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consumo de alcohol&#44; exposici&#243;n a radiaci&#243;n ultravioleta &#91;UV&#93;&#41; prevalentes en estos pacientes<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Actualmente existen distintas terapias para el tratamiento de la psoriasis&#44; cuya selecci&#243;n depende de factores como la gravedad de la enfermedad o la presencia de comorbilidades<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">5</span></a>&#46; El uso de terapias basadas en luz UV y determinados f&#225;rmacos inmunosupresores se ha relacionado con un mayor riesgo de desarrollar c&#225;ncer&#44; aunque los datos son contradictorios<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">6</span></a>&#46; Algunos trabajos sugieren que la fototerapia y las terapias sist&#233;micas aumentan el riesgo de c&#225;ncer cut&#225;neo<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; El tratamiento con terapias biol&#243;gicas tambi&#233;n genera incertidumbre&#44; ya que te&#243;ricamente podr&#237;an tener efectos en las v&#237;as innata y adaptativa de los mecanismos de inmunovigilancia del c&#225;ncer<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">9&#8211;11</span></a>&#46; Los estudios publicados&#44; aunque escasos en n&#250;mero y con bajo nivel de evidencia&#44; muestran que no existe un incremento estad&#237;sticamente significativo en el riesgo de padecer c&#225;ncer en los pacientes tratados con terapias biol&#243;gicas<a class="elsevierStyleCrossRefs" href="#bib0330"><span class="elsevierStyleSup">12&#8211;14</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Con todo&#44; la evidencia disponible para orientar a los dermat&#243;logos en el manejo de la psoriasis en el paciente oncol&#243;gico es escasa y la mayor&#237;a de las gu&#237;as de pr&#225;ctica cl&#237;nica incluyen recomendaciones generales o ambiguas para el manejo de estos pacientes<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">15&#8211;21</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Para el presente estudio&#44; el Grupo de Psoriasis &#40;GPs&#41; de la Academia Espa&#241;ola de Dermatolog&#237;a y Venereolog&#237;a &#40;AEDV&#41; consensu&#243;&#44; mediante el m&#233;todo Delphi&#44; una serie de recomendaciones relacionadas con el abordaje terap&#233;utico y asistencial del paciente oncol&#243;gico con psoriasis&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">M&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se realiz&#243; una consulta Delphi de dos rondas dirigida a un panel de expertos del GPs con una experiencia m&#237;nima de 2 a&#241;os en el manejo de la psoriasis y c&#225;ncer&#46; El dise&#241;o del cuestionario para la primera ronda se bas&#243; en una revisi&#243;n de la literatura y el asesoramiento de un comit&#233; cient&#237;fico constituido por 8 dermat&#243;logos &#40;LP&#44; JN&#44; AL-F&#44; LS&#44; BP&#44; CG&#44; PC&#44; JMC&#41; e inclu&#237;a 91 afirmaciones&#46; El grado de acuerdo se evalu&#243; mediante una escala Likert de 7 puntos &#40;1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#171;en total desacuerdo&#187;&#59; 4<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#171;ni acuerdo ni desacuerdo&#187;&#59; y 7<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#171;totalmente de acuerdo&#187;&#41;&#46; Se alcanz&#243; un consenso cuando al menos el 66&#37; de los panelistas estuvieron de acuerdo &#40;6-7 puntos&#41; o en desacuerdo &#40;1-2 puntos&#41; con la afirmaci&#243;n propuesta&#46; Las afirmaciones que no alcanzaron consenso en la primera ronda fueron replanteadas en una segunda&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Los panelistas evaluaron mediante una escala de 0 a 10 &#40;siendo 0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#171;completamente inadecuado&#187;&#59; 5<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#171;ni adecuado ni inadecuado&#187;&#59; y 10<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#171;totalmente adecuado&#187;&#41; la adecuaci&#243;n de distintos tratamientos para pacientes con psoriasis y c&#225;ncer cut&#225;neo no melanoma y neoplasias hematol&#243;gicas y no hematol&#243;gicas activas y no activas&#46; Tambi&#233;n se evalu&#243; de la misma forma el uso concomitante de inhibidores del <span class="elsevierStyleItalic">checkpoint</span> y tratamientos para la psoriasis en el contexto de pacientes oncol&#243;gicos con psoriasis y posibles efectos adversos relacionados con la estimulaci&#243;n del sistema inmunitario&#44; como desarrollo de colitis&#44; hepatitis&#44; endocrinopat&#237;as y nefritis o enfermedad renal&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Resultados</span><p id="par0035" class="elsevierStylePara elsevierViewall">Un total de 151 miembros del GPs fueron invitados a participar en la consulta&#46; En la primera ronda participaron 45 panelistas &#40;tasa de respuesta&#58; 29&#44;8&#37;&#41;&#44; provenientes de 13 comunidades aut&#243;nomas&#44; y en segunda ronda 36 &#40;tasa de respuesta respecto a la primera ronda&#58; 80&#44;0&#37;&#41;&#46; Las caracter&#237;sticas sociodemogr&#225;ficas y profesionales de los panelistas se detallan en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">De las 91 afirmaciones planteadas&#44; 69 alcanzaron consenso &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">tablas 2-4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Cribado y detecci&#243;n precoz del c&#225;ncer en el paciente con psoriasis</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Recomendaci&#243;n 1&#46; Se recomienda aconsejar al paciente con psoriasis que participe en las campa&#241;as generales de detecci&#243;n precoz de c&#225;ncer seg&#250;n edad y sexo</span></span></p><p id="par0050" class="elsevierStylePara elsevierViewall">En la discusi&#243;n se citaron las gu&#237;as de la Academia Americana de Dermatolog&#237;a &#40;AAD-NPF&#41; y la Asociaci&#243;n Brit&#225;nica de Dermat&#243;logos &#40;BAD&#41;&#44; que recomiendan reforzar y mejorar la educaci&#243;n del paciente sobre la enfermedad y las comorbilidades asociadas<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">16&#44;22</span></a>&#46; Adem&#225;s&#44; estudios recientes sugieren que los pacientes con psoriasis presentan un mayor riesgo de desarrollar determinados tipos de neoplasias&#44; como el c&#225;ncer cut&#225;neo no melanoma o linfomas<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">23&#8211;25</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Recomendaci&#243;n 2&#46; Se recomienda realizar un cribado activo en pacientes con psoriasis para la detecci&#243;n de c&#225;ncer cut&#225;neo no melanoma y melanoma</span></span></p><p id="par0060" class="elsevierStylePara elsevierViewall">La discusi&#243;n se bas&#243; en la gu&#237;a AAD-NPF&#44; que recomienda un enfoque proactivo por parte del dermat&#243;logo para la detecci&#243;n de c&#225;ncer en los pacientes con psoriasis&#44; evaluando activamente la piel en busca de lesiones cancerosas o precancerosas<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">22</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Tratamiento en el paciente oncol&#243;gico con psoriasis</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Adecuaci&#243;n de los tratamientos sist&#233;micos en el paciente oncol&#243;gico con psoriasis</span><p id="par0065" class="elsevierStylePara elsevierViewall">Los panelistas calificaron la adecuaci&#243;n de los tratamientos en funci&#243;n de su eficacia y seguridad y consideraron que&#44; en general&#44; la acitretina y el apremilast ser&#237;an los tratamientos sist&#233;micos no biol&#243;gicos m&#225;s adecuados para el tratamiento de la psoriasis en pacientes oncol&#243;gicos &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A&#41;&#46; Entre las terapias biol&#243;gicas disponibles&#44; los anti-IL-23 y anti-IL-17 se consideran las opciones terap&#233;uticas m&#225;s adecuadas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Recomendaci&#243;n 3&#46; Se recomienda consensuar con el onc&#243;logo el tratamiento para la psoriasis en pacientes con c&#225;ncer activo</span></span></p><p id="par0075" class="elsevierStylePara elsevierViewall">La votaci&#243;n se bas&#243; en las gu&#237;as EuroGuiDerm&#44; BAD&#44; BETA-PSO&#44; la <span class="elsevierStyleItalic">francesa &#40;Groupe de Recherche sur le Psoriasis de la Soci&#233;t&#233; Fran&#231;aise de Dermatologie&#41;</span> y la espa&#241;ola del GPs&#44; que recomiendan discutir&#47;consensuar los tratamientos con el onc&#243;logo&#47;hemat&#243;logo para cada caso individual<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">15&#8211;17&#44;26&#44;27</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Recomendaci&#243;n 4&#46; Tanto la fotoquimioterapia con psoraleno y UVA &#40;PUVA&#41; como la fototerapia con UVB son opciones terap&#233;uticas adecuadas para pacientes con psoriasis y neoplasias en general &#40;activas y no activas&#41;&#44; pero se consideran inadecuadas para pacientes con antecedentes de o predisposici&#243;n al c&#225;ncer cut&#225;neo &#40;melanoma y no melanoma&#41;</span></span></p><p id="par0085" class="elsevierStylePara elsevierViewall">Los datos disponibles en la literatura sobre el uso de la fototerapia y su relaci&#243;n con el c&#225;ncer de piel son contradictorios&#46; Mientras que algunos estudios observacionales han mostrado un aumento del riesgo de desarrollar carcinoma de c&#233;lulas escamosas tras el tratamiento con PUVA&#44; otros no han mostrado un aumento significativo en el riesgo de desarrollar c&#225;ncer<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">28</span></a>&#46; En este contexto&#44; las gu&#237;as EuroGuiDerm y francesa consideran adecuada la fototerapia&#44; en especial el uso de UVB de banda estrecha&#44; en pacientes con psoriasis y c&#225;ncer no cut&#225;neo reciente&#59; no as&#237; en pacientes con c&#225;ncer cut&#225;neo reciente o un elevado riesgo de padecerlo<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">15&#44;27</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Recomendaci&#243;n 5&#46; La ciclosporina es una opci&#243;n inadecuada para los pacientes oncol&#243;gicos con psoriasis&#44; tanto en monoterapia como combinada con fototerapia</span></span></p><p id="par0095" class="elsevierStylePara elsevierViewall">Para esta recomendaci&#243;n se tuvo en cuenta que el uso de ciclosporina se ha asociado con la aparici&#243;n de diversos tipos de c&#225;ncer en el contexto del trasplante de &#243;rganos&#59; sin embargo&#44; esta asociaci&#243;n no es tan clara en pacientes con psoriasis<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">7&#44;29&#44;30</span></a>&#46; Algunas gu&#237;as como la EuroGuiDerm&#44; BETA-PSO y la francesa desaconsejan el uso de ciclosporina en pacientes con psoriasis e historia previa de c&#225;ncer<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">15&#44;26&#44;27</span></a>&#44; especialmente en los casos de carcinoma de c&#233;lulas escamosas agresivos o invasivos<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">26</span></a>&#46; Adem&#225;s&#44; diversos estudios y revisiones sistem&#225;ticas<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">31&#44;32</span></a>&#44; as&#237; como el propio resumen de caracter&#237;sticas del producto<a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">33</span></a>&#44; desaconsejan el empleo concomitante de ciclosporina y fototerapia &#40;PUVA o UVB&#41; en pacientes con psoriasis debido al riesgo potencial de desarrollar c&#225;ncer de piel&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Recomendaci&#243;n 6&#46; El dimetilfumarato es una opci&#243;n terap&#233;utica adecuada en pacientes con psoriasis y c&#225;ncer cut&#225;neo no melanoma&#44; neoplasias no hematol&#243;gicas &#40;activas e inactivas&#41; y hematol&#243;gicas no activas</span></span></p><p id="par0105" class="elsevierStylePara elsevierViewall">La informaci&#243;n sobre el uso de dimetilfumarato en pacientes oncol&#243;gicos con psoriasis es escasa&#46; Estudios recientes de vida real muestran que el dimetilfumarato es una opci&#243;n eficaz y segura para el tratamiento de la psoriasis en pacientes con comorbilidades&#44; incluyendo historia de c&#225;ncer&#44; y no se ha relacionado con la aparici&#243;n de neoplasias o recidiva<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">34&#8211;36</span></a>&#46; Asimismo&#44; existe evidencia de que el dimetilfumarato inhibe el crecimiento de c&#233;lulas transformadas&#47;no-transformadas&#44; as&#237; como la angiog&#233;nesis&#44; tanto <span class="elsevierStyleItalic">in vivo</span> como <span class="elsevierStyleItalic">in vitro</span><a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">37</span></a>&#44; lo que podr&#237;a tener un efecto antipsori&#225;sico y antitumoral<a class="elsevierStyleCrossRefs" href="#bib0455"><span class="elsevierStyleSup">37&#44;38</span></a>&#46; En las neoplasias hematol&#243;gicas activas se considera que la posible linfopenia crea un riesgo innecesario&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Recomendaci&#243;n 7&#46; La acitretina y el apremilast son opciones terap&#233;uticas adecuadas para los pacientes oncol&#243;gicos con psoriasis</span></span></p><p id="par0115" class="elsevierStylePara elsevierViewall">La discusi&#243;n se bas&#243; en las gu&#237;as EuroGuiDerm y BETA-PSO&#44; que proponen apremilast como una opci&#243;n terap&#233;utica v&#225;lida en pacientes con psoriasis y antecedentes de c&#225;ncer&#44; aunque se recomienda su uso con precauci&#243;n al no disponer de suficientes datos de seguridad a largo plazo<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">15&#44;26</span></a>&#46; En este sentido&#44; un estudio reciente sobre una serie de casos y una revisi&#243;n de la literatura sugieren que apremilast es una opci&#243;n eficaz y segura para estos pacientes&#44; aunque se requerir&#237;an m&#225;s estudios que confirmen estos resultados<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">39</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Por otra parte&#44; los datos sobre el uso de acitretina son escasos&#44; aunque seg&#250;n las gu&#237;as EuroGuiDerm y del GPs&#44; y una revisi&#243;n narrativa sobre los pacientes con psoriasis y su riesgo de desarrollar c&#225;ncer&#44; esta opci&#243;n terap&#233;utica parece no modificar el riesgo de c&#225;ncer incidente o de su recidiva en pacientes con psoriasis<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">15&#44;20&#44;40</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Recomendaci&#243;n 8&#46; El metotrexato es una opci&#243;n inadecuada para los pacientes con neoplasias hematol&#243;gicas activas</span></span></p><p id="par0130" class="elsevierStylePara elsevierViewall">La recomendaci&#243;n se basa en el consenso obtenido&#44; para el que se tuvo en cuenta el posible efecto citop&#233;nico del metotrexato&#44; que puede ser contraproducente en estos pacientes&#59; no hubo consenso en cuanto a otras neoplasias&#46; A pesar del uso extendido del metotrexato en pr&#225;ctica cl&#237;nica&#44; no existe consenso sobre su empleo en pacientes con enfermedades inmunomediadas y neoplasias concomitantes&#46; As&#237;&#44; las gu&#237;as EuroGuiDerm y del GPs exponen que el metotrexato podr&#237;a ser empleado como tratamiento sist&#233;mico en pacientes con psoriasis e historia previa de c&#225;ncer en caso de una respuesta inadecuada o contraindicaci&#243;n en el uso de un tratamiento t&#243;pico&#44; fototerapia UVB o acitretina<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">15&#44;18</span></a>&#46; De manera similar&#44; la gu&#237;a BETA-PSO incluye el uso de metotrexato en pacientes con psoriasis y c&#225;ncer s&#243;lido&#44; hematol&#243;gico y c&#225;ncer de piel melanoma y no melanoma&#46; Sin embargo&#44; subraya la importancia de evitar su uso en los casos de carcinoma de c&#233;lulas escamosas agresivos o invasivos<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">26</span></a>&#46; Adem&#225;s&#44; un ensayo cl&#237;nico aleatorizado&#44; llevado a cabo en adultos con enfermedad cardiovascular&#44; diabetes o s&#237;ndrome metab&#243;lico&#44; encontr&#243; una relaci&#243;n entre el uso de dosis bajas de metotrexato y un aumento en el riesgo de c&#225;ncer de piel<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">41</span></a>&#46; Un reciente estudio caso-control en la poblaci&#243;n danesa ha identificado una asociaci&#243;n entre el diagn&#243;stico de c&#225;ncer cut&#225;neo &#40;melanoma y no melanoma&#41; y el tratamiento con metotrexato &#40;dosis acumulada &#8805;<span class="elsevierStyleHsp" style=""></span>2&#44;5<span class="elsevierStyleHsp" style=""></span>g&#41;&#44; de forma dosis-dependiente&#44; aunque en pacientes con psoriasis la asociaci&#243;n s&#243;lo continuaba siendo significativa &#40;<span class="elsevierStyleItalic">odds ratio</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;43&#41; para carcinoma basocelular<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">8</span></a>&#46; Aunque los panelistas no dispusieron de esta evidencia para la discusi&#243;n&#44; probablemente el metotrexato debiera evitarse en pacientes con riesgo de c&#225;ncer cut&#225;neo&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Recomendaci&#243;n 9&#46; Infliximab se considera una opci&#243;n terap&#233;utica inadecuada en pacientes con psoriasis y neoplasias hematol&#243;gicas &#40;activas o inactivas&#41; y no hematol&#243;gicas activas</span></span></p><p id="par0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Recomendaci&#243;n 10&#46; Adalimumab y certolizumab se consideran opciones terap&#233;uticas inadecuadas en pacientes con psoriasis y neoplasias activas&#44; tanto hematol&#243;gicas como no hematol&#243;gicas</span></span></p><p id="par0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Recomendaci&#243;n 11&#46; Etanercept es una opci&#243;n terap&#233;utica adecuada para pacientes con psoriasis y c&#225;ncer cut&#225;neo no melanoma&#44; pero inadecuada para pacientes con neoplasias hematol&#243;gicas activas</span></span></p><p id="par0150" class="elsevierStylePara elsevierViewall">La incidencia de c&#225;ncer&#44; especialmente de piel&#44; asociado con el uso de terapias anti-TNF &#40;adalimumab&#44; certolizumab&#44; etanercept&#44; infliximab&#41; se ha estudiado fundamentalmente en pacientes con artritis reumatoide y enfermedad de Crohn<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">4</span></a>&#46; No obstante&#44; el uso de esta terapia en pacientes con psoriasis no se ha asociado con el riesgo de aparici&#243;n de tumores s&#243;lidos ni con su recidiva&#44; como se refleja en las gu&#237;as de pr&#225;ctica cl&#237;nica de psoriasis<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">15&#44;26&#44;42</span></a>&#44; reumatol&#243;gicas y gastroenterol&#243;gicas<a class="elsevierStyleCrossRefs" href="#bib0485"><span class="elsevierStyleSup">43&#8211;46</span></a>&#46; En general&#44; estas gu&#237;as recomiendan discutir para cada caso el uso de la terapia anti-TNF con el onc&#243;logo&#44; con otros especialistas y con el propio paciente&#46; En la discusi&#243;n de los consensos y las consiguientes recomendaciones se han tenido en cuenta el posible riesgo aumentado de infecciones y la evidencia anecd&#243;tica de desarrollo o progresi&#243;n de neoplasias hematol&#243;gicas &#40;especialmente linfoproliferativas&#41; en pacientes tratados con anti-TNF&#44; as&#237; como el diferente mecanismo de acci&#243;n de etanercept&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Recomendaci&#243;n 12&#46; Ustekinumab es una opci&#243;n terap&#233;utica adecuada en pacientes con psoriasis y c&#225;ncer cut&#225;neo no melanoma y neoplasias no activas&#44; tanto hematol&#243;gicas como no hematol&#243;gicas</span></span></p><p id="par0160" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Recomendaci&#243;n 13&#46; Los tratamientos anti-IL-23 y anti-IL-17 son una opci&#243;n terap&#233;utica adecuada en pacientes oncol&#243;gicos con psoriasis</span></span></p><p id="par0165" class="elsevierStylePara elsevierViewall">El uso tanto de ustekinumab como de los tratamientos anti-IL-23 y anti-IL-17 no se ha relacionado con un mayor riesgo de c&#225;ncer<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">4</span></a>&#46; As&#237;&#44; las gu&#237;as EuroGuiDerm y BETA-PSO proponen el uso de ustekinumab en pacientes con psoriasis e historia previa de c&#225;ncer<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">15&#44;26</span></a> y sugieren que los anti-IL-23 y anti-IL-17 se pueden usar en estos pacientes&#44; aunque con cautela&#44; dada la falta de experiencia y datos de seguridad a largo plazo<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">15&#44;26</span></a>&#46; La falta de consenso en el caso de ustekinumab por lo que se refiere a las neoplasias hematol&#243;gicas y no hematol&#243;gicas activas se justific&#243; por la posible inhibici&#243;n del efecto protector de la respuesta antitumoral Th1 &#40;mediada por IL-12&#41;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">47</span></a>&#46; En todos los casos&#44; se recomienda discutir cada caso particular con el onc&#243;logo&#47;hemat&#243;logo responsable&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a> se incluye un resumen de las recomendaciones para cada uno de los f&#225;rmacos y los tipos de neoplasias&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Inhibidores del <span class="elsevierStyleItalic">checkpoint</span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Adecuaci&#243;n de los tratamientos concomitantes al uso de inhibidores de checkpoint en el paciente oncol&#243;gico con psoriasis</span><p id="par0175" class="elsevierStylePara elsevierViewall">En general&#44; los panelistas consideraron que los agentes biol&#243;gicos anti-IL-23 son el tratamiento m&#225;s adecuado para los pacientes con psoriasis y con otras patolog&#237;as inmunomediadas asociadas al uso de inhibidores de <span class="elsevierStyleItalic">checkpoint</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#44; seguido de ustekinumab y anti-IL-17&#44; excepto&#44; para estos &#250;ltimos&#44; en pacientes con psoriasis y colitis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>B&#41;&#46; Seg&#250;n los panelistas&#44; la ciclosporina es el tratamiento menos adecuado para la mayor&#237;a de estos pacientes &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Recomendaci&#243;n 13&#46; Los tratamientos t&#243;picos son una opci&#243;n terap&#233;utica adecuada en pacientes oncol&#243;gicos tratados con inhibidores de checkpoint en quienes se han desarrollado o exacerbado otras patolog&#237;as como la colitis&#44; hepatitis&#44; endocrinopat&#237;as y nefritis o enfermedad renal</span></span></p><p id="par0185" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Recomendaci&#243;n 14&#46; Los tratamientos sist&#233;micos biol&#243;gicos son una opci&#243;n terap&#233;utica adecuada en pacientes oncol&#243;gicos tratados con inhibidores de checkpoint en quienes se han desarrollado o exacerbado otras patolog&#237;as como la colitis&#44; hepatitis&#44; endocrinopat&#237;as y nefritis o enfermedad renal</span></span></p><p id="par0190" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Recomendaci&#243;n 15&#46; Los tratamientos sist&#233;micos convencionales son una opci&#243;n terap&#233;utica inadecuada en pacientes oncol&#243;gicos tratados con inhibidores de checkpoint en quienes se han desarrollado o exacerbado hepatitis y nefritis o enfermedad renal</span></span></p><p id="par0195" class="elsevierStylePara elsevierViewall">Para estas recomendaciones se tuvo en cuenta que el uso de inhibidores de <span class="elsevierStyleItalic">checkpoint</span> en pacientes oncol&#243;gicos est&#225; asociado con la aparici&#243;n de distintos efectos adversos cut&#225;neos inmunomediados&#44; tales como la psoriasis<a class="elsevierStyleCrossRefs" href="#bib0510"><span class="elsevierStyleSup">48&#44;49</span></a>&#46; Seg&#250;n un estudio reciente sobre informes de reacciones adversas a distintos inhibidores del <span class="elsevierStyleItalic">checkpoint</span> obtenidos de la base de datos EudraVigilance de la Agencia Europea de Medicamentos&#44; la aparici&#243;n de psoriasis en estos pacientes se trata con tratamientos t&#243;picos&#44; sist&#233;micos no biol&#243;gicos o biol&#243;gicos en funci&#243;n de la gravedad<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">49</span></a>&#46; En este sentido&#44; una revisi&#243;n sistem&#225;tica de estudios observacionales ha mostrado que el tratamiento t&#243;pico con corticoesteroides es el m&#225;s com&#250;n&#44; seguido del uso de acitretina&#44; esteroides sist&#233;micos&#44; fototerapia&#44; metotrexato y agentes biol&#243;gicos<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">50</span></a>&#46; En cuanto al uso de las nuevas terapias&#44; distintas publicaciones han mostrado que los inhibidores de IL-17<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">51</span></a> e IL-23<a class="elsevierStyleCrossRefs" href="#bib0530"><span class="elsevierStyleSup">52&#44;53</span></a> suponen una opci&#243;n terap&#233;utica eficaz y segura para el tratamiento de la psoriasis relacionada con la activaci&#243;n inmune&#46;</p></span></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Discusi&#243;n</span><p id="par0200" class="elsevierStylePara elsevierViewall">Para el manejo de la psoriasis en pacientes oncol&#243;gicos&#44; los panelistas recomiendan consensuar con el onc&#243;logo el tratamiento para la psoriasis&#46; Adem&#225;s&#44; mostraron su acuerdo en que la fototerapia con UVA y UVB es adecuada para la psoriasis en pacientes con neoplasias hematol&#243;gicas y no hematol&#243;gicas&#44; activas o inactivas&#44; pero no en pacientes con c&#225;ncer cut&#225;neo &#40;melanoma o no melanoma&#41; o predisposici&#243;n al mismo&#46; Entre los tratamientos sist&#233;micos&#44; la acitretina&#44; el apremilast y los anti-IL-23 y anti-IL-17 se consideran opciones terap&#233;uticas adecuadas para todos los perfiles de pacientes&#44; al contrario que la ciclosporina&#44; considerada inadecuada para cualquier tipo de c&#225;ncer activo o inactivo&#46; En cuanto al resto de las terapias&#44; se consideraron adecuadas o inadecuadas en funci&#243;n del tipo de neoplasia&#44; teniendo en cuenta tanto el posible efecto sobre la progresi&#243;n o inmunovigilancia tumoral como el riesgo de complicaciones infecciosas o efectos adversos que puedan complicar el manejo de estos pacientes&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">En una gu&#237;a elaborada recientemente por un panel multidisciplinar de expertos<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">54</span></a> se recomienda valorar el pron&#243;stico del c&#225;ncer antes de iniciar el tratamiento sist&#233;mico para la psoriasis&#46; As&#237;&#44; para pacientes con un tumor s&#243;lido previo y buen pron&#243;stico&#44; el tratamiento ser&#237;a similar al de un paciente no oncol&#243;gico&#46; En casos de mal pron&#243;stico&#44; se deber&#237;a buscar el equilibrio entre los beneficios del tratamiento para la psoriasis y los posibles riesgos derivados<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">54</span></a>&#46; Por otra parte&#44; en general&#44; se recomiendan los tratamientos t&#243;picos y los biol&#243;gicos&#44; en especial los anti-IL-23 y anti-IL-17 y el ustekinumab&#44; para el tratamiento de la psoriasis que aparece o empeora como un efecto adverso inmunomediado de los inhibidores de <span class="elsevierStyleItalic">checkpoint</span>&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">El presente estudio presenta algunas limitaciones inherentes a la metodolog&#237;a empleada&#44; donde el consenso se sustenta principalmente en la experiencia de los participantes&#46; Adem&#225;s&#44; la aplicaci&#243;n de estas recomendaciones debe contextualizarse en cada caso concreto&#44; y dentro del sistema sanitario espa&#241;ol&#46; No obstante&#44; cabe rese&#241;ar que el consenso ha sido alcanzado entre un n&#250;mero considerable de especialistas de &#225;mbito hospitalario&#44; con experiencia en el manejo de estos pacientes y con representaci&#243;n de casi todas las comunidades aut&#243;nomas&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el consenso alcanzado y las recomendaciones propuestas sobre el manejo y tratamiento de la psoriasis en pacientes oncol&#243;gicos pueden ayudar en la toma de decisiones en la pr&#225;ctica cl&#237;nica habitual&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Financiaci&#243;n</span><p id="par0220" class="elsevierStylePara elsevierViewall">El proyecto ha sido financiado con una beca no restringida de Almirall&#46; Ning&#250;n miembro de la compa&#241;&#237;a ha participado en el desarrollo del proyecto&#44; la discusi&#243;n o la redacci&#243;n del contenido&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflicto de intereses</span><p id="par0225" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">L&#46; Puig</span> ha percibido honorarios como consultor o conferenciante&#44; y ha participado en ensayos cl&#237;nicos patrocinados por AbbVie&#44; Almirall&#44; Amgen&#44; Biogen&#44; Boehringer Ingelheim&#44; Bristol Myers Squibb&#44; Dice&#44; J&#38;J Innovative Medicine&#44; Leo-Pharma&#44; Lilly&#44; Novartis&#44; Pfizer&#44; Sandoz&#44; Sanofi y UCB&#46; <span class="elsevierStyleItalic">P&#46; de la Cueva</span> ha actuado como consultor y&#47;o ponente y&#47;o investigador para J&#38;J Innovative Medicine&#44; AbbVie&#44; MSD&#44; Pfizer&#44; Novartis&#44; Lilly&#44; Almirall&#44; UCB&#44; Biogen&#44; Celgene&#44; Amgen&#44; Sandoz&#44; Boehringer Ingelheim&#44; Sanofi y Leo-Pharma&#46; <span class="elsevierStyleItalic">A&#46; L&#243;pez-Ferrer</span> ha participado como consultora y&#47;o ponente y&#47;o investigadora para AbbVie&#44; Almirall&#44; Amgen&#44; Boehringer Ingelheim&#44; Bristol Myers Squibb&#44; J&#38;J Innovative Medicine&#44; Leo-Pharma&#44; Lilly&#44; Novartis y UCB&#46; <span class="elsevierStyleItalic">B&#46; P&#233;rez Su&#225;rez</span> ha percibido honorarios como consultora o conferenciante y ha participado en ensayos cl&#237;nicos patrocinados por AbbVie&#44; Almirall&#44; Amgen&#44; Boehringer Ingelheim&#44; Bristol Myers Squibb&#44; J&#38;J Innovative Medicine&#44; Leo-Pharma&#44; Lilly&#44; Novartis y UCB&#46; <span class="elsevierStyleItalic">C&#46; Galache</span> ha percibido honorarios como conferenciante de Amgen&#44; Celgene&#44; Novartis y Sanofi&#46; <span class="elsevierStyleItalic">J&#46; Notario</span> ha percibido honorarios como consultor y&#47;o ponente y&#47;o investigador para AbbVie&#44; Almirall&#44; Amgen&#44; Boehringer Ingelheim&#44; Bristol Myers Squibb&#44; J&#38;J Innovative Medicine&#44; Leo-Pharma&#44; Lilly&#44; Novartis&#44; Pfizer&#44; Sanofi y UCB&#46; <span class="elsevierStyleItalic">JM&#46; Carrascosa</span> ha participado como consultor y&#47;o ponente y&#47;o investigador para AbbVie&#44; Almirall&#44; Amgen&#44; Boehringer Ingelheim&#44; Bristol Myers Squibb&#44; J&#38;J Innovative Medicine&#44; Leo-Pharma&#44; Lilly&#44; Novartis y UCB&#46;</p></span></span>"
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              "titulo" => "Cribado y detecci&#243;n precoz del c&#225;ncer en el paciente con psoriasis"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Diversos estudios sugieren que los pacientes con psoriasis tienen un mayor riesgo de aparici&#243;n de neoplasias&#44; especialmente cut&#225;neas&#44; lo que podr&#237;a estar asociado al uso de terapias para tratar la enfermedad&#46; Adem&#225;s&#44; la evidencia disponible sobre la seguridad de algunos tratamientos en este contexto y el manejo de estos pacientes es escasa&#46; As&#237;&#44; las gu&#237;as de pr&#225;ctica cl&#237;nica con recomendaciones para el manejo de la psoriasis en el paciente oncol&#243;gico son ambiguas&#46; En el presente trabajo se recogen recomendaciones para el manejo y el uso de las terapias disponibles para estos pacientes&#46; Estas recomendaciones han sido consensuadas por 45 dermat&#243;logos del Grupo de Psoriasis de la Academia Espa&#241;ola de Dermatolog&#237;a y Venereolog&#237;a utilizando el m&#233;todo Delphi&#44; y tienen por objetivo ayudar a los especialistas en la toma de decisiones en la pr&#225;ctica cl&#237;nica&#46;</p></span>"
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        "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Several studies suggest that patients with psoriasis have a higher incidence of neoplasms&#44; especially of the skin&#44; which could be associated with the use of therapies to treat psoriasis&#46; Furthermore&#44; the evidence available on the safety profile of some treatments in this context&#44; and the management of these patients is scarce&#44; which is why clinical practice guidelines with recommendations on the management of psoriasis in cancer patients are ambiguous&#46; This study provides recommendations on the management and use of the therapies currently available for these patients&#46; They are the result of a Delphi consensus reached by 45 dermatologists of the Spanish Academy of Dermatology and Venereology Psoriasis Working Group&#44; whose goal is to help specialists in the field in their decision-making processes&#46;</p></span>"
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                  \t\t\t\t">51&#44;0 &#40;45&#44;0-58&#44;0&#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="elsevierStyleItalic">Sexo &#40;hombre&#41;&#58; n &#40;&#37;&#41;</span>&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">24 &#40;53&#44;3&#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="elsevierStyleItalic">Experiencia previa &#40;a&#241;os&#41;&#58; mediana &#40;RI&#41;</span>&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">20&#44;0 &#40;15&#44;0-29&#44;0&#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="elsevierStyleItalic">Nivel asistencial&#58; n &#40;&#37;&#41;</span>&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"><span class="elsevierStyleHsp" style=""></span>Segundo nivel &#40;centros de especialidades y hospitales de &#225;rea&#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">10 &#40;22&#44;2&#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>Tercer nivel &#40;hospitales de referencia&#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">35 &#40;77&#44;8&#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="elsevierStyleItalic">Pacientes visitados&#47;mes&#58; mediana &#40;RI&#41;</span>&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">80&#44;0 &#40;55&#44;0-100&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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          "es" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Variables sociodemogr&#225;ficas y profesionales de los participantes</p>"
        ]
      ]
      3 => array:8 [
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        "etiqueta" => "Tabla 2"
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          0 => array:3 [
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            "rol" => "short"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0021" class="elsevierStyleSimplePara elsevierViewall">Celdas en gris&#58; consenso alcanzado&#46;</p>"
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            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">&#205;tem&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">&#37;&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&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">Se recomienda aconsejar al paciente con psoriasis seguir las campa&#241;as generales de detecci&#243;n precoz de c&#225;ncer seg&#250;n edad y sexo &#40;p&#46; ej&#46;&#44; detecci&#243;n de c&#225;ncer de mama y c&#225;ncer de colon&#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">91&#44;1<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</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="" 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">Cribado y detecci&#243;n precoz del c&#225;ncer en el paciente con psoriasis&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">C&#225;ncer cut&#225;neo&#44; no melanoma&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">Melanoma&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">Otras neoplasias s&#243;lidas y hematol&#243;gicas&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">Se recomienda realizar un cribado activo en pacientes con psoriasis para la detecci&#243;n de&#8230;&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">77&#44;8<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</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">68&#44;9<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</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">45&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Consenso sobre el cribado y detecci&#243;n precoz del c&#225;ncer en pacientes oncol&#243;gicos con psoriasis</p>"
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      4 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
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            "detalle" => "Tabla "
            "rol" => "short"
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          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Cut-nM&#58; c&#225;ncer cut&#225;neo no melanoma&#59; Ha&#58; neoplasia hematol&#243;gica activa&#59; Hi&#58; neoplasia hematol&#243;gica no activa&#59; nHa&#58; neoplasia no hematol&#243;gica activa &#40;incluyendo melanoma&#41;&#59; nHi&#58; neoplasia no hematol&#243;gica no activa &#40;incluyendo melanoma&#41;&#46; Celdas en gris&#58; consenso alcanzado&#46; Valores en negrita&#58; consenso en contra&#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-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&#205;tem&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  " colspan="5" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;</th></tr><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">Tratamiento en el paciente oncol&#243;gico con psoriasis&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">Cut-nM&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">Ha&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">Hi&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">nHa&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">nHi&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"><span class="elsevierStyleHsp" style=""></span>Se recomienda consensuar con el onc&#243;logo el tratamiento para la psoriasis en pacientes con c&#225;ncer activo&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">91&#44;1<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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="" 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"><span class="elsevierStyleItalic">Fototerapia</span>&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"><span class="elsevierStyleHsp" style=""></span>La fototerapia PUVA es una opci&#243;n terap&#233;utica adecuada en pacientes con psoriasis y&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="elsevierStyleBold">91&#44;1</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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">66&#44;7<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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">73&#44;3<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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"><span class="elsevierStyleBold">77&#44;8</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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"><span class="elsevierStyleBold">86&#44;1</span>&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>La fototerapia UVB es una opci&#243;n terap&#233;utica adecuada en pacientes con psoriasis y&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="elsevierStyleBold">75&#44;5</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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">77&#44;8<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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">84&#44;5<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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"><span class="elsevierStyleBold">86&#44;1</span>&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="elsevierStyleBold">69&#44;5</span>&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>La ciclosporina es una opci&#243;n terap&#233;utica adecuada de manera concomitante con fototerapia en pacientes con psoriasis y&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"><span class="elsevierStyleBold">95&#44;6</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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="" 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"><span class="elsevierStyleItalic">Tratamiento sist&#233;mico no biol&#243;gico</span>&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"><span class="elsevierStyleHsp" style=""></span>La ciclosporina es una opci&#243;n terap&#233;utica adecuada en pacientes con psoriasis y&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="elsevierStyleBold">80&#44;0</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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"><span class="elsevierStyleBold">97&#44;8</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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"><span class="elsevierStyleBold">86&#44;6</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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"><span class="elsevierStyleBold">97&#44;8</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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"><span class="elsevierStyleBold">88&#44;9</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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"><span class="elsevierStyleHsp" style=""></span>El dimetilfumarato es una opci&#243;n terap&#233;utica adecuada en pacientes con psoriasis y&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">68&#44;9<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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">58&#44;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#44;7&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">69&#44;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#44;8&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>La acitretina es una opci&#243;n terap&#233;utica adecuada en pacientes con psoriasis y&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">100&#44;0<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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">97&#44;7<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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">93&#44;3<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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">97&#44;7<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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">97&#44;8<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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"><span class="elsevierStyleHsp" style=""></span>El apremilast es una opci&#243;n terap&#233;utica adecuada en pacientes con psoriasis y&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">95&#44;6<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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">80&#44;0<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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">93&#44;3<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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">86&#44;7<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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">95&#44;5<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</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"><span class="elsevierStyleHsp" style=""></span>El metotrexato es una opci&#243;n terap&#233;utica adecuada en pacientes con psoriasis y&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">63&#44;8&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="elsevierStyleBold">72&#44;2</span>&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">61&#44;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"><span class="elsevierStyleBold">61&#44;1</span>&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">63&#44;8&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="elsevierStyleItalic">Tratamientos biol&#243;gicos</span>&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"><span class="elsevierStyleHsp" style=""></span>El adalimumab es una opci&#243;n terap&#233;utica adecuada en pacientes con psoriasis y&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&#44;0&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="elsevierStyleBold">86&#44;1</span>&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="elsevierStyleBold">61&#44;1</span>&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="elsevierStyleBold">77&#44;8</span>&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">38&#44;9&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>El certolizumab es una opci&#243;n terap&#233;utica adecuada en pacientes con psoriasis y&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">52&#44;8&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="elsevierStyleBold">80&#44;5</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">52&#44;8</span>&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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                  \t\t\t\t"><span class="elsevierStyleBold">75&#44;0</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30&#44;6&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>El etanercept es una opci&#243;n terap&#233;utica adecuada en pacientes con psoriasis y&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \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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                  \t\t\t\t"><span class="elsevierStyleBold">63&#44;9</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44&#44;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>El infliximab es una opci&#243;n terap&#233;utica adecuada en pacientes con psoriasis y&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">73&#44;3</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">58&#44;3</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>El ustekinumab es una opci&#243;n terap&#233;utica adecuada en pacientes con psoriasis y&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">77&#44;8<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Los anti-IL-23 son una opci&#243;n terap&#233;utica adecuada en pacientes con psoriasis y&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93&#44;4<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">66&#44;7<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93&#44;3<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Los anti-IL-17 son una opci&#243;n terap&#233;utica adecuada en pacientes con psoriasis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">&#205;tem&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#43;Hepatitis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#43;Endocrinopat&#237;as&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Los tratamientos t&#243;picos son una opci&#243;n terap&#233;utica adecuada en pacientes oncol&#243;gicos tratados con inhibidores de <span class="elsevierStyleItalic">checkpoint</span>&#44; que han desarrollado o exacerbado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93&#44;9<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">81&#44;9<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">78&#44;8<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">78&#44;8<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">78&#44;8<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</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
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                  \t\t\t\t">Los sist&#233;micos convencionales son una opci&#243;n terap&#233;utica adecuada en pacientes oncol&#243;gicos tratados con inhibidores de <span class="elsevierStyleItalic">checkpoint</span>&#44; que han desarrollado o exacerbado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Los biol&#243;gicos son una opci&#243;n terap&#233;utica adecuada en pacientes oncol&#243;gicos tratados con inhibidores de <span class="elsevierStyleItalic">checkpoint</span>&#44; que han desarrollado o exacerbado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">70&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">73&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">nHi&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \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
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \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
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                  \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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" 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="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento sist&#233;mico no 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>Ciclosporina&nbsp;\t\t\t\t\t\t\n
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                  \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
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                  \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
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                  \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>Dimetilfumarato&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \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
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                  \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"><span class="elsevierStyleHsp" style=""></span>Acitretina&nbsp;\t\t\t\t\t\t\n
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                  \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
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                  \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"><span class="elsevierStyleHsp" style=""></span>Apremilast&nbsp;\t\t\t\t\t\t\n
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                  \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"><span class="elsevierStyleHsp" style=""></span>Metotrexato&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">-&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">-&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">-&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="6" 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="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamientos biol&#243;gicos</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>Adalimumab&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">-&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">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \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
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                  \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"><span class="elsevierStyleHsp" style=""></span>Certolizumab&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">-&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">-&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">-&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>Etanercept&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
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                  \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
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infliximab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" 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
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                  \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">-&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>Ustekinumab&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
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                  \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
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \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
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                  \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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anti-IL-23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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