ABSTRACT
BACKGROUND: Three biotherapies - etanercept, adalimumab and ustekinumab - are licensed in childhood psoriasis. The few data available on their efficacy and tolerance are mainly derived from industry trials. However, biological drug survival impacts long-term performance in real-life settings. OBJECTIVE: The objective of this study was to evaluate the survival rates of biological therapies in children with psoriasis in real-life conditions. Secondary objectives were to evaluate the factors associated with the choice of the biological therapy and to report severe adverse events. MATERIALS AND METHODS: This study was an observational retrospective study. Data were extracted from the clinical records of 134 children. Kaplan-Meier estimates were used to analyse drug survival overall and in subgroups of plaque psoriasis, bio-naïve and non-naïve patients. RESULTS: We analysed 184 treatment courses: 70 with etanercept, 68 with adalimumab and 46 with ustekinumab. Factors associated with the choice of first-line biological agent were age at initiation (younger for adalimumab, P < 0.0001), age at onset of psoriasis (younger for adalimumab and etanercept, P = 0.03) and baseline Psoriasis Assessment Severity Index and Physician global assessment (both higher for adalimumab, P < 0.001). Drug survival rates were higher for ustekinumab than for adalimumab and etanercept (P < 0.0001) for all treatment and all psoriasis types, plaque-type psoriasis (P = 0.0003), patients naïve for biological agents (P = 0.0007) and non-naïve patients (P = 0.007). We reported eight serious adverse events (SAEs): severe infections (n = 3), significant weight gain (n = 2), psoriasis flare (n = 1) and malaise (n = 1). Biological therapy was discontinued in three children (one with psoriasis flare and two with weight gain). Only the two cases of weight gain resulted in an unfavourable outcome. CONCLUSIONS: Our real-life comparative study found that ustekinumab had the best drug survival outcome. The profile of SAEs in children was comparable to that in adults. These results will assist dermatologists in the decision-making process when choosing treatment options for children with psoriasis in daily practice.
Subject(s)
Adalimumab/therapeutic use , Dermatologic Agents/therapeutic use , Etanercept/therapeutic use , Psoriasis/drug therapy , Ustekinumab/therapeutic use , Adalimumab/adverse effects , Adolescent , Age Factors , Biological Products/therapeutic use , Child , Clinical Decision-Making , Dermatologic Agents/adverse effects , Etanercept/adverse effects , Female , Humans , Kaplan-Meier Estimate , Male , Medication Adherence , Retrospective Studies , Severity of Illness Index , Ustekinumab/adverse effectsABSTRACT
Growers in 45% (44,100 ha) of the citrus acreage in California stopped eradicating Citrus tristeza virus (CTV)-infected trees from their fields in 1995-96. The impact of leaving infected trees on the rate of CTV spread was determined by comparing temporal incidence of CTV in plots in Strathmore, Tulare County without eradication with incidence in a plot in McFarland, Kern County with eradication. From 1997 to 2003, CTV incidence in the Strathmore plots ranged from 6 to 42%, with annual spread rates from 1.6 to 3.6%. CTV incidence in the McFarland plot increased from 0 to 5% between 2001 and 2003 before infected trees were removed. Using a subplot hierarchical bulk sampling method, virus incidence over a 3-year period in a 6.5 km2 area near McFarland was estimated to range from 0.09 to 0.69%, which indicated that CTV suppression was still being achieved in this area. Vector tests using the cotton aphid, Aphis gossypii, identified highly transmissible isolates (30 to 61% transmission rate) and a larger proportion of highly transmissible isolates were found in the McFarland plots. Thirty-six CTV isolates from recently infected plot trees were obtained and analyzed. None of these isolates reacted with monoclonal antibody MCA13 that detects presumptive CTV severe strains. Molecular analysis using polymerase chain reaction and sequence-specific primers showed that all isolates had a genotype identical to the T30 mild isolate from Florida.
ABSTRACT
The automatic implantable cardioverter defibrillatory (AICD) is becoming the treatment of choice for patients with ventricular tachycardia and ventricular fibrillation. The widespread use of the AICD is requiring nurses in a variety of settings to become familiar with the device and device-patient interactions. This article attempts to define specific issues and nursing interventions relative to the AICD.