局部使用Paricalcitol對斑塊性牛皮癬有益


  July 23, 2004 - 根據一篇刊登在英國皮膚學期刊(British Journal of Dermatology)的先驅試驗結果指出,局部使用paricalcitol對斑塊性牛皮癬是安全且有效的。
  
  麻州波士頓大學醫學中心C. Durakovic及他的同事們表示,牛皮癬的治療需要持續地發展新的藥物,局部活性的維他命D化合物,在治療牛皮癬上已經被證實是安全且有效的;Paricalcitol(19-nor-1,25-dihydroxyvitamin D2)是一種全新的維他命D類似物,已經被研發使用於預防慢性腎衰竭病患產生繼發性副甲狀腺功能亢進。
  
  研究人員在一項雙盲、自我控制的臨床試驗中,11位中等嚴重度的斑塊性牛皮癬病患,分別使用paricalcitol軟膏(每日15微克)與安慰劑軟膏,每日使用一次持續12週。為了確認其生物作用,他們比較以paricalcitol治療與使用安慰劑的皮膚上,轉麩氨酸脢K(transglutaminase K)的免疫化學性表現,這個酵素是一種表皮分化的指標。
  
  第1週開始時,以paricalcitol治療就優於安慰劑治療,在紅腫、斑塊提升與結痂全面性的嚴重指數評估上有很大改善(P<.001);Paricalcitol治療12週後,轉麩氨酸脢K的免疫活性完全地轉變與沒有病灶的牛皮癬皮膚相同。
  
  沒有發生局部皮膚刺激,也沒有實驗室數據臨床上相關的改變,包括鈣、磷、副甲狀腺荷爾蒙、與尿液中鈣與肌酸酐比值。然而,研究人員警告延長使用時間或大範圍地使用可能會導致鈣與磷的異常,他們建議需要更多的試驗來評估長期使用效果。
  
  研究人員指出,每日使用一次的paricalcitol療法,在治療斑塊性牛皮癬上是安全且有效的;不過,相較於calcitriol,這個維他命D類似物,在降低血鈣與磷的機轉方面,並不完全清楚。
  
  Abbott實驗室贊助這項試驗中使用的paricalcitol。

Topical Paricalcitol Helpful f

By Laurie Barclay, MD
Medscape Medical News

July 23, 2004 — Topical paricalcitol is safe and effective for plaque psoriasis, according to the results of a pilot study published in the July issue of the British Journal of Dermatology.

"There continues to be a need to develop new pharmacological approaches for treating psoriasis. Topical active vitamin D compounds have proven to be both safe and effective for treating psoriasis," write C. Durakovic, from Boston University Medical Center in Massachusetts, and colleagues. "Paricalcitol (19-nor-1,25-dihydroxyvitamin D2) is a novel vitamin D analogue which has been developed for the prevention of secondary hyperparathyroidism in patients with chronic renal failure."

Investigators in this double-blinded, self-controlled study compared the effects of paricalcitol ointment (15 µg/g) and placebo ointment applied once daily for 12 weeks in 11 patients with moderate plaque psoriasis. To determine the biological effects, they compared immunohistochemical expression of transglutaminase K, a marker for epidermal differentiation, in paricalcitol-treated and placebo-treated skin.

Beginning at week 1, treatment with paricalcitol was superior to placebo treatment, with greater improvements in assessments of and global severity score for erythema, plaque elevation, and scaling (P < .001). After 12 weeks of paricalcitol treatment, the immunoreactivity of transglutaminase K changed almost completely to the pattern typical of nonlesional psoriatic skin.

There were no symptoms of local skin irritation, and no clinically relevant changes in laboratory parameters including serum calcium, phosphorus, parathyroid hormone, and urinary calcium/creatinine ratio. However, the authors cautioned that disturbances of calcium and phosphorus might become more common during prolonged therapy and application over the entire affected skin area. They recommend additional studies to evaluate the long-term effects of therapy.

"Once-daily application of paricalcitol ointment was safe and effective for the treatment of plaque psoriasis," the authors write. "The mechanism for the decreased calcaemic and phosphataemic effect of this vitamin D analogue compared with calcitriol is not fully understood."

Abbott Laboratories supplied the paricalcitol used in this study.

Br J Dermatol. 2004;151:190-195

Reviewed by Gary D. Vogin, MD

    



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