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sin que conlleve una p&#233;rdida de su eficacia&#46; Esta pr&#225;ctica se encuentra instaurada en la psoriasis y algunas enfermedades reumatol&#243;gicas&#44; buscando evitar un sobretratamiento innecesario&#44; una reducci&#243;n de los efectos secundarios y una eficiencia econ&#243;mica<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; A continuaci&#243;n&#44; discutimos los resultados de cinco estudios de pacientes con una DA controlada con dupilumab en los que se decidi&#243; espaciar la dosis m&#225;s all&#225; de dos semanas&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El primer estudio que explor&#243; esta idea es el ensayo cl&#237;nico aleatorizado LIBERTY AD SOLO-CONTINUE&#44; que es una continuaci&#243;n de los ensayos que permitieron la aprobaci&#243;n del dupilumab en la DA&#46; Se evaluaron 422 pacientes que se distribuyeron en cuatro grupos seg&#250;n el intervalo de administraci&#243;n del f&#225;rmaco&#58; Q1W&#47;Q2W&#44; Q4W y Q8W&#46; A las 36 semanas de la reducci&#243;n de la dosis&#44; no se observaron diferencias significativas en el cambio porcentual del <span class="elsevierStyleItalic">Eczema Area and Severity Index</span> &#40;EASI&#41; o en la proporci&#243;n de pacientes con <span class="elsevierStyleItalic">Investigator Global Assessment</span> &#40;IGA&#41; 0-1 entre los grupos Q1W&#47;Q2W y Q4W&#46; Por el contrario&#44; s&#237; que se perdi&#243; una proporci&#243;n de pacientes con EASI-75 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;045&#41; y se increment&#243; la proporci&#243;n de pacientes con al menos una subida de 3 puntos en la escala num&#233;rica del prurito &#40;P-NRS&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#46; El grupo Q8W redujo la eficacia de manera significativa en las escalas mencionadas<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Posteriormente&#44; una cohorte holandesa de 90 pacientes compar&#243; el EASI del r&#233;gimen Q2W vs&#46; Q4W y Q6W&#47;Q8W&#46; El descenso fue gradual&#44; primero a Q3W y&#44; en aquellos que mantuvieron respuesta&#44; las dosis se espaciaron m&#225;s&#46; Tras al menos seis meses de seguimiento&#44; no se observaron incrementos del EASI significativos ni en QW4 ni en Q6W&#47;Q8W&#46; El P-NRS se mantuvo estable en el grupo Q4W&#44; mientras que en el Q6W&#47;Q8W se increment&#243; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; A pesar de la reducci&#243;n de los niveles de f&#225;rmaco&#44; los biomarcadores de gravedad de PARC&#47;CCL18 y TARC&#47;CCL17 permanecieron bajos<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Una serie francesa de 88 pacientes identific&#243; tres factores predictores de la persistencia de la respuesta tras la reducci&#243;n&#58; el espaciamiento realizado por haber conseguido una buena respuesta mantenida y no debido a efectos secundarios &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;034&#41;&#44; una edad mayor &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#41; y una menor dosis mensual de corticoides t&#243;picos &#40;0&#44;016&#41;&#46; Los datos de los estudios consultados se recogen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a><a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; diversos autores proponen un descenso consensuado y gradual de la dosis del dupilumab en los pacientes bien controlados&#46; Se hipotetiza que el mantenimiento de la respuesta ser&#237;a por la selecci&#243;n de s&#250;per respondedores&#44; 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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Q1&#47;2W Q4W Q8W Placebo&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">169 86 84 83 n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>442&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">&#37;EASI-0&#44;06&#44; EASI-75 71&#44;6&#37;&#37;EASI y EASI-75 del r&#233;gimen Q1&#47;2W&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">&#37;EASI-0&#44;06&#44; EASI-75 71&#44;6&#37; &#37;EASI-3&#44;84 &#40;NS&#41;&#44; EASI-75 58&#44;3&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41; &#37;EASI-6&#44;84 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#44; EASI-75 54&#46;9&#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; &#37;EASI-21&#44;6 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; EASI-75 30&#44;4 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#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"><a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>&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">Cohortes prospectivo&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"><span class="elsevierStyleHsp" style=""></span>&#62;18 a&#241;os&#44; 52 semanas Q2W con DUPI 300&#44; EASI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7 por 6 meses&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">EASI y P-NRS tras 6 meses&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">Q2W Q4W Q8W&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">30 30 30 n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>90&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">EASI 6&#44;4&#44; P-NRS 4&#44;0 EASI 1&#44;7&#44; P-NRS 2&#44;0 EASI 2&#44;3&#44; P-NRS 2&#44;0 EASI Y P-NRS alcanzado por cada grupo antes de la reducci&#243;n de la dosis&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">EASI 5&#44;4 &#40;NS&#41;&#44; P-NRS 4&#44;0 &#40;NS&#41; EASI 1&#44;5 &#40;NS&#41;&#44; P-NRS 2&#44;0 &#40;NS&#41; EASI 2&#44;9 &#40;NS&#41;&#44; P-NRS 3&#44;0 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#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"><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&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">Serie de casos&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"><span class="elsevierStyleHsp" style=""></span>&#62;18 a&#241;os&#44; SCORAD50&#44; reducci&#243;n dosis&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">Persistencia respuesta &#40;no se especifica escala&#41;&#44; tras 6&#44;3 meses&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">Q2W Q4W&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">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Los datos no fueron suministrados por el autor en el art&#237;culo original&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">A los 6&#44;3 meses de seguimiento medio&#44; 35 individuos mantuvieron&#47;incrementaron el espaciamiento&#46; Los datos no fueron suministrados por el autor en el art&#237;culo original&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"><a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&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">Serie de casos&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"><span class="elsevierStyleHsp" style=""></span>&#62;18 a&#241;os&#44; 52 semanas Q2W con DUPI 300&#44; EASI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>7 y DLQI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>5 por 6 meses&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">EASI&#44; P-NRS&#44; DLQI tras 32 semanas&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">Q3W Q4W&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">35 9 n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>44<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EASI 0&#44;39&#44; P-NRS 1&#44;04&#44; DLQI 3&#44;28 EASI 0&#44;18&#44; P-NRS 1&#44;05&#44; DLQI 3&#44;55 EASI&#44; P-NRS y DLQI alcanzado por cada grupo antes de la reducci&#243;n de la dosis&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">EASI 0&#44;45 &#40;NS&#41;&#44; P-NRS0&#44;94 &#40;NS&#41;&#44; DLQI 3&#44;2 &#40;NS&#41;&#44; EASI0&#44; 22 &#40;NS&#41;&#44; P-NRS 1&#44;14 &#40;NS&#41;&#44; DLQI 2&#44;8 &#40;NS&#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"><a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>&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">Serie de casos&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"><span class="elsevierStyleHsp" style=""></span>&#62;18 a&#241;os&#44; 52 semanas Q2W con DUPI 300&#44; IGA 0-1&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">EASI e IGA tras 12 meses&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">Q3W Q4W Q2W<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&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">IGA 1&#44;00&#44; EASI -16&#44;05 IGA y EASI alcanzados antes de la reducci&#243;n de la dosis&#44;&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">IGA 1&#44;42 &#40;NS&#41;&#44; EASI-20&#44;10 &#40;NS&#41;Los datos no se encuentran desglosados por grupos&#44;&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"><a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3637922.png"
              ]
            ]
          ]
          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">En caso de varias mediciones&#44; se opt&#243; por la &#250;ltima realizada&#44; excepto en<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> donde solo se encontraban disponibles los datos descritos&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">No se han incluido en esta tabla los pacientes en los que se aument&#243; el intervalo de dosis por efectos secundaria&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Se redujo la dosis a 200<span class="elsevierStyleHsp" style=""></span>mg de dupilumab cada dos semanas&#46;</p> <p class="elsevierStyleNotepara" id="npar0020">DLQI&#58; <span class="elsevierStyleItalic">Dermatology Life Quality Index</span>&#59; DUPI&#58; dupilumab&#59; EASI&#58; <span class="elsevierStyleItalic">Eczema Area and Severity Index</span>&#59; IGA&#58; Investigator Global Assessment&#59; NS&#58; no significativo&#59; P-NRS&#58; escala num&#233;rica del prurito&#59; QXW&#58; cada <span class="elsevierStyleSmallCaps">x</span> semanas&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Estudios donde se decidi&#243; espaciar la dosis de dupilumab por una buena respuesta mantenida</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient-centered dupilumab dosing regimen leads to successful dose reduction in persistently controlled atopic dermatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;S&#46; Spekhorst"
                            1 => "D&#46; Bakker"
                            2 => "J&#46; Drylewicz"
                            3 => "T&#46; Rispens"
                            4 => "F&#46; Loeff"
                            5 => "C&#46;M&#46; Boesjes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/all.15439"
                      "Revista" => array:6 [
                        "tituloSerie" => "Allergy&#46;"
                        "fecha" => "2022"
                        "volumen" => "77"
                        "paginaInicial" => "3398"
                        "paginaFinal" => "3407"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35837880"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dupilumab dose spacing after initial successful treatment or adverse events in adult patients with atopic dermatitis&#58; A retrospective analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46; Patruno"
                            1 => "L&#46; Potestio"
                            2 => "G&#46; Fabbrocini"
                            3 => "M&#46; Napolitano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/dth.15933"
                      "Revista" => array:3 [
                        "tituloSerie" => "Dermatol Ther&#46;"
                        "fecha" => "2022"
                        "volumen" => "35"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy and Safety of Multiple Dupilumab Dose Regimens After Initial Successful Treatment in Patients With Atopic Dermatitis&#58; A Randomized Clinical Trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Worm"
                            1 => "E&#46;L&#46; Simpson"
                            2 => "D&#46; Tha&#231;i"
                            3 => "R&#46; Bissonnette"
                            4 => "J&#46;P&#46; Lacour"
                            5 => "S&#46; Beissert"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamadermatol.2019.3617"
                      "Revista" => array:5 [
                        "tituloSerie" => "JAMA Dermatol&#46;"
                        "fecha" => "2020"
                        "volumen" => "56"
                        "paginaInicial" => "131"
                        "paginaFinal" => "143"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Longer dupilumab dosing intervals in adult patients with atopic dermatitis&#58; experience from a French multicentre retrospective cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Jendoubi"
                            1 => "J&#46; Shourik"
                            2 => "J&#46; Seneschal"
                            3 => "F&#46; Giordano-Labadie"
                            4 => "N&#46; Raison-Peyron"
                            5 => "A&#46; Du-Thanh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bjd.21628"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol&#46;"
                        "fecha" => "2022"
                        "volumen" => "187"
                        "paginaInicial" => "602"
                        "paginaFinal" => "603"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35481677"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
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FORO DE RESIDENTES
FR-Espaciamiento de la dosis de dupilumab en dermatitis atópica: ¿optimización o fracaso terapéutico?
RF-Longer Dupilumab Dosing Intervals in Atopic Dermatitis: Optimization or Therapeutic Failure?
M.A. Lasheras-Pérez
Corresponding author
drmalp97@gmail.com

Autor para correspondencia.
, F. Navarro-Blanco, M. Rodríguez-Serna
Servicio de Dermatología y Venereología, Hospital Universitario y Politécnico la Fe, Valencia, España
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sin que conlleve una p&#233;rdida de su eficacia&#46; Esta pr&#225;ctica se encuentra instaurada en la psoriasis y algunas enfermedades reumatol&#243;gicas&#44; buscando evitar un sobretratamiento innecesario&#44; una reducci&#243;n de los efectos secundarios y una eficiencia econ&#243;mica<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a>&#46; A continuaci&#243;n&#44; discutimos los resultados de cinco estudios de pacientes con una DA controlada con dupilumab en los que se decidi&#243; espaciar la dosis m&#225;s all&#225; de dos semanas&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El primer estudio que explor&#243; esta idea es el ensayo cl&#237;nico aleatorizado LIBERTY AD SOLO-CONTINUE&#44; que es una continuaci&#243;n de los ensayos que permitieron la aprobaci&#243;n del dupilumab en la DA&#46; Se evaluaron 422 pacientes que se distribuyeron en cuatro grupos seg&#250;n el intervalo de administraci&#243;n del f&#225;rmaco&#58; Q1W&#47;Q2W&#44; Q4W y Q8W&#46; A las 36 semanas de la reducci&#243;n de la dosis&#44; no se observaron diferencias significativas en el cambio porcentual del <span class="elsevierStyleItalic">Eczema Area and Severity Index</span> &#40;EASI&#41; o en la proporci&#243;n de pacientes con <span class="elsevierStyleItalic">Investigator Global Assessment</span> &#40;IGA&#41; 0-1 entre los grupos Q1W&#47;Q2W y Q4W&#46; Por el contrario&#44; s&#237; que se perdi&#243; una proporci&#243;n de pacientes con EASI-75 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;045&#41; y se increment&#243; la proporci&#243;n de pacientes con al menos una subida de 3 puntos en la escala num&#233;rica del prurito &#40;P-NRS&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#46; El grupo Q8W redujo la eficacia de manera significativa en las escalas mencionadas<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Posteriormente&#44; una cohorte holandesa de 90 pacientes compar&#243; el EASI del r&#233;gimen Q2W vs&#46; Q4W y Q6W&#47;Q8W&#46; El descenso fue gradual&#44; primero a Q3W y&#44; en aquellos que mantuvieron respuesta&#44; las dosis se espaciaron m&#225;s&#46; Tras al menos seis meses de seguimiento&#44; no se observaron incrementos del EASI significativos ni en QW4 ni en Q6W&#47;Q8W&#46; El P-NRS se mantuvo estable en el grupo Q4W&#44; mientras que en el Q6W&#47;Q8W se increment&#243; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; A pesar de la reducci&#243;n de los niveles de f&#225;rmaco&#44; los biomarcadores de gravedad de PARC&#47;CCL18 y TARC&#47;CCL17 permanecieron bajos<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Una serie francesa de 88 pacientes identific&#243; tres factores predictores de la persistencia de la respuesta tras la reducci&#243;n&#58; el espaciamiento realizado por haber conseguido una buena respuesta mantenida y no debido a efectos secundarios &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;034&#41;&#44; una edad mayor &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#41; y una menor dosis mensual de corticoides t&#243;picos &#40;0&#44;016&#41;&#46; Los datos de los estudios consultados se recogen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a><a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; diversos autores proponen un descenso consensuado y gradual de la dosis del dupilumab en los pacientes bien controlados&#46; Se hipotetiza que el mantenimiento de la respuesta ser&#237;a por la selecci&#243;n de s&#250;per respondedores&#44; 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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#250;m&#46;&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">Elemento para la comparaci&#243;n estad&#237;stica&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">Resultado&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">Referencias&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">Ensayo cl&#237;nico aleatorizado&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"><span class="elsevierStyleHsp" style=""></span>&#62;18 a&#241;os&#44; 16 semanas Q1W&#47;Q2W DUPI 300&#44; EASI-75 IGA 0-1&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">Cambio &#37; EASI Proporci&#243;n pacientes EASI-75 tras 36 semanas&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">Q1&#47;2W Q4W Q8W Placebo&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">169 86 84 83 n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>442&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">&#37;EASI-0&#44;06&#44; EASI-75 71&#44;6&#37;&#37;EASI y EASI-75 del r&#233;gimen Q1&#47;2W&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">&#37;EASI-0&#44;06&#44; EASI-75 71&#44;6&#37; &#37;EASI-3&#44;84 &#40;NS&#41;&#44; EASI-75 58&#44;3&#37; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#41; &#37;EASI-6&#44;84 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#44; EASI-75 54&#46;9&#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; &#37;EASI-21&#44;6 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; EASI-75 30&#44;4 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#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"><a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>&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">Cohortes prospectivo&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"><span class="elsevierStyleHsp" style=""></span>&#62;18 a&#241;os&#44; 52 semanas Q2W con DUPI 300&#44; EASI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>7 por 6 meses&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">EASI y P-NRS tras 6 meses&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">Q2W Q4W Q8W&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">30 30 30 n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>90&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">EASI 6&#44;4&#44; P-NRS 4&#44;0 EASI 1&#44;7&#44; P-NRS 2&#44;0 EASI 2&#44;3&#44; P-NRS 2&#44;0 EASI Y P-NRS alcanzado por cada grupo antes de la reducci&#243;n de la dosis&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">EASI 5&#44;4 &#40;NS&#41;&#44; P-NRS 4&#44;0 &#40;NS&#41; EASI 1&#44;5 &#40;NS&#41;&#44; P-NRS 2&#44;0 &#40;NS&#41; EASI 2&#44;9 &#40;NS&#41;&#44; P-NRS 3&#44;0 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#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"><a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&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">Serie de casos&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"><span class="elsevierStyleHsp" style=""></span>&#62;18 a&#241;os&#44; SCORAD50&#44; reducci&#243;n dosis&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">Persistencia respuesta &#40;no se especifica escala&#41;&#44; tras 6&#44;3 meses&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">Q2W Q4W&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">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Los datos no fueron suministrados por el autor en el art&#237;culo original&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">A los 6&#44;3 meses de seguimiento medio&#44; 35 individuos mantuvieron&#47;incrementaron el espaciamiento&#46; Los datos no fueron suministrados por el autor en el art&#237;culo original&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"><a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&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">Serie de casos&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"><span class="elsevierStyleHsp" style=""></span>&#62;18 a&#241;os&#44; 52 semanas Q2W con DUPI 300&#44; EASI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>7 y DLQI<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>5 por 6 meses&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">EASI&#44; P-NRS&#44; DLQI tras 32 semanas&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">Q3W Q4W&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">35 9 n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>44<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">EASI 0&#44;39&#44; P-NRS 1&#44;04&#44; DLQI 3&#44;28 EASI 0&#44;18&#44; P-NRS 1&#44;05&#44; DLQI 3&#44;55 EASI&#44; P-NRS y DLQI alcanzado por cada grupo antes de la reducci&#243;n de la dosis&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">EASI 0&#44;45 &#40;NS&#41;&#44; P-NRS0&#44;94 &#40;NS&#41;&#44; DLQI 3&#44;2 &#40;NS&#41;&#44; EASI0&#44; 22 &#40;NS&#41;&#44; P-NRS 1&#44;14 &#40;NS&#41;&#44; DLQI 2&#44;8 &#40;NS&#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"><a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>&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">Serie de casos&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"><span class="elsevierStyleHsp" style=""></span>&#62;18 a&#241;os&#44; 52 semanas Q2W con DUPI 300&#44; IGA 0-1&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">EASI e IGA tras 12 meses&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">Q3W Q4W Q2W<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&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">IGA 1&#44;00&#44; EASI -16&#44;05 IGA y EASI alcanzados antes de la reducci&#243;n de la dosis&#44;&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">IGA 1&#44;42 &#40;NS&#41;&#44; EASI-20&#44;10 &#40;NS&#41;Los datos no se encuentran desglosados por grupos&#44;&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"><a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3637922.png"
              ]
            ]
          ]
          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">En caso de varias mediciones&#44; se opt&#243; por la &#250;ltima realizada&#44; excepto en<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> donde solo se encontraban disponibles los datos descritos&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">No se han incluido en esta tabla los pacientes en los que se aument&#243; el intervalo de dosis por efectos secundaria&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Se redujo la dosis a 200<span class="elsevierStyleHsp" style=""></span>mg de dupilumab cada dos semanas&#46;</p> <p class="elsevierStyleNotepara" id="npar0020">DLQI&#58; <span class="elsevierStyleItalic">Dermatology Life Quality Index</span>&#59; DUPI&#58; dupilumab&#59; EASI&#58; <span class="elsevierStyleItalic">Eczema Area and Severity Index</span>&#59; IGA&#58; Investigator Global Assessment&#59; NS&#58; no significativo&#59; P-NRS&#58; escala num&#233;rica del prurito&#59; QXW&#58; cada <span class="elsevierStyleSmallCaps">x</span> semanas&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Estudios donde se decidi&#243; espaciar la dosis de dupilumab por una buena respuesta mantenida</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient-centered dupilumab dosing regimen leads to successful dose reduction in persistently controlled atopic dermatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;S&#46; Spekhorst"
                            1 => "D&#46; Bakker"
                            2 => "J&#46; Drylewicz"
                            3 => "T&#46; Rispens"
                            4 => "F&#46; Loeff"
                            5 => "C&#46;M&#46; Boesjes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/all.15439"
                      "Revista" => array:6 [
                        "tituloSerie" => "Allergy&#46;"
                        "fecha" => "2022"
                        "volumen" => "77"
                        "paginaInicial" => "3398"
                        "paginaFinal" => "3407"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35837880"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dupilumab dose spacing after initial successful treatment or adverse events in adult patients with atopic dermatitis&#58; A retrospective analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46; Patruno"
                            1 => "L&#46; Potestio"
                            2 => "G&#46; Fabbrocini"
                            3 => "M&#46; Napolitano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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Article information
ISSN: 00017310
Original language: Spanish
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