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Effektivitet av tacrolimus jämfört med konventionell behandling vid atopisk dermatit hos vuxna och barn
Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
2016 (Swedish)Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
Abstract [sv]

Bakgrund: Atopisk dermatit (AD) är en kronisk inflammatorisk återkommande hudsjukdom som karaktäriseras av torr hud och klåda. Glukokortikoider utgör grundbehandlingen av AD men har, vid långtidsanvändning, visat sig ge biverkningar som bl a irreversibel hudatrofi. I andrahand rekommenderas nya generationens topikala immunsuppressiva läkemedel, innehållande tacrolimus eller pimecrolimus.

Syfte: Arbetet utfördes i syfte att utvärdera tacrolimus effektivitet i behandlingen av AD hos vuxna och barn, jämfört med konventionell behandling.

Metod och material: Arbetet utfördes som en litteraturstudie där fem kliniska studier hämtade från databasen PubMed analyserades. Fyra kliniska studier jämförde tacrolimus med glukokortikoider hos vuxna eller barn, en klinisk studie jämförde tacrolimus med pimecrolimus hos vuxna.

Resultat: Det gemensamma effektmåttet EASI eller den utökade versionen mEASI, tillämpades i samtliga studier. Verktyget används för att bedöma AD utbredning och svårighetsgrad. Resultatet visade att tacrolimus 0,03 % var signifikant effektivare än hydrokortisonacetat 1 % och likvärdig metylprednisolon aceponat 0,1 %. Tacrolimus 0,1 % visade sig vara signifikant effektivare än hydrokortisonbutyrat 0,1 %, pimecrolimus 1 % samt tacrolimus 0,03 %. Resultatet visade även att biverkningarna klåda och brännande känsla i huden på applikationsområdet förekom bland fler patienter behandlade med tacrolimus.

Slutsats: Tacrolimus är ett effektivt läkemedel att använda som andrahandspreparat i behandlingen av AD vid ökad risk för biverkningar från glukokortikoider.

Abstract [en]

Atopic dermatitis (AD) also known as eczema, is a chronic inflammatory skin disease, characterized by dry skin, itching and erythema. The prevalence of AD has been estimated between 10-20 % in children and 1-3 % in adults.

 In the early 1950s the anti-inflammatory group of drugs, topical glucocorticoids, were developed and have since been established as the golden standard for the treatment of AD. Long-term use of these drugs can lead to some serious side effects like chronic skin thinning. This has led to the development of new anti-inflammatory drugs, so called topical immunomodulators, containing the substances tacrolimus or pimecrolimus. Unlike topical glucocorticoids these drugs do not affect the collagen synthesis, and therefore do not cause any skin thinning.

Tacrolimus is also a commonly used substance in drugs intended to reduce the activation of the immune system after organ transplantation. Long-term studies in this field have shown an increased risk of developing lymfoma and skin cancer. Because of the still unknown risk for topical use, the federal agency U.S. Food and Drug Administration (FDA) added a “black box” warning to its label. Therefore, tacrolimus has not replaced glucocorticoids as a first-line treatment of AD.

This study analyzed a total of five clinical trials from the PubMed database, to examine tacrolimus efficacy and safety for short-term treatment. Four of these clinical trials compared tacrolimus with glucocoticoids in both adults and children. One of the clinical trials compared tacrolimus and pimecrolimus in adults. The results show that tacrolimus is at least equivalent or more effective than glucocorticoids and pimecrolimus, but it induces more short-term side effects like skin burning and intense itching on the treated area. In summary, tacrolimus is an effective drug to use in the short-term treatment of AD in both children and adults. Future long-term studies have to be made to evaluate the safety concern of cancer development. 

Place, publisher, year, edition, pages
2016. , 28 p.
Keyword [sv]
Protopic, Tacrolimus, Atopisk dermatit, Eksem
National Category
Natural Sciences Medical and Health Sciences
Identifiers
URN: urn:nbn:se:lnu:diva-53281OAI: oai:DiVA.org:lnu-53281DiVA: diva2:935161
Subject / course
Pharmacy
Educational program
Bachelor of Science Programme in Pharmacy, 180 credits
Supervisors
Examiners
Available from: 2016-06-10 Created: 2016-06-10 Last updated: 2016-06-10Bibliographically approved

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