背景:尽管长期治疗银屑病至关重要,这种方法在临床实践中具有挑战性.在最近的PSO-LONG试验中,二丙酸倍他米松(BD)和卡泊三醇(Cal)泡沫的固定剂量组合,每周两次,非连续治疗52周(主动治疗),可降低复发风险.然而,Cal/BD泡沫在银屑病长期治疗中的作用需要进一步澄清.主动管理(PAM)计划,一个全国性的意大利项目,旨在就积极治疗银屑病的作用达成共识。
方法:一个指导委员会通过名义分组技术(NGT)产生了一些陈述。这些声明由专家小组在经过改编的德尔福投票过程中进行了投票。
结果:提出了18项声明,他们中的大多数(14/18)在德尔福投票中达成了共识。提供长期主动局部治疗以降低治疗挑战性疾病部位或光疗或全身疗法禁忌/无效的患者的复发风险的需要已被广泛认识。关于将主动治疗与系统和生物治疗联系起来的可能性达成了共识。不需要加强剂量,因此有利于长期缓解。此外,在增加无复发时间方面,前瞻性治疗被认为比周末治疗更有效.提高依从性的方法,另一方面,需要进一步调查。
结论:在指南中纳入有效治疗方案中的主动策略将是轻度-中度银屑病治疗方法发展的基本步骤。
BACKGROUND: Although long-term management of psoriasis is paramount, this approach is challenging in clinical practice. In the recent PSO-LONG trial, a fixed-dose combination of
betamethasone dipropionate (BD) and calcipotriol (Cal) foam applied twice a week on non-consecutive days for 52 weeks (proactive treatment) reduced the risk of relapse. However, the role of Cal/BD foam in the long-term management of psoriasis needs further clarifications. The ProActive Management (PAM) program, a nationwide Italian project, aims at reaching a
consensus on the role of proactive management of psoriasis.
METHODS: A steering committee generated some statements through the nominal group technique (NGT). The statements were voted by an expert panel in an adapted Delphi voting process.
RESULTS: Eighteen statements were proposed, and the majority of them (14/18) reached a
consensus during the Delphi voting. The need to provide long-term proactive topical treatment to reduce the risk of relapse for the treatment of challenging diseases sites or in patients where phototherapy or systemic therapies are contraindicated/ineffective was widely recognized. A
consensus was reached about the possibility to associate the proactive treatment with systemic and biological therapies, without the need for dose intensification, thus favoring a prolonged remission. Moreover, the proactive treatment was recognized as more effective than weekend therapy in increasing time free from relapses. Approaches to improve adherence, on the other hand, need further investigation.
CONCLUSIONS: The inclusion in
guidelines of a proactive strategy among the effective treatment options will be a fundamental step in the evolution of a mild-moderate psoriasis therapeutic approach.