阿达木单抗治疗儿童中重度斑块型银屑病11例临床疗效及安全性观察

Clinical Efficacy and Safety of Adalimumab in the Treatment for 11 Cases of Pediatric Moderate-to-Severe Plaque Psoriasis

目的观察阿达木单抗治疗儿童中重度斑块状银屑病的疗效及安全性。方法选取2020年3月-2021年7月就诊于新疆维吾尔自治区人民医院皮肤性病科的11例中重度斑块状银屑病患儿。体重<30 kg者,首次给予皮下注射阿达木单抗20 mg,之后1、3、5、7、9、11、13、15周注射20 mg;体重≥30 kg者,首次治疗予皮下注射阿达木单抗40 mg,之后第1、3、5、7、9、11、13、15周注射40 mg,于第4、8、12、16周时记录患儿银屑病皮损面积和严重度指数(PASI)及儿童皮肤病生活质量指数(CDLQI)。治疗过程密切监测不良反应。结果治疗16周PASI及CDLQI与治疗前比较均显著下降(P<0.05)。4周时,4例PASI改善率可达50%(PASI50);8周时,7例达PASI75;12周时,11例均达PASI75,其中5例达PASI90;16周时,8例达PASI90,其中1例达PASI100。11例患者均未发生感染、肿瘤等严重不良反应,其中1例患儿出现肝功能轻度异常。结论隔周皮下注射阿达木单抗治疗儿童中重度银屑病临床疗效显著,同时需密切关注不良反应的发生。

Objective To evaluate the efficacy and safety of adalimumab in the treatment of pediatric moderate-to-severe plaque psoriasis.Methods From March 2020 to July 2021,11 children with moderat-to-severe plaque psoriasis were collected from Department of Dermatology and Venereology,People's Hospital of Xinjiang Uygur Autonomous Region.Patients with body weight<30 kg,after initial subcutaneous injection of adalimumab at a dose of 20 mg,were subcutaneously injected with adalimumab at a dose of 20 mg at weeks 1,3,5,7,9,11,13 and 15;patients with body weight≥30 kg,after initial subcutaneous injection of adalimumab at a dose of 40 mg,were subcutaneously injected with adalimumab at a dose of 40 mg at weeks 1,3,5,7,9,11,13 and 15.At weeks 4,8,12 and 16,psoriasis area severity index(PASI)and children′s dermatology life quality index(CDLQI)were recorded.Adverse reactions were monitored during the treatment.Results PASI and CDLQI were significantly decreased at 16 weeks after treatment compared with baseline values(P<0.05).At week 4,4 patients achieved PASI50.At week 8,7 patients achieved PASI75.At week 12,all 11 patients achieved PASI75,of which 5 achieved PASI90.At week 16,8 patients achieved PASI90,including 1 patient achieved PASI100.No infections,tumors or other severe adverse reactions occurred in the 11 patients,but 1 patient got mild abnormal liver function.Conclusion Subcutaneous injection of adalimumab every other week has a significant clinical effect in the treatment of pediatric moderate-to-severe plaque psoriasis,and the occurrence of adverse reactions should be paid close attention.