Under the epidemic, most people "slowed down" at home, and Deputy Dean of Shanghai Dermatology Hospital and director of the Psoriasis Research Institute of Tongji University School of Medicine Professor Shi Yuling and the team "run". "We use doctors to prescribe online, cold chain transportation , or allow patients who can prescribe home certificates to go to the hospital to dispense medicine. The related drug services are more convenient, and we try every means to continue the treatment of patients, so as not to interrupt, so as to avoid recurrence of the disease." Professor Shi Yuling said.
The fierce Omickron is a challenge for patients with chronic diseases, in addition to fighting the epidemic, their own disease management has also added challenges. Can patients with psoriasis receive the new crown vaccine ? What are the exciting progress in the field of psoriasis treatment? Are the latest biologics suitable for everyone? Professor Shi Yuling gave a detailed explanation on the concerns of patients.
20年，11个新药，疗效飞跃进展
电线杆上的牛皮癣曾是大众对银屑病的传统印象，如今，这类广告在大城市基本不见踪影。 What is the progress of psoriasis treatment? "Psoriasis is a major disease among all skin diseases, and it is also the fastest treatment and the most drug choices. The efficacy has made leaps and progress." Shi Yuling happily told reporters that in the past 10 years, especially in all skin disease treatment areas in China, psoriasis diagnosis and treatment are the fastest-developing disease. Among them, the continuous emergence of innovative drugs is an important reason.
"Due to the continuous progress of basic research on psoriasis around the world, we have gained a very deep understanding of the pathogenesis of psoriasis, especially immunology, and found important inflammatory factors related to the onset of psoriasis, such as interleukin 17a, TNF-α, and interleukin 23. These inflammatory factors have played an important role in the onset of psoriasis." Shi Yuling said that after the advent of targeted innovative drugs, they have brought about therapeutic effects that are incomparable to traditional system treatments.
The world's first psoriatic biological agent was launched in 2004, and 11 innovative biological agents have been born in the past 20 years. Especially in 2019, the emergence of innovative drugs related to interleukin 17a inhibitors has brought psoriasis treatment into a new era. Because after these innovative drugs treatments, the response rates of PASI90 and PASI100 in patients are much better than those of previous biological agents, which has increased the treatment target of psoriasis from the original PASI75 response rate to PASI90 or even 100. That is to say, for patients, 90% lesions clearance or 100% lesions clearance.
Shanghai Dermatology Psoriasis Diagnosis and Treatment Center is also the Psoriasis Clinical Research Center of Tongji University . There is nearly 10,000 outpatient clinics here every year, and Shi Yuling has witnessed the most benefits of patients. "Taking the interleukin 17a inhibitor represented by echizumab as an example, many patients used it when other traditional drugs were ineffective. The results tell us: Over the years, we can finally wear shorts and short-sleeved shirts. Some patients received the first injection and received a follow-up visit of nearly 50%, and the onset speed was very fast." Shi Yuling said that for patients, there are two main demands: one is that the treatment takes effect quickly, and the other is that the removal of skin lesions is high. The emergence of biological agents has met the patient's demands very well. For dermatologists, especially specialized doctors who study and treat psoriasis, it is very happy to see the patient reborn and truly achieve the removal of skin lesions.
Good medicine + medical insurance benefit the people, the burden on patients has further decreased
Also excited Shi Yuling is that in China, in the past five years, biological agents have gradually entered the medical insurance negotiation catalog, and the people can "use it and afford it."
"Always take echizumab as an example. It was approved for marketing in 2019. In January this year, with the implementation of the new medical insurance negotiation catalog, it has been included in the medical insurance, and the price of drugs has dropped further significantly. One dose of 1,218 yuan is absolutely good news for patients, and the accessibility of drugs is getting higher and higher." Shi Yuling said that behind this, my country's drug supervision department and medical insurance department have done a lot of work on the accessibility of innovative drugs for ordinary people. Most biological agents have just been approved for overseas approval and can be approved for marketing in China in one or two years. After it is launched, they soon entered medical insurance.
drugs are getting cheaper and cheaper, and they enter medical insurance, and the cost is reduced. Good medicines are used, and the treatment can be continued and the condition can be controlled for a long time. Shi Yuling smiled and said that now is a very happy era for patients with psoriasis.
Psoriasis patients can get the COVID-19 vaccine in the stable period
Of course, biological agents are not suitable for all patients. Shi Yuling analyzed that in the Chinese psoriasis treatment guide he participated in the preparation, it was particularly mentioned that the types suitable for biological treatment are moderate to severe plaque psoriasis, as well as heavy types such as pustule psoriasis, articular psoriasis, erythroderma psoriasis . For mild and moderate psoriasis patients, topical medication and phototherapy are recommended. "Biologic agents are similar to the top of the pyramid for psoriasis treatment. For mild and medium-sized psoriasis, we still focus on the bottom of the tower - topical drugs and phototherapy treatment." Shi Yuling emphasized that we must grasp the indications for the use of biologic agents, rather than just using them as soon as we diagnose them.
During the epidemic, Shi Yuling and her team did a lot of work to ensure that patients’ treatment is not interrupted. Regarding whether psoriasis patients asked by a large number of patients can receive the COVID-19 vaccine, Shi Yuling said that based on clinical experience, literature and corresponding discussions in the guidelines, experts generally believe that vaccines have an important role in preventing severe COVID-19 for patients with psoriasis in the stable stage. It is recommended to get the COVID-19 vaccine during the interval between the biologics. For example, echilizumab is given every four weeks during the maintenance treatment stage. It is recommended to get the COVID-19 vaccine two weeks after the previous dose, or echilizumab again after the other two weeks. During this period, you can make an appointment to get the COVID-19 vaccine. However, if the disease is in the progressive stage and is very serious, it is recommended to wait until the condition is stable before vaccination.
Regarding home care during the epidemic, Shi Yuling said that for psoriasis, the most important skin care is whole body moisturizing. The main clinical manifestations of psoriasis are papules or plaques, so a large amount of scales will occur every day. If you take a bath every day, you can choose to shower and apply moisturizing cream after showering. The water temperature is recommended to be below 40 degrees Celsius. If you do basic skin care, the incidence of psoriasis will be mild, the recurrence interval will be longer and the chance of recurrence will be low.
It should be noted that there will be sporadic occurrences during the use of biological agents, because biological agents cannot achieve a 100% complete regression effect. It is normal to emit a few rashes. At this time, you should actively use ointments on topical surfaces. Topical drugs are throughout the treatment of psoriasis. In addition, it is recommended that patients maintain a happy mood and exercise appropriately, which will help maintain a better condition.
Author: Tang Wenjia
Editor: Jiang Peng
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