特应性皮炎药物治疗与药学监护中国专家共识

Chinese expert consensus on drug therapy and pharmaceutical care of atopic dermatitis

特应性皮炎(atopic dermatitis,AD)是全球疾病负担最高的慢性炎症性皮肤病,需要积极治疗和长期管理。过去AD治疗以局部外用糖皮质激素(topical corticosteroids,TCS)、外用钙调磷酸酶抑制剂(topical calcineurin inhibitors,TCI)以及系统使用传统免疫抑制剂为主。由于患者对激素、传统免疫抑制剂不良反应的顾虑以及各地医疗水平不均衡等原因,临床上AD的治疗,特别是中重度AD的系统治疗,往往存在启动延迟、患者依从性不佳等问题。近年来,生物制剂、Janus激酶(Janus kinase,JAK)抑制剂等靶向药物陆续上市,AD系统治疗逐步完善。然而由于这些药物的临床应用经验相对有限,药物选择、用药时机、如何减停、不良反应处理等问题给临床治疗带来新的挑战。随着“达标治疗”理念的引入,AD治疗强调以患者需求为中心、治疗目标为导向,开展个体化管理。其中,治疗药物管理和患者依从性管理等成为影响“达标”的重要因素,因此,药学服务在AD治疗药物管理中的作用日益凸显。该共识旨在规范AD管理中的药物使用,归纳药学监护要点,保障用药安全,提升患者药物治疗依从性,从而提高治疗效果,促进我国AD治疗管理质量提升。

With the highest global disease burden,atopic dermatitis(AD)is a chronic inflammatory skin disease requiring positive treatment and long-term management.In the past,topical corticosteroids(TCS),topical calcineurin inhibitors(TCI)and systemic immunosuppressants acted as major treatments for AD.Due to patient concerns of adverse reactions of TCS and tra-ditional immunosuppressants,as well as uneven medical levels among different regions,clinical therapy of AD,especially sys-temic therapy of moderate-to-severe AD,often faces the problems of delayed initiation and poor patient compliance.Recently tar-geted drugs such as biologics and Janus kinase(JAK)inhibitors have been successively approved and systemic therapy for AD has gradually improved.However,due to relatively limited clinical application experiences of these drugs,drug selection,drug tim-ing,tapering and withdrawing,adverse reaction management and other issues have brought new challenges to clinical therapy.With the introduction of the concept of“treat-to-target”,AD therapy has emphasizes primary patient needs,guidance of therapy goal and individualized management.Therefore therapeutic drug dosing and patient compliance management have become impor-tant factors affecting the“treat-to-target”.And pharmaceutical care plays a growingly prominent role in the management of AD therapeutic drugs.This consensus was intended to standardize drug use in AD management,summarize key points of pharmaceuti-cal care,ensure drug safety and improve patient medication compliance,thereby improving the therapy outcomes and promoting the quality of AD therapy management in China.