RESUMEN
Background: Psoriatic disease, a chronic immune-mediated systemic inflammatory condition, significantly impairs patients' quality of life. The advent of highly targeted biological therapies has transformed treatment strategies, emphasizing the importance of selecting the most effective and cost-efficient option. Secukinumab, an IL-17A inhibitor, has demonstrated efficacy and safety in treating moderate-to-severe plaque psoriasis (PsO). However, long-term real-world data on its effectiveness and persistence rate are limited. Methods: This retrospective study, conducted across eight Italian dermatology centers, aimed to evaluate the 6-year persistence rate and effectiveness of secukinumab in patients with PsO. Additionally, the study investigated the onset of psoriatic arthritis during treatment. Results: Overall, 166 adult patients were analyzed. Their median age was 53.9 years. The mean BMI was 26.5. Of the 166 patients, 64 were bio-experienced while 102 were bio-naïve. A progressive reduction in PsO severity measured by PASI scores over 6 years of treatment was revealed: the PASI score decreased from a baseline value of 18.1 (±9.1) to 0.7 (±1.6) after 6 years of follow-up. Adverse events, including mucocutaneous fungal infections and cardiovascular disturbances, were reported in 19.9% of patients. The persistence rate was 86.8% at 24 months, decreasing to 66.4% at 72 months. Psoriatic arthritis onset during treatment was observed in 15 (9.0%) of patients. Conclusions: This study highlights the sustained effectiveness and favorable safety profile of secukinumab over 6 years, providing valuable real-world evidence. Understanding the long-term persistence rate and predictors of discontinuation could help clinicians optimize treatment decisions and improve patient outcomes in PsO management. We found that the absence of scalp PsO, no involvement of the genital area and normal weight were the best factors of persistence in secukinumab treatment in the long term.
RESUMEN
Derived inflammatory indexes from routine hematological parameters might be useful for predicting early-response vs. late/non-response to dupilumab, the first biological agent approved for moderate-to-severe atopic dermatitis (AD). We tested this hypothesis by retrospectively investigating the association between pre-specified baseline inflammatory indexes and dupilumab response (≥50% reduction in the Eczema Area and Severity Index, EASI 50) at 4 and 16 weeks in a consecutive series of 66 AD patients (38 males and 28 females). Forty-six patients (69.7%) were early-responders at 4 weeks, whereas the remaining twenty (30.3%) were late/non-responders at 16 weeks. In logistic regression, the platelet-to-lymphocyte ratio (PLR) was independently associated with early-response (OR = 1.0159, 95% CI 1.0005 to 1.0315, p = 0.0426). The predictive performance of PLR and other derived indexes towards early-response was further improved by their combination with serum IgE concentrations, with a maximum AUC value for the combined systemic immune inflammation index (SII)-IgE of 0.797 (95% CI = 0.677 to 0.884, p < 0.0001). Derived inflammatory indexes, particularly SII-IgE, might be useful to identify early-responders to dupilumab and develop alternative treatment protocols for late/non-responders.
RESUMEN
Health care spending in Italy is high and continues to increase; assessing the long-term health and economic outcomes of new therapies is essential. Atopic dermatitis (AD) is a chronic, pruritic, immune-mediated inflammatory dermatosis, a clinical condition that significantly affects patients' quality of life at a high cost and requires continuous care. This retrospective study aimed to assess the direct cost and adverse drug reactions (ADRs) of Dupilumab and patients' clinical outcomes. All AD patients treated with Dupilumab at the Sassari University Hospital, Italy, between January 2019 and December 2021 were included. Eczema Area Severity Index, Dermatology Life Quality Index, and Itch Numeric Rating Scale scores were measured. ADRs and drug expenses were analyzed. A statistically significant posttreatment improvement was observed for all the indices measured: EASI (P < 0.0001), DLQI (P < 0.0001), NRS (P < 0.0001). The total expenditure for Dupilumab, in the observed period, amounted to 589.748,66 for 1358 doses, and a positive correlation was shown between annual expenditure and delta percentage of variation pre- and posttreatment for the clinical parameters evaluated.
Asunto(s)
Araña Reclusa Parda , Enfermedades de la Piel/diagnóstico , Picaduras de Arañas/diagnóstico , Adulto , Amoxicilina/uso terapéutico , Animales , Antibacterianos/uso terapéutico , Betametasona/uso terapéutico , Ácido Clavulánico/uso terapéutico , Quimioterapia Combinada , Femenino , Gentamicinas/uso terapéutico , Glucocorticoides/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades de la Piel/patología , Picaduras de Arañas/tratamiento farmacológico , Picaduras de Arañas/patologíaAsunto(s)
Productos Biológicos/efectos adversos , COVID-19/epidemiología , Dermatitis Atópica/tratamiento farmacológico , Hidradenitis Supurativa/tratamiento farmacológico , Psoriasis/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/diagnóstico , COVID-19/inmunología , COVID-19/prevención & control , Comorbilidad , Factores de Confusión Epidemiológicos , Dermatitis Atópica/diagnóstico , Dermatitis Atópica/epidemiología , Dermatitis Atópica/inmunología , Femenino , Hidradenitis Supurativa/epidemiología , Hidradenitis Supurativa/inmunología , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Psoriasis/diagnóstico , Psoriasis/epidemiología , Psoriasis/inmunología , SARS-CoV-2/inmunología , SARS-CoV-2/aislamiento & purificación , Índice de Severidad de la Enfermedad , Adulto JovenAsunto(s)
Ganglios Linfáticos/microbiología , Linfadenitis/diagnóstico , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Cutánea/diagnóstico , Adulto , Biopsia , Femenino , Humanos , Italia , Ganglios Linfáticos/patología , Linfadenitis/microbiología , Linfadenitis/patología , Piel/patología , Prueba de Tuberculina , Tuberculosis Cutánea/microbiología , Tuberculosis Cutánea/patologíaRESUMEN
Antiphospholipid syndrome (APS) is an autoimmune thrombophilic condition characterized by the onset of venous and/or arterial thrombosis, often multiple, and pregnancy morbidity in a background of antiphospholipid antibodies (aPL) positivity. Some patients can be carrier of aPL with no clinical symptoms, in other cases clinical manifestation can range from the classical presentation to an acute life-threatening condition named catastrophic APS. APS can be considered as primary or associated to other disease, however pregnancy acts as a triggering factor on a susceptible background that lead to the clinical manifestations through immunological and non-immunological mechanism. APS is characterized by thrombotic manifestation involving both venous and arterial vessels of different size, in any part of the body the clinical presentation can be extremely polymorphic. Livedo reticularis is the most common cutaneous finding, however it is not specific for APS and other cutaneous manifestation such as ulcers or purpura can be the only presentation of APS. Diagnosis is established by clinical and laboratory criteria. Counselling, pregnancy plan and monitoring during pregnancy is mandatory in APS patients. Treatment can be challenging, and it is mainly based on the use of anticoagulant and antiaggregant medications. A literature review on PubMed about APS and pregnancy was performed, and the significant information in conjunction with our clinical experience lead to the drafting of this paper. We present a review of APS and its management in pregnancy, with a special focus on the dermatological presentation and the role of the dermatologists in diagnosing and managing this potential life-threatening condition.
Asunto(s)
Anticuerpos Antifosfolípidos/inmunología , Síndrome Antifosfolípido/terapia , Complicaciones del Embarazo/terapia , Síndrome Antifosfolípido/diagnóstico , Síndrome Antifosfolípido/fisiopatología , Femenino , Humanos , Livedo Reticularis/etiología , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/fisiopatología , Trombosis/etiologíaRESUMEN
Alternaria spp may cause opportunistic mycoses in the skin after cutaneous inoculation or through blood dissemination in immune-suppressed patients. Here, we describe a case of cutaneous infection with Alternaria spp in a 62-year-old man, presenting with multifocal papules and erythematous nodules involving distal limbs bilaterally. The absence of inflammatory bowel disease was confirmed by a gastroenterologist. The patient was under treatment for uveitis of unknown origin with immunosuppressive doses of cyclosporin and prednisolone for approximately 3 months. The diagnosis was based on clinical signs, demonstration of fungal elements in skin biopsies and deep fungal culture. Complete clinical remission was achieved by oral and systemic treatment with antifungal drugs. However, because cessation of the immunosuppressive medication was not possible, his clinical history was characterised by multiple flares requiring each time oral and intravenous antifungal treatment.
Asunto(s)
Alternaria/aislamiento & purificación , Alternariosis/diagnóstico , Terapia de Inmunosupresión , Administración Oral , Alternariosis/tratamiento farmacológico , Alternariosis/etiología , Alternariosis/patología , Antifúngicos/administración & dosificación , Antifúngicos/uso terapéutico , Diagnóstico Diferencial , Humanos , Enfermedad Iatrogénica , Infusiones Intravenosas , Masculino , Persona de Mediana EdadRESUMEN
Pulmonary and extra-pulmonary diseases caused by nontuberculous mycobacteria: new clinical and public health threats http://ow.ly/87Dm30eMFd9.