研究樂無喘對慢性蕁麻疹之療效

To Examine the Efficacy of Omalizumab in Patients with Chronic Idiopathic Urticaria

許寶寶(BAO-BAO HSU)

指導教授 ： 黃憲斌

國立中正大學/理學院/生命科學系生物醫學研究所/碩士(2016年)

摘要

慢性蕁麻疹是一種以皮膚癢及肉色地圖樣突起表現的皮膚病。一般小於六週者稱為急性蕁麻疹，大於六週者稱慢性蕁麻疹。大約四成蕁麻疹的病患會出現血管性水腫。無論是大人或小孩，大約八九成的慢性蕁麻疹與過敏原無關。這不明原因的蕁麻疹目前有各種推論，但沒有真正被證實的原因。一般成人一生中發生蕁麻疹的機率是百分之一。相較於小孩，成人的發生率比較高。其中，女性又比男性常見。慢性尋麻疹的診斷主要是臨床判斷。目前的治療以抗阻織胺為主，也是目前唯一核可治療慢性蕁麻疹的藥物。然而，大部分的病患對於抗組織胺效果不佳，甚至使用到治療劑量的三到四倍仍達不到治療效果。這份研究主要是要提出目前治療頑固性蕁麻疹的生物製劑樂無喘的效果和安全性。
這是一個回溯性研究，希望能夠探討19位慢性蕁麻疹病患使用Omalizumab長達24週的效果和安全。這些病患都是對於抗組織安無效的病患。病患年齡層介於20-59歲，每隔四週接受一次300mg Omalizumab長達24週。
蕁麻疹活動度指數(Urticaria activity score 7, UAS7) 病人平均是36分。在接受Omalizumab之後，94.73% (18/19)位病人的UAS7<6。此外，口服抗組織胺的使用率也減少。在這24週的研究期間，其中一位病患出現血管性水腫，一位病患出現氣喘。研究過程當中沒有病患死亡或過敏性休克。Omalizumab可明顯改善使用抗組織胺後控制不良的病患。

關鍵字

慢性特發性蕁麻疹 ； 慢性自發性蕁麻疹 ； H1抗組織胺 ； 樂無喘

並列摘要

Chronic Idiopathic urticaria (CIU), also known as chronic spontaneous urticaria (CSU), is defined by the presence of urticaria (hives), on most days of the week, for a period of six weeks or longer. About 40 percent of patients with CIU/CSU have accompanying episodes of angioedema. No external allergic cause or contributing disease process can be identified in 80 to 90 percent of adults and children with CIU/CSU. There are several theories regarding the pathogenesis of idiopathic chronic urticaria, none of which have been conclusively established. Up to 1 percent of the adult population develops CIU/CSU at some point in their lives. Adults are affected more often than children, and women are affected more often than men. The diagnosis of CIU/CSU is made clinically. Nonsedating H1-antihistamines are the current mainstay for initial treatment and are the only agents licensed for use in patients with chronic idiopathic urticaria. However, a majority of patients do not have a response to H1-antihistamines, even when the drugs are administered at three to four times their licensed dose.
It was a retrospective study to evaluate the efficacy and safety of subcutaneous omalizumab as add-on therapy for 24 weeks in 19 patients with CIU/CSU who remained symptomatic despite H1-antihistamines treatment at licensed doses. Patients aged 20-59 years with CIU/CSU were received subcutaneous omalizumab 300 mg every 4 weeks for 24 weeks.
Baseline UAS7 was approximately 36 in all CIU patients. UAS 7 of ≤ 6 in 94.73% (18/19 patients) after omalizumab therapy. The mean numbers of H1-antihistamine tablets that patients were taking as rescue medication was decreased. During the 24-week study period, one patient reported local reaction, one had angioedema, and one had bronchial asthma. No episodes of anaphylactic shock or death was reported during the study. Omalizumab diminished clinical symptoms and signs of CIU in patients who remained symptomatic despite the use of approved doses of H1-antihistamines.

並列關鍵字

Chronic Idiopathic Urticaria. ； Chronic Spontaneous Urticaria. ； H1-antihistamines. ； Omalizumab

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