RESUMEN
BACKGROUND: Obesity is associated with an increased risk of psoriasis. OBJECTIVE: In this study, we examined whether body mass index (BMI) is taken into account when choosing first-line biologic therapy for psoriasis. METHODS: In this cohort study, we compared obese (BMI ≥30 kg/m2) and non-obese patients for the first-line biologic therapy prescribed, its survival, reasons for discontinuation, therapy optimization, co-prescription of methotrexate and factors associated with long drug survival. RESULTS: A total of 931 patients were included: 594 (64%) were male, median age was 46 years (interquartile range 36-56). The most-prescribed biologic agents as first-line treatment were adalimumab (ADA; 42.7%), ustekinumab (UST; 29.9%) and etanercept (ETA; 22.9%); only frequency of infliximab (IFX) prescription differed between groups. Drug survival was significantly shorter for obese than non-obese patients (p < 2.10-4) and was worse for obese than non-obese patients for UST (p = 0.009) and ETA (p = 0.02), with no difference for ADA (p = 0.11). The main reason for discontinuation was primary inefficacy (62%), which was more frequent in obese than non-obese patients. The cumulative incidence of optimization did not significantly differ between the groups, except for ADA (SHR 1.91, 95% CI [1.23-2.96], p = 0.005). On multivariate analysis, risk of discontinuation was associated with only ETA as first-line biologic therapy (HR 1.51, 95% CI 1.04-2.19). CONCLUSION: This study highlighted the lack of difference in prescription of first-line biologic treatment, except for IFX, between obese and non-obese patients presenting moderate-to-severe psoriasis. Drug survival in obese patients is shorter, mainly because of inefficacy, than in non-obese patients. This highlights the need for targeted pharmacological studies in obese individuals to find optimal administration schemes.
Asunto(s)
Terapia Biológica , Fármacos Dermatológicos/uso terapéutico , Obesidad/complicaciones , Psoriasis/complicaciones , Psoriasis/tratamiento farmacológico , Adalimumab/uso terapéutico , Adulto , Anticuerpos Monoclonales Humanizados/uso terapéutico , Índice de Masa Corporal , Estudios de Cohortes , Etanercept/uso terapéutico , Femenino , Francia , Humanos , Infliximab/uso terapéutico , Masculino , Metotrexato/uso terapéutico , Persona de Mediana Edad , Selección de Paciente , Ustekinumab/uso terapéuticoAsunto(s)
Linfoma Cutáneo de Células T/terapia , Neoplasias Cutáneas/terapia , Antineoplásicos/uso terapéutico , Humanos , Antígeno Ki-1/metabolismo , Linfoma Cutáneo de Células T/inmunología , Linfoma Cutáneo de Células T/patología , Terapia PUVA , Fotoquimioterapia , Radioterapia Adyuvante , Neoplasias Cutáneas/inmunología , Neoplasias Cutáneas/patología , Organización Mundial de la SaludRESUMEN
Vaccine-induced cutaneous lymphoid hyperplasia (CLH) is rare. Its natural evolution is not well known, nor is its treatment. We report a case of B-cell CLH with secondary dissemination that occurred following vaccination. The symptoms lasted 12 years and were efficiently treated by thalidomide. A 17-year-old girl presented CLH which had begun at the age of 8 at the site of hepatitis B vaccination. The lesions progressively enlarged and disseminated far from the injection sites. There was no spontaneous remission. Cyclins and hydroxychloroquine were inefficient. Thalidomide treatment finally led to complete remission. Aluminium hydroxide is used as adjuvant in the majority of vaccinations. In this case, occurrence of lesions far from the injection site of the vaccine suggested that it was not the only cause and that CLH may occur in other localizations after a vaccination. Furthermore, the diagnosis of CLH should not be excluded in front of such a prolonged course, and we underline the potential efficacy of thalidomide.