期待小分子藥物根治異位性皮膚炎？研究顯示，銳虎無法停，一停藥就會迅速復發

本篇研究，“Upadacitinib treatment withdrawal and retreatment in patients with moderate-to-severe atopic dermatitis: Results from a phase 2b, randomized, controlled trial”，請見這裡（外部網站），期刊摘要如下：

Background：

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by pruritic eczematous lesions. The effect of treatment withdrawal after response to upadacitinib oral treatment is not fully characterized.

Objectives：

Assess the effect of upadacitinib withdrawal on skin clearance and itch improvement in adult patients with moderate-to-severe AD and evaluate the kinetics of recovery on rescue treatment.

Methods：

Data from a phase 2b randomized, placebo-controlled trial (NCT02925117)of upadacitinib in patients with moderate-to-severe AD were analysed.

Patients were randomized 1：1：1：1 to receive upadacitinib 7.5 mg, 15 mg, 30 mg or placebo, and then at Week 16, patients were re-randomized 1：1 to receive the same dose of upadacitinib(upadacitinib 30 mg for patients initialized to placebo) or placebo.

From Week 20,those who experienced loss of response defined as Eczema Area and Severity Index<50% improvement from baseline (EASI 50) received rescue treatment with upadacitinib 30 mg.

Results：

Patients who withdrew from upadacitinib experienced a rapid loss of skin clearance response, while those who switched from placebo to upadacitinib gained response.

Loss of skin clearance response occurred within 4 weeks and worsening of itch occurred within 5 days.

In patients who originally received placebo or a lower dose of upadacitinib leading to a loss of EASI response, rescue treatment with upa-dacitinib 30 mg resulted in rapid recovery or improvement of both skin and itch responses; most patients who were re-randomized to placebo achieved EASI 75 andIGA 0/1 by 8 weeks of rescue treatment.

No new safety risks were observed.

Conclusions：

Continuous treatment with upadacitinib is suggested to maintain skin clearance and antipruritic effects.

原始論文

Upadacitinib treatment withdrawal and retreatment in patients with moderate-to-severe atopic dermatitis: Results from a phase 2b, randomized, controlled trial（外部網站）

Guttman-Yassky E, Silverberg JI, Thaçi D, Papp KA, et al. Journal of the European Academy of Dermatology and Venereology. 2023;37(12):2558-2568. doi:10.1111/jdv.19391

論文摘要（Google 翻譯）

以下為 Google 翻譯，並校正明顯錯誤，僅供參考，內容以英文原文為準。

中重度異位性皮膚炎患者停用與重新使用 upadacitinib：第 2b 期隨機對照試驗結果

背景：異位性皮膚炎（AD）是一種以搔癢性濕疹樣皮損為特徵的慢性發炎性皮膚病。口服 upadacitinib 治療有反應後停藥的影響，尚未完全釐清。

目的：評估停用 upadacitinib 對中重度 AD 成年患者皮膚清除與搔癢改善的影響，並評估接受救援治療後的恢復速度。

方法：分析 upadacitinib 用於中重度 AD 患者之第 2b 期隨機、安慰劑對照試驗（NCT02925117）的資料。

患者以 1:1:1:1 隨機分配接受 upadacitinib 7.5 mg、15 mg、30 mg 或安慰劑；第 16 週時再以 1:1 重新隨機分配，接受相同劑量的 upadacitinib（起始為安慰劑者改用 upadacitinib 30 mg）或安慰劑。

自第 20 週起，失去反應（定義為濕疹面積與嚴重度指數較基線改善未達 50%，即未達 EASI 50）者，接受 upadacitinib 30 mg 救援治療。

結果：停用 upadacitinib 的患者迅速失去皮膚清除反應，而由安慰劑改用 upadacitinib 的患者則獲得反應。

皮膚清除反應在 4 週內喪失，搔癢則在 5 天內惡化。

在原本接受安慰劑或較低劑量 upadacitinib 而失去 EASI 反應的患者中，以 upadacitinib 30 mg 救援治療可使皮膚與搔癢反應迅速恢復或改善；大多數重新隨機分配至安慰劑的患者，在救援治療 8 週內達到 EASI 75 與 IGA 0/1。

未觀察到新的安全風險。

結論：建議持續使用 upadacitinib 治療，以維持皮膚清除與止癢效果。

以下為台大皮膚科醫師之衛教報導（外部網站）：

「口服小分子標靶藥物近年來逐漸成為治療的重要選擇，其能快速抑制體內過度活化的免疫反應，減少皮膚紅腫發炎與劇烈搔癢，讓患者在短時間內明顯感受到改善。

但由於藥效消退得也比較快，一旦停藥，復發的速度可能比傳統藥物停藥後的復發更快。」

銳虎治療後的中醫經方治療實例，請見這裡。

停中藥後的患者現況追蹤，請見

這裡。

異位性皮膚炎，中醫經方的治療實例，請見這裡。

小兒異位性皮膚炎，中醫經方的治療實例，請見這裡。

成人異位性皮膚炎，中醫經方的治療實例，請見這裡。

異位性皮膚炎，期刊研究，請看這裡。

期刊研究整理，請見這裡。