A systematic review of treatments for bullous pemphigoid.
A systematic review of treatments for bullous pemphigoid.
复制标题
大疱性类天疱疮治疗的系统评价。
DOI：
10.1001/archderm.138.3.385
复制
发表时间：
2002
影响因子：
--
通讯作者：
G. Kirtschig
中科院分区：
文献类型：
--
作者：
N. Khumalo;D. Murrell;F. Wojnarowska;G. Kirtschig
目标
评估大疱性类天疱疮治疗的有效性。
方法
Cochrane 图书馆检索策略用于从 MEDLINE 和 EMBASE 中识别随机对照试验，从它们开始到 2001 年 9 月 30 日。所有经免疫荧光研究证实的大疱性类天疱疮干预措施的随机对照试验都包括在内。
结果
我们发现了 6 项随机对照试验，共有 293 名患者参与。两项试验，一项比较每天 0.75 mg/kg 的泼尼松龙与每天 1.25 mg/kg 的泼尼松龙，另一项比较甲基泼尼松龙与泼尼松龙，没有发现有效性有任何显着差异。然而，较高剂量的泼尼松龙与更严重的不良反应相关。一项试验中泼尼松与硫唑嘌呤的联合治疗以及另一项试验中泼尼松龙与血浆置换的联合治疗可将所需皮质类固醇剂量减半（平均+/-标准差，血浆置换治疗组为 0.52 +/- 0.28 mg/kg，而仅泼尼松龙治疗组为 0.97 +/- 0.33 mg/kg）。然而，第五项试验，包括所有 3 个治疗组（单独使用泼尼松龙、泼尼松龙和硫唑嘌呤、以及泼尼松龙和血浆置换），未能证实联合治疗相对于单独使用泼尼松龙的益处。一项对 20 名患者进行的试验，将泼尼松与四环素和烟酰胺进行比较，发现两组之间的反应没有统计学上的显着差异，但泼尼松治疗组的不良反应更为严重。
结论
没有足够的证据来推荐大疱性类天疱疮的具体治疗方法，并且需要进行更大规模、具有足够功效的随机对照试验。每天超过 0.75 mg/kg 的泼尼松龙起始剂量似乎不会带来额外的益处，并且似乎较低的剂量可能足以控制疾病。尚未确定在皮质类固醇中添加血浆置换或硫唑嘌呤的有效性。四环素和烟酰胺的联合治疗似乎有用，尽管这需要进一步验证。
OBJECTIVE
To assess the effectiveness of treatments for bullous pemphigoid.
METHODS
The Cochrane Library search strategy was used to identify randomized controlled trials from MEDLINE and EMBASE, from their inception to September 30, 2001. All randomized controlled trials on interventions for bullous pemphigoid, confirmed by immunofluorescence studies, were included.
RESULTS
We found 6 randomized controlled trials with a total of 293 patients. Two trials, one comparing prednisolone, 0.75 mg/kg per day, with prednisolone, 1.25 mg/kg per day, and the other comparing methylprednisolone with prednisolone, did not find any significant difference in effectiveness. The higher dose of prednisolone, however, was associated with more severe adverse effects. Combination treatments of prednisone with azathioprine in one trial and of prednisolone with plasma exchange in another were useful in halving the corticosteroid dose required (mean +/- SD, 0.52 +/- 0.28 mg/kg in the plasma exchange-treated group vs 0.97 +/- 0.33 mg/kg in the prednisolone only-treated group). However, a fifth trial, including all 3 treatment groups (prednisolone alone, prednisolone and azathioprine, and prednisolone and plasma exchange), failed to confirm the benefit of combination treatment over prednisolone alone. A trial of 20 patients, comparing prednisone with tetracycline and niacinamide, found no statistically significant difference in response between the 2 groups, but the prednisone-treated group had more serious adverse effects.
CONCLUSIONS
There is inadequate evidence for a recommendation of a specific treatment for bullous pemphigoid, and there is a need for larger randomized controlled trials with adequate power. Starting doses of prednisolone greater than 0.75 mg/kg per day do not seem to give additional benefit, and it seems that lower doses may be adequate for disease control. The effectiveness of the addition of plasma exchange or azathioprine to corticosteroids has not been established. Combination treatment with tetracycline and niacinamide seems useful, although this needs further validation.