使用Dupilumab是否能緩解兒童異位性皮膚炎所引起之皮膚症狀

Su-Ping Liao; Sheue-Fen Huang; Ciou-Syen Chen; Sin-Yi Lai

doi:10.6647/CN.202409_31(3).0007

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P29 - 44

医药卫生 > 预防保健与卫生学
医药卫生 > 社会医学

DOI： 10.6647/CN

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使用Dupilumab是否能缓解儿童异位性皮肤炎所引起之皮肤症状

The Effectiveness of Using Dupilumab to Relieve Skin Symptoms Caused by Atopic Dermatitis in Children

廖思苹(Su-Ping Liao) ；黄雪芬(Sheue-Fen Huang) ；陈秋雪(Ciou-Syen Chen) ；赖炘怡(Sin-Yi Lai)

彰化护理； 31 卷 3 期 (2024 / 09 / 01) ， P29 - 44

繁体中文;英文 DOI： 10.6647/CN.202409_31(3).0007

异位性皮肤炎；儿童； Dupilumab ； atopic dermatitis (AD) ； children ； dupilumab

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摘要 │ 参考文献 (8)

摘要〈TOP〉

并列摘要〈TOP〉

Ask an answerable question: Atopic dermatitis (AD) is a chronic inflammatory disease of the skin caused by genetic allergies and epidermal barrier defects. About 15~25% of children worldwide are affected, (Giavina-Bianchi & Giavina-Bianchi, 2021; Zhu, 2019; Liao, 2020). Different treatments are given according to the degrees of severity. The consensus of Taiwan Dermatology Association in 2020 on the treatment of atopic dermatitis recommends adding new biological agent therapy for moderate to severe patients with AD. The biological agent Dupilumab subcutaneous injection was approved by the National Health Insurance in February 2024 for those qualified candidates over 6 years old. About 50% of atopic dermatitis is diagnosed by the age of 1, and 85% is diagnosed by the age of 5 (Lin and Chen, 2024). Children who are under 6 years old, or over 6 years old but not qualified for health insurance benefits, must pay for the treatment by themselves. Biological agents are expensive and long-term treatment is a huge burden. Family members often have doubts about the effectiveness of this treatment. Therefore, the effectiveness of using the biological agent Dupilumab in relieving atopic dermatitis is empirically explored in this study. The Method and Analysis of Literature Review: Both Chinese and English keywords were used to search for MeSh terms by PubMed MeSH Databased (P: children with atopic dermatitis, I: use of Dupilumab, C: routine care, O: alleviating skin symptoms). Union and intersection of sets were conducted based on Bollinger logic through PubMed, CINAHL, and CEPS by setting Randomized Controlled Trial (RCT) and Meta- Analysis from 2018 to 2023. A total of 3 articles were obtained after excluding 5 duplicate articles and 22 incompatible articles. Critical Appraisal: The literature review was conducted based on the 2018 Randomized controlled trial version of the National Health Service (NHS) Critical Appraisal Skills Programme (CASP). According to the evidence level of the Oxford EBM Center (2011), the evidence level of these three articles is [Level 2]. Results, Conclusions and Recommendations: Based on the evidence, the experimental group, who received Dupilumab treatment for 12 weeks demonstrated significant differences in terms of the Eczema area, severity index, symptoms and life quality than those of the control group. As for the safety of using Dupilumab, those over 12 years old is the same as that for adults. For clients of 6-month-old to less 6-year-old, the safety of using Dupilumab is the same as older children and adults. Due to the high cost of biologics, patients who are not qualified for health insurance benefits are advised to pay for treatment by themselves, resulting in a heavy burden for the average family. It is recommended that financial issues should be included in medical consultation regarding to treatment plans.

参考文献 ( 8 ) 〈TOP〉

Giavina-Bianchi, M., & Giavina-Bianchi, P. (2021). Efficacy and Safety of Dupilumab in two adolescents with severe atopictitis. Einstein,19. https://doi.org/10.31744/einstein_journal/2021RC6064
连结：
Paller, A. S., Bansal, A., Simpson, E. L., Boguniewicz, M., Blauvelt, A., Siegfried, E. C., Guttman-Yassky, E., Hultsch, T., Chen, Z., Mina-Osorio, P., Lu, Y., Rossi, A. B., He, X., Kamal, M., Graham, N. M. H., Pirozzl, G., Ruddy, M., Eckert, L., & Gadkari, A. (2020). Clinically Meaningful Responses to Dupilimab in Adolescents with Uncontrolled Moderate-to-Severe Atopic Dermatitis: Post-hoc Analyses from a Randomized Clinical Trial. American Journal of Clinical Dermatology, 21(1), 119-131. https://doi.org/10.1007/s40257-019-00478-y
连结：
Paller, A. S., Siegfried, E. C., Thaci, D., Wollenberg, A., Cork, M. J., Arkwright, P. D., Gooderham, M., Beck, L. A., Boguniewicz, M., Sher, L., Weisman, J., O’Malley, J. T., Patel, N., Hardin, M. G., Graham, N. M. H., Ruddy, M., Sun, X., Davis, J. D., Kamal, M. A. P., … Shumel, B. (2020). Efficacy and safe of dupilumab with concomitant topical corticosteroids in children 6 to 11 years old with sever atopic dermatitis: A randomized, double-blinded, placebo-controlled phase 3 trial. Journal of the American Academy of Dermatology, 83(5), 1282-1293. https://doi.org/10.1016/j.jaad.2020.06.054
连结：
Paller, A. S., Simpson, E. L., Siegfried, E. C., Cork, M., Wollenberg, A., Arkwright, P. D., Schneider, W. S., Sidbury, R., Lockshin, B., Meltzer, S., Wang, Z., Mannent, L. P., Akinlade, N. A., Dillion, M., Kosloski, M. P., Kamal, M. A., Dubost-Brama, A., Patel, N., Yancopoulos, D. G. D., … Bansal, A. (2022). Dupilumab in children aged 6 months to younger than 6 years with uncontrolled atopic dermatitis: a randomised, double-blind, placebo-controlled, phase 3 trial. The Lancet, 400(10356), 908-919. https://doi.org/10.1016/S0140-6736(22)01539-2
连结：
朱家瑜(2019)．异位性皮肤炎的生物制剂治疗．健康世界，507，18-25。

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