RESUMEN
The aim of the study was to assess the long-term effectiveness and safety of secukinumab in Spanish patients with moderate-to-severe psoriasis in a daily practice setting. Nationwide multicenter, observational, retrospective, non-interventional, single-cohort study including patients who initiated treatment with secukinumab in daily clinical practice conditions. Subjects were followed for a minimum of 3 months and a maximum of 24 months. Psoriasis Area Severity Index (PASI), Body Surface Area and Physician's Global Assessments were collected at baseline and months 3, 6, 12, 18 and 24 during treatment. Adverse events and reasons for secukinumab withdrawal were collected and classified for analyses. A total of 384 patients were enrolled in the study. Median PASI declined rapidly from 14.3 at baseline to 2.7 at month 3, 2.1 at month 12, and remained low (2.8) at month 24. Within the group of patients with PASI ≥10 at baseline (n = 278), 58.3%, 60.4% and 56.5% achieved a PASI90 response at months 3, 12 and 24, respectively. As for absolute PASI, 86.5%, 69.5%, 42.7% and 37% achieved PASI <5, < 3, < 1 and 0, respectively, at month 3. Secukinumab was more effective in biologic-naïve patients and in those with lower Body Mass Index. Secukinumab presented a good long-term safety profile. Secukinumab was effective and safe in a routine clinical setting, in a large cohort of patients with moderate-to-severe plaque psoriasis, in the short-, medium- and long-term (up to 24 months).
Asunto(s)
Anticuerpos Monoclonales , Psoriasis , Humanos , Estudios Retrospectivos , Estudios de Cohortes , Anticuerpos Monoclonales/efectos adversos , Resultado del Tratamiento , Psoriasis/diagnóstico , Psoriasis/tratamiento farmacológico , Psoriasis/inducido químicamente , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Limited information is available regarding the risk of incident liver disease in patients with psoriasis receiving systemic therapies. OBJECTIVES: To describe the liver safety findings of conventional and modern systemic therapies for moderate-to-severe psoriasis, and to compare the relative incidence rates of hepatic adverse events (AEs) for each drug. METHODS: All the patients on the BIOBADADERM registry were included. Crude and adjusted incidence rate ratios (cIRR and aIRR, respectively) of hepatic AEs, using anti-TNF drugs as reference, were determined. Outcomes of interest were hypertransaminasemia, nonalcoholic fatty liver disease (NADFLD) and a group of other, less represented, hepatic AEs. RESULTS: Our study included 3,171 patients exposed to systemic drugs (6279 treatment cycles). Incident hypertransaminasemia was the most frequent hepatic AE (incidence rate of 21 per 1000 patients-years [CI 95% 18-23]), followed by NAFLD (8 cases per 1000 patients-years [95% CI 6-10]). Methotrexate (aIRR 3.06 [2.31-4.4]; p = 0.000) and cyclosporine (aIRR 2.37 [1.05-5.35]; p = .0378) were associated with an increased risk for hypertransaminasemia when compared to anti-TNF-α agents. No differences were observed between different groups of biologics. Conventional therapies were not associated with new incident NAFLD. CONCLUSIONS: Comparative information of the incidence of hepatic AEs could facilitate drug selection in moderate-to-severe psoriasis.
Asunto(s)
Enfermedad del Hígado Graso no Alcohólico , Psoriasis , Humanos , Enfermedad del Hígado Graso no Alcohólico/inducido químicamente , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Estudios Prospectivos , Psoriasis/tratamiento farmacológico , Sistema de Registros , Inhibidores del Factor de Necrosis TumoralAsunto(s)
Escabiosis/diagnóstico , Escabiosis/terapia , Dermoscopía , Humanos , Microscopía ConfocalRESUMEN
BACKGROUND: There is no consensus on the imaging tests that should be performed at the initial staging of melanoma patients. OBJECTIVE: To evaluate the diagnostic accuracy of 4 imaging studies for the initial staging of melanoma patients. METHODS: Cross-sectional study with prospectively collected data, from January 2011 to April 2017, including patients with clinical stage T2b to T4b according to 2009 American Joint Committee on Cancer, without evidence of metastasis. RESULTS: Initial staging of 308 patients detected 16.6% of metastases and 5.8% false-positive results, overall. Regional lymph node ultrasonography showed a metastasis detection rate (MDR) of 12.8%, false-positive rate of 0.8%, and accuracy of 96.0%. Computed tomography (CT) and positron emission tomography-CT had the highest detection rates at stage T4b: MDR, 13.3%; false-positive rate, 8.9%; accuracy, 91.1%; and MDR, 6.9%; false-positive rate, 0%; and accuracy, 93.1%, respectively. Brain magnetic resonance imaging showed a MDR of 2.0% in T4b. LIMITATIONS: Single-center study. CONCLUSION: Performing ultrasound scans for assessing lymph node metastasis in patients with American Joint Committee on Cancer T2b stage and above is advisable. In patients with stage T4b, CT or positron emission tomography-CT are suitable for the detection of metastasis. Brain magnetic resonance imaging at T4b deserves further discussion, considering the ultimate clinical benefit in management and therapeutic options for asymptomatic patients.
Asunto(s)
Biomarcadores de Tumor/sangre , Ganglios Linfáticos/patología , Melanoma/diagnóstico por imagen , Melanoma/patología , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/patología , Centros Médicos Académicos , Adulto , Anciano , Estudios Transversales , Reacciones Falso Positivas , Femenino , Humanos , Ganglios Linfáticos/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica/patología , Metástasis de la Neoplasia/diagnóstico por imagen , Metástasis de la Neoplasia/patología , Estadificación de Neoplasias , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Sensibilidad y Especificidad , España , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía Doppler/métodosAsunto(s)
Naltrexona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Pénfigo Familiar Benigno/tratamiento farmacológico , Adulto , Anciano , Superficie Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Naltrexona/administración & dosificación , Antagonistas de Narcóticos/administración & dosificación , Calidad de Vida , RetratamientoRESUMEN
Oropharyngeal lymphogranuloma venereum (LGV) is an uncommon presentation and mainly consists of either asymptomatic infections or enlarged cervical lymphadenopathy. According to cross-sectional studies, the prevalence of pharyngeal LGV among men who have sex with men (MSM) seems to be very low. Tissue tropism could explain the difference between rectal and oral mucosa infection frequencies. This paper reports the singular case of an oral ulcer caused by LGV in an MSM who had also an asymptomatic rectal infection. Given the increasing number of cases of LGV, unusual presentations such as oral ulceration may be seen more frequently.