, pp.299~306 (1998)
- Ständer S, "Neurophysiology of pruritus: cutaneous elicitation of itch", Arch Dermatol, 139, pp.1463~1470 (2003)
- Furue M, "Clinical dose and adverse effects of topical steroids in daily management of atopic dermatitis", Br J Dermatol, 148, pp.128~133 (2003)
- Wahlgren CF, "Itch and atopic dermatitis: clinical and experimental studies", Acta Derm Venereol Suppl, 165, pp.1~53 (1991)
- Boguniewicz M, "A randomized, vehicle-controlled trial of tacrolimus ointment for treatment of atopic dermatitis in children. Pediatric Tacrolimus Study Group", J Allergy Clin Immunol, 102, pp.637~644 (1998)
- "Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis", Dermatology, 186, pp.23~31 (1993)
- Furue M, "Dosage and adverse effects of topical tacrolimus and steroids in daily management of atopic dermatitis", J Dermatol, 31, pp.277~283 (2004)
- Fleischer AB Jr, "Tacrolimus ointment for the treatment of atopic dermatitis is not associated with an increase in cutaneous infections", J Am Acad Dermatol, 47, pp.562~570 (2002)
- Rivard J, "Ultraviolet phototherapy for pruritus", Dermatol Ther, 18, pp.344~354 (2005)
- Chuang TY, "PUVA and skin cancer. A historical cohort study on 492 patients", J Am Acad Dermatol, 26, pp.173~177 (1992)
- Hon KL, "Assessing itch in children with atopic dermatitis treated with tacrolimus: objective versus subjective assessment", Adv Ther, 24, pp.23~28 (2007)
- Reitamo S, "Efficacy and safety of tacrolimus ointment compared with that of hydrocortisone butyrate ointment in adult patients with atopic dermatitis", J Allergy Clin Immunol, 109, pp.547~555 (2002)
- Japanese FK-506 Ointment Study Group, "Phase III study of FK-506 (Tacrolimus) ointment in patients with atopic dermatitis -Comparison study with 0.12% betamethasone valerate ointment for trunk and extremities lesions-", Nishinihon J Dermatol, 59, pp.870~879 (1997)
- Inagaki N, "Inhibition of scratching behavior associated with allergic dermatitis in mice by tacrolimus, but not by dexamethasone", Eur J Pharmacol, 546, pp.189~196 (2006)
- Inagaki N, "Depletion of substance P, a mechanism for inhibition of mouse scratching behavior by tacrolimus", Eur J Pharmacol, 626, pp.283~289 (2010)
- Inoue T, "Prolonged topical application of tacrolimus inhibits immediate hypersensitivity reactions by reducing degranulation of mast cells", Acta Derm Venereol, 86, pp.13~16 (2006)
- Kido M, "Scratching behavior does not necessarily correlate with epidermal nerve fiber sprouting or inflammatory cell infiltration", J Dermatol Sci, 58, pp.130~135 (2010)
- Takeuchi S, "Collared mice: a model to assess the effects of scratching", J Dermatol Sci, 57, pp.44~50 (2010)