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o 150<span class="elsevierStyleHsp" style=""></span>mg &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>46 pacientes&#41; de secukinumab en las semanas 0-5 y&#44; posteriormente&#44; cada 4 semanas seg&#250;n el criterio del facultativo prescriptor&#46; La posolog&#237;a con 150<span class="elsevierStyleHsp" style=""></span>mg no se utiliz&#243; en pacientes con artropat&#237;a psori&#225;sica exclusivamente&#46; La dosis utilizada en estos casos fue pautada por cada facultativo seg&#250;n las caracter&#237;sticas basales del paciente&#46; Se recogieron las variables demogr&#225;ficas &#40;edad&#44; sexo&#44; tiempo de evoluci&#243;n de psoriasis e &#237;ndices antropom&#233;tricos-peso y talla&#41; y comorbilidades &#40;artritis psori&#225;sica&#44; diabetes mellitus&#44; hipertensi&#243;n&#44; dislipemia&#44; depresi&#243;n&#44; h&#237;gado graso&#44; neoplasias y eventos cardiovasculares mayores&#41;&#46; La evaluaci&#243;n de la supervivencia se determin&#243; con un an&#225;lisis de supervivencia Kaplan-Meier utilizando el paquete estad&#237;stico SSPS&#174; versi&#243;n 25&#46; Se defini&#243; paciente censurado &#40;activo&#41; aquellos pacientes que contin&#250;an el tratamiento y paciente no censurado &#40;evento&#41; aquellos que interrumpen el tratamiento por cualquier causa &#40;p&#233;rdida de eficacia &#91;fallo primario&#44; si el paciente no ha alcanzado al menos PASI75&#44; y fallo secundario&#44; si el paciente a pesar de una respuesta inicial superior a PASI75 pierde esta&#93;&#44; acontecimientos adversos&#44; p&#233;rdida en seguimiento o decisi&#243;n propia del paciente por mejor&#237;a de la enfermedad&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Este se ha realizado con ambas dosis de forma conjunta y tambi&#233;n por separado&#46; Para ver si hay diferencias en el tiempo de supervivencia entre ambas dosis se ha realizado la prueba de contraste de los rangos logar&#237;tmicos &#40;Chi-cuadrado modificado&#41; para calcular la significaci&#243;n estad&#237;stica de la prueba&#46; Si el valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 podemos afirmar con un 95&#37; de confianza que s&#237; hay diferencias estad&#237;sticamente significativas en el tiempo de supervivencia entre ambas dosis&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Previamente se realizaron las pruebas de independencia para ver la asociaci&#243;n entre las variables&#44; las dosis&#44; el estado y el n&#250;mero de semanas&#46; En la prueba de la Chi-cuadrado para ver la independencia entre dosis&#47;estado se obtuvo un valor &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;323&#59; Z<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;976&#41; y en las pruebas de Mann-Whitney para la independencia entre el n&#250;mero de semanas con la variable dosis y estado se obtiene &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#59; U<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1603&#44;5&#41;&#44; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;046&#59; U<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1236&#44;5&#41;&#44; respectivamente&#46; Posteriormente&#44; se realiz&#243; tambi&#233;n una regresi&#243;n log&#237;stica binaria considerando la variable estado como dependiente y n&#250;mero de semanas y dosis como independientes&#46; En la regresi&#243;n se obtuvo en porcentaje global de predicci&#243;n del 87&#44;1 siendo este porcentaje del 100&#37; en el grupo de no suspensi&#243;n&#44; tambi&#233;n se obtuvo significaci&#243;n estad&#237;stica en la prueba &#243;mnibus &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41; y en el test de Wald &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;000&#41; por lo que las variables dosis y n&#250;mero de semanas son buenos predictores para la variable estado&#46; Adem&#225;s&#44; se obtuvieron un R-cuadrado de Cox y Snell &#40;0&#44;505&#41; y un R-cuadrado de&#160;Nagelkerke &#40;0&#44;602&#41; que indican la parte de la varianza de la variable dependiente&#160;explicada por el modelo&#44; en este caso oscilar&#237;a entre el 50&#44;5 y el 60&#44;2&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas cl&#237;nicas y demogr&#225;ficas de los pacientes quedan reflejadas en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Tras una mediana de seguimiento de 123 semanas&#44; 22 &#40;13&#37;&#41; pacientes tuvieron que suspender el f&#225;rmaco debido a p&#233;rdidas de eficacia &#40;fallo 1&#46;&#176; o 2&#46;&#176;&#44; acontecimientos adversos o p&#233;rdida en seguimiento&#41;&#46; Las principales interrupciones se producen entre la semana 24 y 52&#44; no registr&#225;ndose ninguna a partir de la semana 104&#44; 128 y 150 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> y <a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">La supervivencia estimada hasta la suspensi&#243;n del f&#225;rmaco fue del 87&#37; a 132 semanas&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La comparaci&#243;n entre las dosis pautadas mostr&#243; que el grupo con la dosis de 300<span class="elsevierStyleHsp" style=""></span>mg&#47;4 semanas present&#243; 18 &#40;14&#44;4&#37;&#41; eventos frente al grupo de la dosis de 150<span class="elsevierStyleHsp" style=""></span>mg&#47;4 semanas en el que hubo 4 &#40;9&#37;&#41; eventos&#44; diferencias que fueron estad&#237;sticamente significativas &#40;<span class="elsevierStyleItalic">log-rank</span> p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El tiempo medio hasta la suspensi&#243;n del f&#225;rmaco por acontecimientos adversos fue de 118 semanas para los pacientes bajo la dosis de 300<span class="elsevierStyleHsp" style=""></span>mg&#47;4 semanas y de 86 semanas para la dosis de 150<span class="elsevierStyleHsp" style=""></span>mg&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">En los ensayos cl&#237;nicos aleatorizados el dato de supervivencia a 52 semanas oscila seg&#250;n el tipo de estudio &#40;SCULPTURE&#44; ERASURE y FIXTURE&#41; entre un 78&#44;2&#44; un 80&#44;5 y un 80&#44;5&#37;&#44; respectivamente<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#44;3</span></a>&#46; Las diferentes series de pr&#225;ctica cl&#237;nica real apuntan a un claro descenso en la eficacia de secukinumab en pr&#225;ctica cl&#237;nica real en relaci&#243;n a los estudios pivotales&#44; si bien los datos resultan ampliamente discordantes&#46; Los datos m&#225;s pr&#243;ximos a los RCT publicados proceden del estudio de Sotiriou et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a>&#44; que&#44; en su serie de 42 pacientes en seguimiento durante un a&#241;o muestran una supervivencia cifrada en mantenimiento de PASI75 del 82&#44;4&#37; y supervivencia del 78&#44;6&#37; sin que encontrasen diferencias entre pacientes que hayan recibido previamente o no tratamiento con biol&#243;gico&#46; La media de tiempo de supervivencia quedaba cifrada en 110 semanas con independencia de la causa&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Por otro lado&#44; Lee et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> nos refieren que solo el 41&#44;7&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>48&#41; de los pacientes que reciben secukinumab en su serie no requieren tratamiento combinado ni cambio a una terapia alternativa y establecen por tanto la tasa m&#225;s baja de supervivencia publicada hasta la fecha&#46; Atribuyen la mayor tasa de abandonos a un mayor periodo de seguimiento en su serie&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Georgakopoulos e al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> en su serie &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>41&#41; establece una supervivencia del 68&#44;3&#37; de los pacientes ajustados a ficha t&#233;cnica a 52 semanas con pacientes que mantienen PASI75 o PGA 0-1 siendo la p&#233;rdida de eficacia la principal causa de suspensi&#243;n de tratamiento&#46; Finalmente van den Reek et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> present&#243; resultados similares con un n&#250;mero m&#225;s elevado de pacientes &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>196&#41; con un 76&#37; de supervivencia a 52 semanas&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Los resultados obtenidos en nuestra serie de pr&#225;ctica cl&#237;nica real muestran una supervivencia elevada de los pacientes tratados con secukinumab con ambas dosis&#44; y un menor n&#250;mero de interrupciones con la dosis de 150<span class="elsevierStyleHsp" style=""></span>mg&#47;4 semanas&#46; Este hecho puede ser producto de un menor n&#250;mero de pacientes y un menor seguimiento con esta dosis&#44; as&#237; como del uso de uso de dosis en ficha t&#233;cnica en pacientes m&#225;s complejos&#44; con mayor probabilidad de fracaso terap&#233;utico&#46; Aunque&#44; hay que tener en cuenta que los pacientes que no contin&#250;an y est&#225;n con la dosis de 150<span class="elsevierStyleHsp" style=""></span>mg&#47;4 semanas tienen menor tiempo de supervivencia que con la dosis de 300<span class="elsevierStyleHsp" style=""></span>mg&#47;4 semanas &#40;35 vs&#46; 74 semanas&#44; respectivamente&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">No obstante&#44; el principal factor limitante de todas las series publicadas&#44; y la nuestra no es una excepci&#243;n&#44; es la ausencia de un grupo de referencia que contextualice los hallazgos encontrados&#46; Estos datos preliminares nos ponen en situaci&#243;n de realizar un suban&#225;lisis de supervivencia seg&#250;n la presencia o ausencia de artropat&#237;a psori&#225;sica o seg&#250;n el paciente haya sido tratado o no previamente con otros biol&#243;gicos&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicto de intereses</span><p id="par0075" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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    "fechaRecibido" => "2019-02-15"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Secukinumab es un anticuerpo monoclonal selectivo a la interleucina 17A de tipo IgG1&#47;&#954; para el tratamiento de la psoriasis en placas de moderada a grave en adultos candidatos a tratamientos sist&#233;micos&#46; Las comparaciones indirectas de eficacia entre f&#225;rmacos anti-TNF&#44; ustekinumab y secukinumab nos han ido revelando que este &#250;ltimo presenta menores tasas de supervivencia libre de enfermedad a pesar de su r&#225;pido inicio de acci&#243;n y eficacia&#44; pues un elevado n&#250;mero de pacientes alcanzan PASI90 y PASI100&#46; Aportamos los datos de un estudio retrospectivo de 5 hospitales de la comunidad aut&#243;noma andaluza que incluyen 171 pacientes con una supervivencia global de secukinumab del 87&#37; incluyendo pacientes con dosis de 300 y 150<span class="elsevierStyleHsp" style=""></span>mg&#47;4 semanas&#46; Estos datos contrastan con las series previamente publicadas en la literatura&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Secukinumab&#44; an immunoglobulin G1&#47;&#954; monoclonal antibody that selectively targets interleukin 17a&#44; is used to treat moderate to severe plaque psoriasis in adults who are eligible for systemic treatment&#46; Indirect comparisons of the efficacy of secukinumab&#44; ustekinumab&#44; and anti-tumor necrosis factor agents have found lower drug survival rates for patients on secukinumab&#44; in spite of that biologic&#39;s rapid onset of action and efficacy as demonstrated by the large number of patients reaching a Psoriasis Area and Severity Index of 90 or 100&#46; We present data from a retrospective study of 171 patients treated with doses of 300<span class="elsevierStyleHsp" style=""></span>mg or 150<span class="elsevierStyleHsp" style=""></span>mg of secukinumab every 4 weeks in 5 hospitals in the Spanish autonomous community of Andalusia&#46; Eighty-seven percent continued on treatment at 132 weeks&#44; contrasting with reports from previously published case series&#46;</p></span>"
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PASI&#59; media &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;80 &#40;7&#44;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DLQI&#59; media &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;04 &#40;5&#44;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbilidades</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PsA&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64 &#40;37&#44;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;14&#44;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HTA&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50 &#40;29&#44;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dislipemias&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64 &#40;37&#44;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HGNA&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;16&#44;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Depresi&#243;n&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;9&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento biol&#243;gico</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No tratamiento biol&#243;gico previo&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;32&#44;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1 Biol&#243;gico previo&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;22&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2 Biol&#243;gicos previos&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;21&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3 Biol&#243;gicos previos&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;15&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4 Biol&#243;gicos previos&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;8&#44;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Motivo discontinuaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem 24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem 52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem 76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem 104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem 128&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem 150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fallo 1&#46;&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fallo 2&#46;&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#233;rdida seguimiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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Comunicación Breve
Secukinumab: supervivencia en práctica clínica real
Secukinumab: Drug Survival in Clinical Practice Settings
R. Ruiz-Villaverdea,
Corresponding author
ismenios@hotmail.com

Autor para correspondencia.
, L. Rodríguez Fernández-Freireb, M. Galán-Gutiérrezc, J.C. Armario-Hitad, L. Martinez-Pilare
a Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, España
b Unidad de Gestión Clínica de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, España
c Servicio de Dermatología, Hospital Universitario Reina Sofía, Córdoba, España
d Unidad de Dermatología, Hospital Universitario de Puerto Real, Universidad de Cádiz, Puerto Real, Cádiz, España
e Unidad de Gestión Clínica de Dermatología, Hospital Regional Universitario de Málaga, Málaga, España
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o 2&#46;&#176;&#44; acontecimientos adversos o p&#233;rdida en seguimiento&#41;&#46; Las principales interrupciones se producen entre la semana 24 y 52&#44; no registr&#225;ndose ninguna a partir de la semana 104&#44; 128 y 150 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> y <a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">La supervivencia estimada hasta la suspensi&#243;n del f&#225;rmaco fue del 87&#37; a 132 semanas&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">La comparaci&#243;n entre las dosis pautadas mostr&#243; que el grupo con la dosis de 300<span class="elsevierStyleHsp" style=""></span>mg&#47;4 semanas present&#243; 18 &#40;14&#44;4&#37;&#41; eventos frente al grupo de la dosis de 150<span class="elsevierStyleHsp" style=""></span>mg&#47;4 semanas en el que hubo 4 &#40;9&#37;&#41; eventos&#44; diferencias que fueron estad&#237;sticamente significativas &#40;<span class="elsevierStyleItalic">log-rank</span> p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El tiempo medio hasta la suspensi&#243;n del f&#225;rmaco por acontecimientos adversos fue de 118 semanas para los pacientes bajo la dosis de 300<span class="elsevierStyleHsp" style=""></span>mg&#47;4 semanas y de 86 semanas para la dosis de 150<span class="elsevierStyleHsp" style=""></span>mg&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">En los ensayos cl&#237;nicos aleatorizados el dato de supervivencia a 52 semanas oscila seg&#250;n el tipo de estudio &#40;SCULPTURE&#44; ERASURE y FIXTURE&#41; entre un 78&#44;2&#44; un 80&#44;5 y un 80&#44;5&#37;&#44; respectivamente<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1&#44;3</span></a>&#46; Las diferentes series de pr&#225;ctica cl&#237;nica real apuntan a un claro descenso en la eficacia de secukinumab en pr&#225;ctica cl&#237;nica real en relaci&#243;n a los estudios pivotales&#44; si bien los datos resultan ampliamente discordantes&#46; Los datos m&#225;s pr&#243;ximos a los RCT publicados proceden del estudio de Sotiriou et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a>&#44; que&#44; en su serie de 42 pacientes en seguimiento durante un a&#241;o muestran una supervivencia cifrada en mantenimiento de PASI75 del 82&#44;4&#37; y supervivencia del 78&#44;6&#37; sin que encontrasen diferencias entre pacientes que hayan recibido previamente o no tratamiento con biol&#243;gico&#46; La media de tiempo de supervivencia quedaba cifrada en 110 semanas con independencia de la causa&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Por otro lado&#44; Lee et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> nos refieren que solo el 41&#44;7&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>48&#41; de los pacientes que reciben secukinumab en su serie no requieren tratamiento combinado ni cambio a una terapia alternativa y establecen por tanto la tasa m&#225;s baja de supervivencia publicada hasta la fecha&#46; Atribuyen la mayor tasa de abandonos a un mayor periodo de seguimiento en su serie&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Georgakopoulos e al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> en su serie &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>41&#41; establece una supervivencia del 68&#44;3&#37; de los pacientes ajustados a ficha t&#233;cnica a 52 semanas con pacientes que mantienen PASI75 o PGA 0-1 siendo la p&#233;rdida de eficacia la principal causa de suspensi&#243;n de tratamiento&#46; Finalmente van den Reek et al&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> present&#243; resultados similares con un n&#250;mero m&#225;s elevado de pacientes &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>196&#41; con un 76&#37; de supervivencia a 52 semanas&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Los resultados obtenidos en nuestra serie de pr&#225;ctica cl&#237;nica real muestran una supervivencia elevada de los pacientes tratados con secukinumab con ambas dosis&#44; y un menor n&#250;mero de interrupciones con la dosis de 150<span class="elsevierStyleHsp" style=""></span>mg&#47;4 semanas&#46; Este hecho puede ser producto de un menor n&#250;mero de pacientes y un menor seguimiento con esta dosis&#44; as&#237; como del uso de uso de dosis en ficha t&#233;cnica en pacientes m&#225;s complejos&#44; con mayor probabilidad de fracaso terap&#233;utico&#46; Aunque&#44; hay que tener en cuenta que los pacientes que no contin&#250;an y est&#225;n con la dosis de 150<span class="elsevierStyleHsp" style=""></span>mg&#47;4 semanas tienen menor tiempo de supervivencia que con la dosis de 300<span class="elsevierStyleHsp" style=""></span>mg&#47;4 semanas &#40;35 vs&#46; 74 semanas&#44; respectivamente&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">No obstante&#44; el principal factor limitante de todas las series publicadas&#44; y la nuestra no es una excepci&#243;n&#44; es la ausencia de un grupo de referencia que contextualice los hallazgos encontrados&#46; Estos datos preliminares nos ponen en situaci&#243;n de realizar un suban&#225;lisis de supervivencia seg&#250;n la presencia o ausencia de artropat&#237;a psori&#225;sica o seg&#250;n el paciente haya sido tratado o no previamente con otros biol&#243;gicos&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicto de intereses</span><p id="par0075" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Secukinumab es un anticuerpo monoclonal selectivo a la interleucina 17A de tipo IgG1&#47;&#954; para el tratamiento de la psoriasis en placas de moderada a grave en adultos candidatos a tratamientos sist&#233;micos&#46; Las comparaciones indirectas de eficacia entre f&#225;rmacos anti-TNF&#44; ustekinumab y secukinumab nos han ido revelando que este &#250;ltimo presenta menores tasas de supervivencia libre de enfermedad a pesar de su r&#225;pido inicio de acci&#243;n y eficacia&#44; pues un elevado n&#250;mero de pacientes alcanzan PASI90 y PASI100&#46; Aportamos los datos de un estudio retrospectivo de 5 hospitales de la comunidad aut&#243;noma andaluza que incluyen 171 pacientes con una supervivencia global de secukinumab del 87&#37; incluyendo pacientes con dosis de 300 y 150<span class="elsevierStyleHsp" style=""></span>mg&#47;4 semanas&#46; Estos datos contrastan con las series previamente publicadas en la literatura&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Secukinumab&#44; an immunoglobulin G1&#47;&#954; monoclonal antibody that selectively targets interleukin 17a&#44; is used to treat moderate to severe plaque psoriasis in adults who are eligible for systemic treatment&#46; Indirect comparisons of the efficacy of secukinumab&#44; ustekinumab&#44; and anti-tumor necrosis factor agents have found lower drug survival rates for patients on secukinumab&#44; in spite of that biologic&#39;s rapid onset of action and efficacy as demonstrated by the large number of patients reaching a Psoriasis Area and Severity Index of 90 or 100&#46; We present data from a retrospective study of 171 patients treated with doses of 300<span class="elsevierStyleHsp" style=""></span>mg or 150<span class="elsevierStyleHsp" style=""></span>mg of secukinumab every 4 weeks in 5 hospitals in the Spanish autonomous community of Andalusia&#46; Eighty-seven percent continued on treatment at 132 weeks&#44; contrasting with reports from previously published case series&#46;</p></span>"
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          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">DLQI&#58; <span class="elsevierStyleItalic">dermatology life quality index</span>&#59; HGNA&#58; h&#237;ado graso no alcoh&#243;lico&#59; HTA&#58; hipertensi&#243;n&#59; PASI&#58; <span class="elsevierStyleItalic">psoriasis activity skin index</span>&#59; PsA&#58; artropat&#237;a psori&#225;sica&#59; SD&#58; desviaci&#243;n est&#225;ndar&#46;</p>"
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                  \t\t\t\t">64 &#40;37&#44;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>HGNA&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;16&#44;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Depresi&#243;n&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;9&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento biol&#243;gico</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No tratamiento biol&#243;gico previo&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;32&#44;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1 Biol&#243;gico previo&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;22&#44;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2 Biol&#243;gicos previos&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;21&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3 Biol&#243;gicos previos&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;15&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>4 Biol&#243;gicos previos&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;8&#44;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2561724.png"
              ]
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          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas cl&#237;nicas y demogr&#225;ficas de los pacientes de nuestra serie</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">AA&#58; acontecimientos adversos&#59; Sem&#58; semana&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Motivo discontinuaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem 24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem 52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem 76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem 104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem 128&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sem 150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fallo 1&#46;&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fallo 2&#46;&#176;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P&#233;rdida seguimiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mejor&#237;a sintomatolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#250;mero total de eventos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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ISSN: 00017310
Original language: Spanish
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