Current Status and Prospect for Psoriasis Treatment in Taiwan

Dermatol Sinica, June 2005 69

From the Department of Dermatology, National Taiwan University HospitalReprint requests: Tsen-Fang Tsai, M.D., Department of Dermatology, National Taiwan University Hospital, 7 Chung-Shan SouthRoad, , Taipei, Taiwan, R.O.C. TEL: 886-2-23123456 ext. 5734 FAX: 886-2-23934177

Current Status and Prospect for Psoriasis Treatment in Taiwan

Tsen-Fang Tsai

From the Department of Dermatology, National Taiwan University HospitalReprint requests: Tsen-Fang Tsai, M.D., Department of Dermatology, National Taiwan University Hospital, 7 Chung-Shan SouthRoad, , Taipei, Taiwan, R.O.C. TEL: 886-2-23123456 ext. 5734 FAX: 886-2-23934177

8 10

D

A 1 2 700

acitretin 2 300

oxsoralen 176 1 5

T I M

D A

anthralin

皮質類固醇

1993 1996 clobetasone

butyrate fluticasone propionate

prednicarbate tipredane methyl-

prednisolone aceponate (Advantan®)1

fluticasone propionate

(tachy-

phylaxis)

70 Dermatol Sinica, June 2005

TIM ( )

1.

(SEGRAs) ZK 2163482

2. NCX-1015

prednisolone 103

3.

4.

外用維生素D

D calcipotriol(

calcipotriene Daivonex

Dovonex Psorcutan

10

86 2 Daivonex

D

D calcipotriol

Leo

tachyphylaxis (

3

2 3

100

(lentigines)

halobetasol propionate


Daivonex

Daivobet (

Dovobet Psorcutan Beta)

Daivonex ointment

Daivonex cream

Caltriol

D

D, calcitriol Silkis

Daivonex

(compliance) Silkis

Silkis

4 Daivonex

Daivonex Silkis

Daivonex Silkis

D (VDR)5

Hailey-Hailey disease6

D 10

D

7

D alphacal-

cidol

D

tacalcitol (Curatoderm

Bonalfa ) maxacalcitol hexa-

fluoro-1 25-dihidroxy-calcitriol paricalatol

(19-nor-1 , 25- dihydroxycalcitriol)

KH1650 QRX-101 OCT 2-oxo-1, 25-

dihidroxy-calcitriol

tacalcitol

calcipotriol calcitriol

D

外用維生素A酸

A

A 1971

tretinoin

adapalene isotretinoin tazarotene (

Tazorac Zorac )

A

0.1% 0.05%

A

tazarotene

TIG-1(tazorotene-induced gene-1) TIG-2

TIG-38

tazarotene Daivonex

Daivonex

tazarotene Daivonex


X Tazarotene

acitretin 2 3

FDA

A

targretin

外用免疫抑制劑

Protopic 9 Elidel10 (TIM, topi-

cal immune modulators) cyclosporine

D

11 2005 3 10

FDA

FDA

pimecrolimus

cyclosporine12

40 mg 4 PASI

60%, 30 mg 4 PASI

60% T

Tar (焦油)

100

FDA

Polytar liquid emollient

Multitar T/Sal T/Gel Fongitar

Polytar

(CTS)

Goeckerman

Anthralin

Anthralin Margiton

1916 chrysarobin(

)

Micanol

Ditrastick

Methotrexate

methotrexate (MTX)

methotrexate 1958

1971

FDA

methotrexate

methotrexate

methotrexate

dihydrofolate reductase

DNA

12 3

methotrexate


3

methotrexate

4

folinic acid (Leucovorin)

methotrexate

methotrexate

methotrexate

4 type

procollagen aminopeptide (P NP)13

1972

methotrexate

4 1998

4~8

1.5g 1.0 ~ 1.5g14

(acute interstitial pneumonitis)

(electroporation)

trimetrex-

ate 2001 IMS

methotrexate 42.5%

acitretin cyclosporine oxsoralen

28.9% 17.1% 11.5% 15


methotrexate

methotrexate

methotrexate

維他命A酸

etretinate 1986

acitretin acitretin

2~3 (etretinate 100 )

iso-acitretin

etretinate

etretinate

acitretin

2

R e t i n o i d s

microarray 1555

Re t ino ids 16

Retinoids

Retinoids

Retinoids

PUVA (Re-PUVA)

UVB

acitretin acitretin

A

acitretin

(GOT GPT LDH)

acitretin

10%

isotretinoin 37%

5

LDL/HDL

retinoid

acitretin

Retinoid

(tissue lipase)

gemfibrozil

300 mg bid

statin cholestyramine

statin

cholestyramine retinoid

Cyclosporine

Cyclosporine 1979

1998

T

IL-2

Langerhans

(mast cell)

Cyclosporine


(3 ~ 5mg/kg/day)

70%

cyclosporine

cyclosporine

cyclosporine

D a i v o n e x

cyclosporine17 12

2

creatinine creatinine

(baseline) 1/3

(glomerular filtration rate)

cyclosporine

cyclosporine

Fumaric acid esters

Fumaric acid esters (

) fumaric acid monoethyl dimethyl

esters18

Schweckendiek

ICAM-1

( Th )

70%

(

)

1.29g/day

乾癬生物製劑

FDA 2003 1 31

Amevive

( Probiotics)


DNA

19

ale-

facept efalizumab etanercept

alefacept etanercept 1998

etanercept

infliximab 1996 Crohn's dis-

ease

cyclosporine methotrexate

methotrexate

75%

PASI 75( )

1. etaner-

cept Enbrel etanercept

Amgen Immunex

Boehr inger

Ingelheim etanercept

2002

etanercept

TNF IgG1

T

infliximab

Etanercept

50mg( )

25mg 25mg 24

PASI 75% 59% 44%

25%20

25mg

40000

C

12 2

25 50mg 2

25mg

2 25mg

2 25mg

6 37%

50% 18

5

1~2 4

Enbrel

3 3

Lenercept


2004 4 30

9 30

Wegener Langerhans

(congestive heart failure)

2. Efalizumab Raptiva

Xoma

Genetech Sereno

hu-1124 Xanelim

T

(LFA-1) CD11

T

T

CD11c+

50 2005 efal-

izumab

1mg/kg 12 12

438 21

( 111 ) 12

51% 6~8

24 75%

44%

35000

1213

12 50~75% >75%

32% 27%

(3.2%) 12

12 15% >50% < 5%

>25%

5%

39%

3. Alefacept Amevive

LFA3TIP Biogene

alefacept

LFA-3 IgG1

T (CD45RO+) CD2

CD4 250/ L

2

15mg 14 21%

PASI75

12 228 28

7

12 22

995 12

40 CD4

2000 Amevive


12

12

CD4

CD4 CD8

CD4

CD4

4. Infliximab (Remicade)

cyclosporine

3 24

48% 75% 22

Infliximab Centocor

etanercept

Crohn ulcerative colitis infliximab

TNF

caspase 3 T

249

3 5

2 3 10

72% 88%

75% 5

4 75% 10

90% 6 48% 75%

55% 50%

8

PPD X

Sjogren

infliximab

5. Adalimumab Humira®

Abbott

infliximab

40mg 12 PASI75

80% 53%22

12 PASI75

infliximab

Humira

Enbrel Raptiva Enbrel

Raptiva

Raptiva

Enbrel

Amevive 20%

12

Amevive

Enbrel Raptiva 12


23

(1)

(2)

(3)

(4)

(5)

(6)

(7)

其他的乾癬治療

Anti-CD4-Ab IL-2 diph-

theria fusion toxin (DAB389 IL-2)

Th Onercept

anti-TNF 3

anti-TNF CDP-571 IDEC

IDEC114 IL-4 IL-10(Tenovil)

Abgenix ABX-IL-8 GSK SB 33 2235

B M S - 1 8 8 6 6 7

OKTcdr4a(Imuclone) GSK clenoliximab

Medimmune MEDI-507 (Siplizumab)

anti-IL-18 anti-p40 ( IL-12 IL-23)

R A M B A s

(retinoid acid metabolism blocking agents)

Liarozole

Rambazole retinoids

ret inoids

P PAR agon i s t ( p i og l i t a zone )

Endothelin-1 antagonist (atrasentan)

Topiramate (Topamax ) mycophenolic

acid (Cellcept ) hydroxyurea (Hydrea

) dapsone 6-thioguanine (Lanvis

) leflunomide (Arava )

basiliximab(Simulect )

(rotation

treatment) (sequential ther-

apy)

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Current Status and Prospect for Psoriasis Treatment in Taiwan