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2003-11-06 06:39:29 , 조회:
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프로토픽은 면역억제제로서..처음엔...장기이식과 같은 자가면역질환에 응용되었습니다.
그러다가 면역억제의 효과가 좋아서..스테로이드 대신 바르는 연고로서의 가능성을 보고..
아토피와 같은 알레르기 질환에 적용해 보기 시작한 것입니다.
자가면역질환에 있어서는 먹는경우가 많았는데..
스테로이드와 같은 부작용은 거의 없고.. 신경정신적인 문제가 가끔보이는것 같기는 합니다.
물론 이것도 아토피 환자들이 아니고.. 장기이식후 지속적으로 먹었을때 이야기고.
아토피 환자들이 바르는 정도에는 이런 문제는 없습니다.
프로토픽과 부작용( protopic, side effect )으로 검색을 해봤습니다.
결과는 아래와 같습니다.
Nippon Yakurigaku Zasshi. 2001 May;117(5):351-7. Related Articles, Links
[Pharmacological profile and clinical effect of tacrolimus ointment (Protopic ointment) for atopic dermatitis]
[Article in Japanese]
Hiroi J.
Scientific Advisory Staff, Research Division, Fujisawa Pharmaceutical Co. Ltd., 4-7, Doshomachi 3-Chome, Chuo-Ku, Osaka 541-8514, Japan. jun_hiroi@po.fujisawa.co.jp
Atopic dermatitis (AD) is thought to be induced by a complex of various allergic reactions and T cells are implicated in its etiology. Since tacrolimus strongly inhibits T cell activation, tacrolimus ointment has been developed as a novel drug for AD throughout the world. Tacrolimus inhibits mast cell and eosinophil activation and antigen presenting activity of Langerhans cells in vitro. In the in vivo experimental animal models of AD, such as contact and spontaneous dermatitis in mice and repeated hapten treated skin inflammation in rats, tacrolimus ointment showed inhibitory activity. In clinical studies with AD patients in Japan, USA and Europe, tacrolimus ointment showed a marked effect. In comparative studies in Japan, it showed the same efficacy as a strong class steroid ointment on eczema at the trunk and extremities and superior efficacy at the face and neck compared to a medium class steroid. The most prominent adverse event is experienced at the local application site with reactions such as a burning sensation and erythema. Systemic side effects were rarely observed. While there is a possibility of skin infections when using tacrolimus, skin atrophy, even after long term treatment, was not observed. Thus tacrolimus ointment could be an efficient alternative to steroid ointment for AD.
위 논문에서는 장기사용에도 불구하고 전신적인 부작용은 없다고 나와있네요.
피부에 있어서 스테로이드와 같은 atrophy 도 없다고 하구요.
겨우 언급된것이 작열감과 홍반정도네요.
얼굴과 목에 중간정도의 스테로이드보다 효과가 좋다는 언급이 있구요.
Semin Cutan Med Surg. 2001 Dec;20(4):250-9. Related Articles, Links
Tacrolimus clinical studies for atopic dermatitis and other conditions.
Bergman J, Rico MJ.
Division of Pediatric and Adolescent Dermatology, Children's Hospital, San Diego, CA, USA.
The first topical immunomodulator approved for human use, tacrolimus ointment (Protopic, Fujisawa, Healthcare, Inc, Deerfield, IL), has been shown to be effective and safe in the treatment of children (aged 2 years and older) and adults with atopic dermatitis (AD). Clinical trials conducted worldwide have involved 12,000 patients, with safety and efficacy data available for up to 3 years of treatment. In addition to its beneficial effects in the management of AD, topical tacrolimus has also been reported to be of benefit in other immunologically mediated skin diseases including: hand dermatitis, contact dermatitis, eyelid dermatitis, erosive lichen planus, steroid-induced rosacea, pyoderma gangrenosum, and graft-versus-host disease. This article reviews the clinical experience of topical tacrolimus in the treatment of AD and other skin conditions.
어린애를 포함한 12000명의 환자들에게 3년동안 사용후...
여기도 부작용에 관한 언급은 없죠??
Drug Ther Bull. 2002 Oct;40(10):73-5. Related Articles, Links
Topical [symbol: see text] tacrolimus--a role in atopic dermatitis?
[No authors listed]
Conventional treatment of atopic dermatitis includes the regular, frequent use of emollients, and intermittent application of topical corticosteroids to control acute 'flares'. [symbol: see text] Tacrolimus (pronounced ta-kro-li-mus), which is available for systemic use for the prevention of organ rejection following allogenic liver and kidney transplantation, is now formulated as an immunosuppressant ointment (Protopic-Fujisawa). This is licensed for use in adults and children aged 2 years and over with moderate to severe atopic dermatitis inadequately responsive to conventional therapy. Promotion states that, in these groups, tacrolimus is "at least as effective as topical steroids" and "without the potential side effects of conventional therapy". Here we consider the place of tacrolimus ointment in the management of atopic dermatitis.
여기도 없네요.. 어린애들한테 썼는데요..
J Dermatolog Treat. 2003 Jun;14(2):86-94. Related Articles, Links
Safe treatment of head/neck AD with tacrolimus ointment.
Kang S, Paller A, Soter N, Satoi Y, Rico MJ, Hanifin JM.
Department of Dermatology, University of Michigan Medical Center, 1618 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0314, USA. swkang@med.umich.edu
BACKGROUND: Atopic dermatitis(AD) with head and neck involvement is common and therapeutically challenging. METHODS: Efficacy and safety data specific to treatment of head/neck regions with tacrolimus ointment (Protopic) from three double-blind, randomized, vehicle-controlled studies are reported. A total of 631 adult and 352 pediatric patients with moderate to severe atopic dermatitis applied the vehicle, 0.03% or 0.1% tacrolimus ointment twice daily to affected areas for up to 12 weeks. RESULTS: Significant improvements from baseline to end of treatment for signs of atopic dermatitis (erythema, edema, excoriation, oozing, scaling, and lichenification) were noted for head/neck and non-head/neck areas treated with either 0.03% or 0.1% tacrolimus ointment (p<0.001). Within each treatment group, the overall 12-week adjusted incidence rate of application site adverse events was similar for both head/neck and non-head/neck areas. The incidence of common adverse events such as pruritus, "skin burning", erythema, infection, and skin tingling in head/neck areas was comparable to that observed in non-head/neck areas within each treatment group. The overall prevalence of application site adverse events decreased rapidly during the first few days of treatment. CONCLUSION: Tacrolimus ointment is a safe and effective treatment for atopic dermatitis on the head and neck.
여기도 얼굴과 목의 아토피에 효과적이고 안전하다는 이야기 밖에 없네요..
마지막으로..
Am Fam Physician. 2002 Nov 15;66(10):1899-902. Related Articles, Links
Comment in:
Am Fam Physician. 2003 May 1;67(9):1874.
Topical tacrolimus: a new therapy for atopic dermatitis.
Russell JJ.
Family Practice Residency Program, Abington Memorial Hospital, Abington, Pennsylvania, USA.
Atopic dermatitis is a common problem affecting up to 10 percent of all children. The mainstays of therapy have been oral antihistamines, topical emollients, topical doxepin, and topical corticosteroids. Side effects associated with higher potency topical corticosteroids have limited their use in children and for facial areas. Tacrolimus (Protopic) is an immunosuppressive agent typically used systemically in transplant patients. Used topically, it has been found to be effective in treating moderate to severe atopic dermatitis without causing the atrophy that might occur with prolonged use of topical corticosteroids. Tacrolimus works equally well in children and adults, with more than two thirds of both groups having an improvement of greater than 50 percent. Despite its potency, very little of the medication is systemically absorbed, and absorption decreases as the atopic dermatitis resolves. The main side effects are burning and itching, but these also decrease with improvement of the atopic dermatitis.
여기또한 안전하다고 나왔고..
주요한 부작용이... 작열감, 가려움인데...
이것또한 아토피 증상이 개선되면서... 덜해진다고 나와있네요..
프로토픽은 크게 걱정하지 않고 써도될듯합니다.
하지만 프로토픽역시..면역억제제로서의 피부를 관리해 나가는 기능입니다.
치료제로 보기에는....역시..부족하죠..
하지만...얼굴과 목이 아토피가 심하다면...관리 차원에서..도움이 많이 되겟죠??
* 아토피아님에 의해서 게시물 복사되었습니다 (2003-11-06 10:28)
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