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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction and objectives</span><p id="par0005" class="elsevierStylePara elsevierViewall">Psoriasis is a chronic inflammatory immune-mediated systemic disease manifesting in the skin&#44; joints&#44; or both&#44; which is commonly associated with several important medical conditions including mood disorders&#44; chronic kidney disease and cardiometabolic syndrome&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a> Interleukin &#40;IL&#41;23&#47;IL-17 axis&#44; and IL-17 producing cells play a major role in the development of psoriasis&#46; Immune checkpoint blockade of these cytokines and tumour necrosis factor alpha &#40;TNF&#945;&#41; provided by biological therapies has revolutionized the management of severe chronic plaque psoriasis&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Tildrakizumab is a humanized IgG1&#47;&#954; type monoclonal antibody that selectively targets the p19 subunit of the cytokine interleukin 23 &#40;IL-23&#41;&#46; It was approved in 2018 to treat patients with moderate-to-severe cutaneous psoriasis by the main regulatory agencies &#40;both the U&#46;S&#46; Food and Drug Administration &#91;FDA&#93; and the European Medicines Agency &#91;EMA&#93;&#41;&#46; However&#44; only the latter approved its use at a dose of 200<span class="elsevierStyleHsp" style=""></span>mg in patients &#62;90<span class="elsevierStyleHsp" style=""></span>kg&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">2</span></a> The short- and long-term safety efficacy of tildrakizumab have been evaluated in two randomized phase III&#44; multicenter&#44; double blinded&#44; placebo-controlled landmark trials &#40;reSURFACE 1 and 2&#41;&#44; while etanercept &#40;reSURFACE 2&#41; has been studied in patients with moderate-to-severe plaque psoriasis eligible for systemic or advanced therapies&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3&#8211;5</span></a> The regulatory approval of medical drugs is based on strict randomized clinical trials &#40;RCT&#41;&#46; Still&#44; long-term non-interventional studies are needed to determine the safety and efficacy profile in the real-world practice to bridge the gap between RCT and the routine clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> Although&#44; in the past few years&#44; some authors<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">2&#44;5&#8211;10</span></a> have demonstrated the short- and mid-term real-world safety and efficacy profile of tildrakizumab in the management of plaque psoriasis&#44; including difficult-to-treat-areas<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> more studies are still needed&#46; The aim of this study is to evaluate the short- and mid-term safety&#44; efficacy&#44; tolerability&#44; and survival of tildrakizumab in our cohort and compare the results obtained with those previously reported in other real-world series and RCT&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Materials and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">We conducted a multicentric&#44; non-interventional&#44; observational&#44; and retrospective study among 13 hospitals from the Valencian community&#44; Spain and followed patients of our routine clinical practice from January 2020 through January 2022&#46; Patients included were adults with moderate-to-severe cutaneous psoriasis eligible for systemic treatment&#44; including special areas&#46; Participants were followed for up to 52 weeks&#46; At baseline SC tildrakizumab 100<span class="elsevierStyleHsp" style=""></span>mg was administered on weeks 0 and 4&#44; followed by a maintenance dose every 12 weeks&#46; Cohort monitoring was performed at baseline and on weeks 4&#44; 12&#44; 28&#44; 36 and 52&#44; when available&#46; Demographic data&#44; previous systemic therapies and the study variables measured are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Disease severity and tildrakizumab response were assessed using the Psoriasis Area and Severity Index &#40;PASI&#41;&#44; and the Dermatology Life Quality Index &#40;DLQI&#41;&#46; Disease control<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a> was confirmed after reaching an absolute PASI &#8804;3 in plaque psoriasis&#44; or PGA &#8804;1 in difficult-to-treat sites on weeks 4&#44; 12&#44; 24&#44; 36 and 52&#44; when available&#46; The safety and tolerability of tildrakizumab were evaluated at the follow-up&#46; No substitution tools were used for missing data&#46; Quantitative variables were expressed as mean and standard deviation &#40;SD&#41;&#44; and the qualitative ones as frequencies&#46; Log-rank test was used to compare tildrakizumab efficacy and survival time in non-obese &#91;body mass index &#40;BMI&#41; &#60;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#93; vs obese patients &#40;BMI &#62;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; presence vs absence of psoriatic arthritis&#44; age older or younger than 65 years&#44; presence or absence of metabolic syndrome&#44; biological therapy-na&#239;ve vs experienced subjects&#44; and the number of previous courses of biological therapies received&#46; Cox regression models were used to study the potential relationship between drug survival and patient&#39;s age&#44; weight&#44; presence of psoriatic arthritis&#44; presence of metabolic syndrome and previous biological therapies used&#46; Overall survival was estimated using the Kaplan&#8211;Meier curves&#46; Missing data was managed as observed&#46; Odds ratios &#40;OR&#41; were reported&#44; and <span class="elsevierStyleItalic">P</span> values &#60;&#46;05 were considered statistically significant&#46; Any reason associated with drug discontinuation was reported and considered in the analysis&#46; Analyses were performed using IBM SPSS v21&#46;0 statistical software package &#40;Armonk&#44; NY&#44; United States&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0020" class="elsevierStylePara elsevierViewall">A total of 91 patients &#40;53 men&#41; with moderate-to-severe psoriasis treated with tildrakizumab were included&#46; Baseline characteristics of the cohort are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The participants&#8217; mean age was 50&#46;6 &#40;SD&#44; 15&#46;5&#41;&#46; The mean psoriasis history since diagnosis was 14&#46;8 years &#40;SD&#44; 10&#46;8&#41;&#44; and the mean BMI&#44; 30&#46;26 &#40;SD&#44; 7&#46;7&#41;&#46; A total of 35 patients &#40;45&#46;5&#37;&#41; were obese and 30 subjects &#40;35&#46;7&#37;&#41; were smokers&#46; Regarding psoriasis phenotypes&#44; 85&#46;7&#37; of the patients showed classical psoriasis plaques&#44; while considering only psoriasis in hard-to-treat-areas&#59; scalp&#44; nail&#44; palmoplantar and genital involvement was present in 28&#46;7&#37;&#44; 16&#46;1&#37;&#44; 8&#37; and 6&#46;9&#37; of the study participants&#44; respectively&#46; Only one patient showed erythrodermic psoriasis&#46; Among the comorbidities evaluated&#44; only 10 patients &#40;11&#46;4&#37;&#41; had psoriatic arthritis&#46; Regarding cardiovascular risk factors&#44; 35&#46;2&#37;&#44; 13&#46;8&#37;&#44; 44&#46;3&#37; and 29&#46;5&#37; of the patients had arterial hypertension&#44; diabetes&#44; dyslipidemia&#44; and metabolic syndrome&#44; respectively&#46; Mood disorders &#40;depression or anxiety&#41; were presents in 25 patients &#40;27&#46;2&#37;&#41;&#46; Three patients had a past medical history of neoplasm&#44; but did not relapse while on therapy&#46; Additionally&#44; 17 patients were diagnosed of latent tuberculosis &#40;TB&#41; infection &#40;16 of them were on chemoprophylaxis&#41;&#44; while no patients developed active infections&#46; The prevalence of main comorbidities and other psoriasis-related diseases is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Methotrexate was the most widely used &#40;65&#37;&#41; classical systemic treatment&#46; A total of 28 patients &#40;30&#46;7&#37;&#41; were biological therapy-na&#239;ve vs 41 &#40;45&#46;1&#37;&#41; and 15 &#40;16&#46;5&#37;&#41; participants who had previously received&#44; at least&#44; 1 and 2 courses of biological therapies&#44; respectively&#46; Adalimumab was the most previously prescribed biological therapy &#40;29 patients&#44; 31&#46;8&#37;&#41; in the biological therapy-experienced group&#44; followed by etanercept &#40;29&#46;6&#37;&#41; and ustekinumab &#40;18&#46;7&#37;&#41;&#46; Guselkumab therapy had failed in three patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The mean baseline PASI was 9&#46;09 &#40;SD&#44; 5&#46;30&#41;&#44; body surface area was 11&#46;5 &#40;SD&#44; 11&#46;3&#41;&#44; and the Dermatology Life Quality Index &#40;DLQi&#41; was 8&#46;87 &#40;SD&#44; 5&#46;42&#41;&#46; The overall survival rate of tildrakizumab was 93&#46;5&#37; for a mean treatment exposure of 30&#46;2 weeks &#40;SD&#44; 16&#46;6&#41;&#44; with only six drug withdrawals &#40;three secondary failures and three primary failures&#41;&#46; No drug discontinuation was associated with drug tolerability or adverse events&#46; No association was found either between the different variables collected and these withdrawals&#44; such as age&#44; BMI&#44; metabolic syndrome&#44; presence of psoriatic arthritis&#44; or previous experience with biological therapies&#46; On week 28&#44; 91&#46;3&#37; and 71&#46;7&#37; of the 46 patients who came to our office for evaluation&#44; reached absolute PASIs &#8804;3 and &#8804;1&#44; respectively&#44; with a mean DLQI of 1&#46;3 &#40;SD&#44; 2&#46;42&#41;&#46; On treatment week 52&#44; patients who completed that treatment period were assessed &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#41;&#44; 96&#46;5&#37; and 65&#46;2&#37; of whom reached absolute PASIs &#8804;3 and 0&#44; respectively&#44; with a mean DLQI of 0&#46;83 &#40;SD&#44; 1&#46;47&#41;&#46; The mean PASI and DLQi responses on weeks 4&#44; 12 and 36 are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; The overall effectiveness and survival rates associated with age&#44; BMI&#44; metabolic syndrome&#44; presence or absence of psoriatic arthritis&#44; being biological therapy-na&#239;ve or not&#44; and the number of previous biological therapies received were analyzed&#46; Nonsignificant differences were seen in the log-rank-tests &#40;<a class="elsevierStyleCrossRef" href="#sec0040">Supplementary data&#46; Figs&#46; 2A&#47;2B&#44; 3A&#47;3B and 4</a>&#41;&#46; No severe adverse events associated with the administration or exposure to tildrakizumab were reported either&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Patients with moderate-to-severe cutaneous psoriasis treated with tildrakizumab in the routine clinical practice differed significantly from those included in the reSURFACE clinical trials 1&#8211;2&#44;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3&#44;4</span></a> where inclusion criteria were strict&#44; both highly pretreated patients&#44; and commonly excluded fragile participants&#46; Currently&#44; different real-world series assessing the safe and efficacy of tildrakizumab have been published&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">2&#44;5&#8211;10</span></a> Our results are similar to those obtained from previous real-world series&#44; and slightly higher than those obtained from the reSURFACE clinical trials 1&#8211;2 &#40;72&#37; and 43&#37; of the patients included maintained PASI 90 and PASI 100 responses&#44; respectively&#44; on week 52&#41;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3&#8211;5</span></a> and from the Tilot trial&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> The mean PASI in our cohort was lower 9&#46;09 &#40;SD&#44; 5&#46;30&#41; than that reported in the reSURFACE trials &#40;20&#46;5 &#91;SD 7&#46;6&#93;&#41;&#46; However&#44; our number of participants who used biological therapies was higher &#40;69&#46;3&#37; vs 17&#46;9&#37;&#41; and no-washout period was required&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3&#44;4</span></a> Regarding biological therapy-na&#239;ve patients&#44; in our cohort&#44; the rate &#40;30&#46;7&#37;&#41; was higher than that reported by Ruiz-Villaverde et al&#46; &#40;5&#37;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> and lower than that reported by Caldarola et al&#46; &#40;60&#37;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a> and as occurred in these series&#44; in our study&#44; all special differences regarding effectiveness were reported&#46; An interesting piece of information from our series is that three patients who had developed a previous solid malignancy did not experience cancer reactivation at the 52-week follow-up&#46; This patient profile was also reported by Ruiz-Villaverde et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> and Wei et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">2</span></a> but was not included in the RCT&#44; which is why this finding could contribute to reinforce the safe use of this drug in this fragile population&#46; In our series&#44; the overall efficacy and survival were not impacted by age&#44; BMI&#44; metabolic syndrome&#44; presence of psoriatic arthritis&#44; being biological therapy-na&#239;ve or not&#44; or by the number of previous biologicals therapies received&#46; On the other hand&#44; some authors<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> reported that a shorter duration of the disease&#44; scalp involvement and a low number of previous biological therapies could be associated with a great drug survival and better patient outcomes&#46; This high degree of effectiveness was also confirmed in difficult-to-treat-areas&#44; specially scalp and nails&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">6&#44;11&#44;13</span></a> The mean limitation of our study was its retrospective design&#44; lack of control group&#44; and the sample size&#44; although we believe that it is suitable for comparison purposes with other reported real-world series&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="par0030" class="elsevierStylePara elsevierViewall">Based on our own results&#44; tildrakizumab may represent an effective and safe strategy for the management of patients with moderate-to-severe cutaneous psoriasis&#44; including patients with several comorbidities&#46; Future studies should be conducted to assess the effectiveness of tildrakizumab vs other IL-23 inhibitors&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">14&#8211;17</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tildrakizumab is an IL-23-inhibitor that has been approved to treat plaque psoriasis&#46; However&#44; few reports have become available on its efficacy profile in the real-world&#46; Our objective was to study the mid-term efficacy of tildrakizumab in patients with moderate-to-severe psoriasis in the Spanish routine clinical practice setting&#46; This was a retrospective multicenter study that included a total of 91 psoriatic patients on tildrakizumab&#46; The mean Psoriasis Area and Severity Index &#40;PASI&#41; was 9&#46;09 &#40;SD&#44; 5&#46;30&#41;&#46; The overall tildrakizumab survival rate was 93&#46;47&#37; for a mean treatment exposure of 30&#46;18 weeks &#40;SD&#44; 16&#46;57&#41;&#46; No drug discontinuation was associated with drug tolerability&#44; or adverse reactions&#46; Absolute PASI &#8804;3 was reached by 91&#46;3&#37; and 96&#46;5&#37; of the patients on weeks 28 and 52&#44; respectively&#46; Response was not impacted by weight&#44; age &#40;&#62;65&#41;&#44; metabolic syndrome&#44; presence of arthritis&#44; or previous number of biological therapies used&#46; Based on our own experience tildrakizumab is an effective strategy to treat plaque psoriasis and difficult-to-treat-areas&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El tildrakizumab es un inhibidor de la interleucina 23 &#40;IL-23&#41; aprobado para el tratamiento de la psoriasis en placas&#46; Sin embargo&#44; existen pocos estudios acerca de su eficacia en pr&#225;ctica cl&#237;nica&#46; Nuestro objetivo fue analizar la eficacia a medio plazo del tildrakizumab en los pacientes con una psoriasis moderada-grave en la pr&#225;ctica diaria en Espa&#241;a&#46; Se realiz&#243; un estudio multic&#233;ntrico incluyendo a 91 pacientes con psoriasis en tratamiento con tildrakizumab&#46; La media del &#205;ndice de &#193;rea y Gravedad de la Psoriasis &#40;PASI&#41; fue de 9&#44;09 &#40;desviaci&#243;n est&#225;ndar &#91;DE&#93; 5&#44;30&#41;&#46; La supervivencia global al tildrakizumab fue del 93&#44;5&#37; para una exposici&#243;n media al tratamiento de 30&#44;2 semanas &#40;DE 16&#44;6&#41;&#46; No hubo interrupciones relacionadas con la tolerabilidad o efectos&#46; El 91&#44;3&#37; y el 96&#44;5&#37; alcanzaron un PASI &#8804; 3 en las semanas 28 y 52&#44; respectivamente&#46; La respuesta no se vio influida por el peso&#44; la edad &#40;&#62;65&#41;&#44; el s&#237;ndrome metab&#243;lico&#44; la presencia de artritis o el n&#250;mero previo de terapias biol&#243;gicas&#46; En nuestra experiencia&#44; el tildrakizumab es un f&#225;rmaco eficaz para el tratamiento de la psoriasis en placas y las &#225;reas dif&#237;ciles de tratar&#46;</p></span>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Absolut PASI and DLQI evolution from week 0 to week 52&#46; The reduced number of patients seen between weeks 0 and 52 is mainly associated with patients not having reached that phase of the follow-up period yet&#46; Only six patients experienced drug discontinuations&#44; three due to primary failure&#44; and three due to secondary failure&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">BMI&#44; mean &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;26 &#40;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:1.0px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Comorbidities</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><span class="elsevierStyleItalic">Smoking habit</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="char" valign="\n
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                  \t\t\t\t">30 &#40;35&#46;7&#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><span class="elsevierStyleItalic">Psoriatic arthritis</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;11&#46;4&#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><span class="elsevierStyleItalic">Hypertension</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;35&#46;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><span class="elsevierStyleItalic">Diabetes</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;13&#46;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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dyslipidemia</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;44&#46;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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Metabolic syndrome</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;29&#46;5&#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><span class="elsevierStyleItalic">Non-fatty liver disease</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;21&#46;7&#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><span class="elsevierStyleItalic">Cancer history</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;3&#46;5&#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><span class="elsevierStyleItalic">Latent tuberculosis infection</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;18&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:1.0px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Time since psoriasis diagnosis &#40;years&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;86 &#40;10&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:1.0px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Previous biologic treatment</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Treatments</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><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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;29&#46;6&#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><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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;31&#46;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="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Infliximab&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#46;1&#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><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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;18&#46;7&#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><span class="elsevierStyleHsp" style=""></span>Secukinumab&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;12&#46;1&#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><span class="elsevierStyleHsp" style=""></span>Ixekizumab&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;5&#46;4&#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><span class="elsevierStyleHsp" style=""></span>Brodalumab&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#46;1&#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><span class="elsevierStyleHsp" style=""></span>Guselkumab&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Lines of treatment</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><span class="elsevierStyleHsp" style=""></span>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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;30&#46;7&#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><span class="elsevierStyleHsp" style=""></span>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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;45&#46;1&#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><span class="elsevierStyleHsp" style=""></span>&#8805;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;32&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                            0 => "C&#46;E&#46;M&#46; Griffiths"
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                            2 => "J&#46;E&#46; Gudjonsson"
                            3 => "J&#46;N&#46;W&#46;N&#46; Barker"
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                      "doi" => "10.1016/S0140-6736(20)32549-6"
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                        "tituloSerie" => "Lancet"
                        "fecha" => "2021"
                        "volumen" => "397"
                        "paginaInicial" => "1301"
                        "paginaFinal" => "1315"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33812489"
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                    0 => array:2 [
                      "titulo" => "Retrospective analysis in patients with moderate to severe plaque psoriasis treated with tildrakizumab&#58; real-life clinical data"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46;W&#46; Wei"
                            1 => "S&#46; Chi"
                            2 => "M&#46;G&#46; Lebwohl"
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                      ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Psoriasis Psoriatic Arthritis"
                        "fecha" => "2022"
                        "volumen" => "7"
                        "paginaInicial" => "55"
                        "paginaFinal" => "59"
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Brief Comunication
52-Week Mid-term Efficacy of Tildrakizumab in Moderate-to-severe Psoriasis: A Real-life Multicenter Experience
Eficacia a medio plazo (52 semanas) de tildrakizumab en el tratamiento de la psoriasis moderada a severa: un estudio multicéntrico de práctica clínica
F.J. Melgosa Ramosa,
Corresponding author
javimelgo@gmail.com

Corresponding author.
, A. Mateu Puchadesa, J. Matáix-Díazb, L. Schneller-Pavelescuc, I. Belinchón-Romerod, S. Santos Alarcóne
a Department of Dermatology, University Hospital Doctor Peset of Valencia, Valencia, Spain
b Department of Dermatology, Hospital Marina Alta, Vila-Joyosa, Alicante, Spain
c Department of Dermatology, Hospital de la Vega Baja, Orihuela, Alicante, Spain
d Department of Dermatology, General University Hospital of Alicante, Alicante, Spain
e Department of Dermatology, University Hospital Virgen de los Lirios, Alcoy, Alicante, Spain
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type monoclonal antibody that selectively targets the p19 subunit of the cytokine interleukin 23 &#40;IL-23&#41;&#46; It was approved in 2018 to treat patients with moderate-to-severe cutaneous psoriasis by the main regulatory agencies &#40;both the U&#46;S&#46; Food and Drug Administration &#91;FDA&#93; and the European Medicines Agency &#91;EMA&#93;&#41;&#46; However&#44; only the latter approved its use at a dose of 200<span class="elsevierStyleHsp" style=""></span>mg in patients &#62;90<span class="elsevierStyleHsp" style=""></span>kg&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">2</span></a> The short- and long-term safety efficacy of tildrakizumab have been evaluated in two randomized phase III&#44; multicenter&#44; double blinded&#44; placebo-controlled landmark trials &#40;reSURFACE 1 and 2&#41;&#44; while etanercept &#40;reSURFACE 2&#41; has been studied in patients with moderate-to-severe plaque psoriasis eligible for systemic or advanced therapies&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3&#8211;5</span></a> The regulatory approval of medical drugs is based on strict randomized clinical trials &#40;RCT&#41;&#46; Still&#44; long-term non-interventional studies are needed to determine the safety and efficacy profile in the real-world practice to bridge the gap between RCT and the routine clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> Although&#44; in the past few years&#44; some authors<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">2&#44;5&#8211;10</span></a> have demonstrated the short- and mid-term real-world safety and efficacy profile of tildrakizumab in the management of plaque psoriasis&#44; including difficult-to-treat-areas<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">11</span></a> more studies are still needed&#46; The aim of this study is to evaluate the short- and mid-term safety&#44; efficacy&#44; tolerability&#44; and survival of tildrakizumab in our cohort and compare the results obtained with those previously reported in other real-world series and RCT&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Materials and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">We conducted a multicentric&#44; non-interventional&#44; observational&#44; and retrospective study among 13 hospitals from the Valencian community&#44; Spain and followed patients of our routine clinical practice from January 2020 through January 2022&#46; Patients included were adults with moderate-to-severe cutaneous psoriasis eligible for systemic treatment&#44; including special areas&#46; Participants were followed for up to 52 weeks&#46; At baseline SC tildrakizumab 100<span class="elsevierStyleHsp" style=""></span>mg was administered on weeks 0 and 4&#44; followed by a maintenance dose every 12 weeks&#46; Cohort monitoring was performed at baseline and on weeks 4&#44; 12&#44; 28&#44; 36 and 52&#44; when available&#46; Demographic data&#44; previous systemic therapies and the study variables measured are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Disease severity and tildrakizumab response were assessed using the Psoriasis Area and Severity Index &#40;PASI&#41;&#44; and the Dermatology Life Quality Index &#40;DLQI&#41;&#46; Disease control<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">12</span></a> was confirmed after reaching an absolute PASI &#8804;3 in plaque psoriasis&#44; or PGA &#8804;1 in difficult-to-treat sites on weeks 4&#44; 12&#44; 24&#44; 36 and 52&#44; when available&#46; The safety and tolerability of tildrakizumab were evaluated at the follow-up&#46; No substitution tools were used for missing data&#46; Quantitative variables were expressed as mean and standard deviation &#40;SD&#41;&#44; and the qualitative ones as frequencies&#46; Log-rank test was used to compare tildrakizumab efficacy and survival time in non-obese &#91;body mass index &#40;BMI&#41; &#60;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#93; vs obese patients &#40;BMI &#62;30<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#44; presence vs absence of psoriatic arthritis&#44; age older or younger than 65 years&#44; presence or absence of metabolic syndrome&#44; biological therapy-na&#239;ve vs experienced subjects&#44; and the number of previous courses of biological therapies received&#46; Cox regression models were used to study the potential relationship between drug survival and patient&#39;s age&#44; weight&#44; presence of psoriatic arthritis&#44; presence of metabolic syndrome and previous biological therapies used&#46; Overall survival was estimated using the Kaplan&#8211;Meier curves&#46; Missing data was managed as observed&#46; Odds ratios &#40;OR&#41; were reported&#44; and <span class="elsevierStyleItalic">P</span> values &#60;&#46;05 were considered statistically significant&#46; Any reason associated with drug discontinuation was reported and considered in the analysis&#46; Analyses were performed using IBM SPSS v21&#46;0 statistical software package &#40;Armonk&#44; NY&#44; United States&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0020" class="elsevierStylePara elsevierViewall">A total of 91 patients &#40;53 men&#41; with moderate-to-severe psoriasis treated with tildrakizumab were included&#46; Baseline characteristics of the cohort are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The participants&#8217; mean age was 50&#46;6 &#40;SD&#44; 15&#46;5&#41;&#46; The mean psoriasis history since diagnosis was 14&#46;8 years &#40;SD&#44; 10&#46;8&#41;&#44; and the mean BMI&#44; 30&#46;26 &#40;SD&#44; 7&#46;7&#41;&#46; A total of 35 patients &#40;45&#46;5&#37;&#41; were obese and 30 subjects &#40;35&#46;7&#37;&#41; were smokers&#46; Regarding psoriasis phenotypes&#44; 85&#46;7&#37; of the patients showed classical psoriasis plaques&#44; while considering only psoriasis in hard-to-treat-areas&#59; scalp&#44; nail&#44; palmoplantar and genital involvement was present in 28&#46;7&#37;&#44; 16&#46;1&#37;&#44; 8&#37; and 6&#46;9&#37; of the study participants&#44; respectively&#46; Only one patient showed erythrodermic psoriasis&#46; Among the comorbidities evaluated&#44; only 10 patients &#40;11&#46;4&#37;&#41; had psoriatic arthritis&#46; Regarding cardiovascular risk factors&#44; 35&#46;2&#37;&#44; 13&#46;8&#37;&#44; 44&#46;3&#37; and 29&#46;5&#37; of the patients had arterial hypertension&#44; diabetes&#44; dyslipidemia&#44; and metabolic syndrome&#44; respectively&#46; Mood disorders &#40;depression or anxiety&#41; were presents in 25 patients &#40;27&#46;2&#37;&#41;&#46; Three patients had a past medical history of neoplasm&#44; but did not relapse while on therapy&#46; Additionally&#44; 17 patients were diagnosed of latent tuberculosis &#40;TB&#41; infection &#40;16 of them were on chemoprophylaxis&#41;&#44; while no patients developed active infections&#46; The prevalence of main comorbidities and other psoriasis-related diseases is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Methotrexate was the most widely used &#40;65&#37;&#41; classical systemic treatment&#46; A total of 28 patients &#40;30&#46;7&#37;&#41; were biological therapy-na&#239;ve vs 41 &#40;45&#46;1&#37;&#41; and 15 &#40;16&#46;5&#37;&#41; participants who had previously received&#44; at least&#44; 1 and 2 courses of biological therapies&#44; respectively&#46; Adalimumab was the most previously prescribed biological therapy &#40;29 patients&#44; 31&#46;8&#37;&#41; in the biological therapy-experienced group&#44; followed by etanercept &#40;29&#46;6&#37;&#41; and ustekinumab &#40;18&#46;7&#37;&#41;&#46; Guselkumab therapy had failed in three patients &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The mean baseline PASI was 9&#46;09 &#40;SD&#44; 5&#46;30&#41;&#44; body surface area was 11&#46;5 &#40;SD&#44; 11&#46;3&#41;&#44; and the Dermatology Life Quality Index &#40;DLQi&#41; was 8&#46;87 &#40;SD&#44; 5&#46;42&#41;&#46; The overall survival rate of tildrakizumab was 93&#46;5&#37; for a mean treatment exposure of 30&#46;2 weeks &#40;SD&#44; 16&#46;6&#41;&#44; with only six drug withdrawals &#40;three secondary failures and three primary failures&#41;&#46; No drug discontinuation was associated with drug tolerability or adverse events&#46; No association was found either between the different variables collected and these withdrawals&#44; such as age&#44; BMI&#44; metabolic syndrome&#44; presence of psoriatic arthritis&#44; or previous experience with biological therapies&#46; On week 28&#44; 91&#46;3&#37; and 71&#46;7&#37; of the 46 patients who came to our office for evaluation&#44; reached absolute PASIs &#8804;3 and &#8804;1&#44; respectively&#44; with a mean DLQI of 1&#46;3 &#40;SD&#44; 2&#46;42&#41;&#46; On treatment week 52&#44; patients who completed that treatment period were assessed &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#41;&#44; 96&#46;5&#37; and 65&#46;2&#37; of whom reached absolute PASIs &#8804;3 and 0&#44; respectively&#44; with a mean DLQI of 0&#46;83 &#40;SD&#44; 1&#46;47&#41;&#46; The mean PASI and DLQi responses on weeks 4&#44; 12 and 36 are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; The overall effectiveness and survival rates associated with age&#44; BMI&#44; metabolic syndrome&#44; presence or absence of psoriatic arthritis&#44; being biological therapy-na&#239;ve or not&#44; and the number of previous biological therapies received were analyzed&#46; Nonsignificant differences were seen in the log-rank-tests &#40;<a class="elsevierStyleCrossRef" href="#sec0040">Supplementary data&#46; Figs&#46; 2A&#47;2B&#44; 3A&#47;3B and 4</a>&#41;&#46; No severe adverse events associated with the administration or exposure to tildrakizumab were reported either&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Patients with moderate-to-severe cutaneous psoriasis treated with tildrakizumab in the routine clinical practice differed significantly from those included in the reSURFACE clinical trials 1&#8211;2&#44;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3&#44;4</span></a> where inclusion criteria were strict&#44; both highly pretreated patients&#44; and commonly excluded fragile participants&#46; Currently&#44; different real-world series assessing the safe and efficacy of tildrakizumab have been published&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">2&#44;5&#8211;10</span></a> Our results are similar to those obtained from previous real-world series&#44; and slightly higher than those obtained from the reSURFACE clinical trials 1&#8211;2 &#40;72&#37; and 43&#37; of the patients included maintained PASI 90 and PASI 100 responses&#44; respectively&#44; on week 52&#41;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3&#8211;5</span></a> and from the Tilot trial&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">6</span></a> The mean PASI in our cohort was lower 9&#46;09 &#40;SD&#44; 5&#46;30&#41; than that reported in the reSURFACE trials &#40;20&#46;5 &#91;SD 7&#46;6&#93;&#41;&#46; However&#44; our number of participants who used biological therapies was higher &#40;69&#46;3&#37; vs 17&#46;9&#37;&#41; and no-washout period was required&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">3&#44;4</span></a> Regarding biological therapy-na&#239;ve patients&#44; in our cohort&#44; the rate &#40;30&#46;7&#37;&#41; was higher than that reported by Ruiz-Villaverde et al&#46; &#40;5&#37;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> and lower than that reported by Caldarola et al&#46; &#40;60&#37;&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">10</span></a> and as occurred in these series&#44; in our study&#44; all special differences regarding effectiveness were reported&#46; An interesting piece of information from our series is that three patients who had developed a previous solid malignancy did not experience cancer reactivation at the 52-week follow-up&#46; This patient profile was also reported by Ruiz-Villaverde et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> and Wei et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">2</span></a> but was not included in the RCT&#44; which is why this finding could contribute to reinforce the safe use of this drug in this fragile population&#46; In our series&#44; the overall efficacy and survival were not impacted by age&#44; BMI&#44; metabolic syndrome&#44; presence of psoriatic arthritis&#44; being biological therapy-na&#239;ve or not&#44; or by the number of previous biologicals therapies received&#46; On the other hand&#44; some authors<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">5</span></a> reported that a shorter duration of the disease&#44; scalp involvement and a low number of previous biological therapies could be associated with a great drug survival and better patient outcomes&#46; This high degree of effectiveness was also confirmed in difficult-to-treat-areas&#44; specially scalp and nails&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">6&#44;11&#44;13</span></a> The mean limitation of our study was its retrospective design&#44; lack of control group&#44; and the sample size&#44; although we believe that it is suitable for comparison purposes with other reported real-world series&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusions</span><p id="par0030" class="elsevierStylePara elsevierViewall">Based on our own results&#44; tildrakizumab may represent an effective and safe strategy for the management of patients with moderate-to-severe cutaneous psoriasis&#44; including patients with several comorbidities&#46; Future studies should be conducted to assess the effectiveness of tildrakizumab vs other IL-23 inhibitors&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">14&#8211;17</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tildrakizumab is an IL-23-inhibitor that has been approved to treat plaque psoriasis&#46; However&#44; few reports have become available on its efficacy profile in the real-world&#46; Our objective was to study the mid-term efficacy of tildrakizumab in patients with moderate-to-severe psoriasis in the Spanish routine clinical practice setting&#46; This was a retrospective multicenter study that included a total of 91 psoriatic patients on tildrakizumab&#46; The mean Psoriasis Area and Severity Index &#40;PASI&#41; was 9&#46;09 &#40;SD&#44; 5&#46;30&#41;&#46; The overall tildrakizumab survival rate was 93&#46;47&#37; for a mean treatment exposure of 30&#46;18 weeks &#40;SD&#44; 16&#46;57&#41;&#46; No drug discontinuation was associated with drug tolerability&#44; or adverse reactions&#46; Absolute PASI &#8804;3 was reached by 91&#46;3&#37; and 96&#46;5&#37; of the patients on weeks 28 and 52&#44; respectively&#46; Response was not impacted by weight&#44; age &#40;&#62;65&#41;&#44; metabolic syndrome&#44; presence of arthritis&#44; or previous number of biological therapies used&#46; Based on our own experience tildrakizumab is an effective strategy to treat plaque psoriasis and difficult-to-treat-areas&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El tildrakizumab es un inhibidor de la interleucina 23 &#40;IL-23&#41; aprobado para el tratamiento de la psoriasis en placas&#46; Sin embargo&#44; existen pocos estudios acerca de su eficacia en pr&#225;ctica cl&#237;nica&#46; Nuestro objetivo fue analizar la eficacia a medio plazo del tildrakizumab en los pacientes con una psoriasis moderada-grave en la pr&#225;ctica diaria en Espa&#241;a&#46; Se realiz&#243; un estudio multic&#233;ntrico incluyendo a 91 pacientes con psoriasis en tratamiento con tildrakizumab&#46; La media del &#205;ndice de &#193;rea y Gravedad de la Psoriasis &#40;PASI&#41; fue de 9&#44;09 &#40;desviaci&#243;n est&#225;ndar &#91;DE&#93; 5&#44;30&#41;&#46; La supervivencia global al tildrakizumab fue del 93&#44;5&#37; para una exposici&#243;n media al tratamiento de 30&#44;2 semanas &#40;DE 16&#44;6&#41;&#46; No hubo interrupciones relacionadas con la tolerabilidad o efectos&#46; El 91&#44;3&#37; y el 96&#44;5&#37; alcanzaron un PASI &#8804; 3 en las semanas 28 y 52&#44; respectivamente&#46; La respuesta no se vio influida por el peso&#44; la edad &#40;&#62;65&#41;&#44; el s&#237;ndrome metab&#243;lico&#44; la presencia de artritis o el n&#250;mero previo de terapias biol&#243;gicas&#46; En nuestra experiencia&#44; el tildrakizumab es un f&#225;rmaco eficaz para el tratamiento de la psoriasis en placas y las &#225;reas dif&#237;ciles de tratar&#46;</p></span>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Absolut PASI and DLQI evolution from week 0 to week 52&#46; The reduced number of patients seen between weeks 0 and 52 is mainly associated with patients not having reached that phase of the follow-up period yet&#46; Only six patients experienced drug discontinuations&#44; three due to primary failure&#44; and three due to secondary failure&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients&#58; 91<span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">BMI&#44; mean &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#46;26 &#40;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:1.0px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Comorbidities</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><span class="elsevierStyleItalic">Smoking habit</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="char" valign="\n
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                  \t\t\t\t">30 &#40;35&#46;7&#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><span class="elsevierStyleItalic">Psoriatic arthritis</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;11&#46;4&#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><span class="elsevierStyleItalic">Hypertension</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;35&#46;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><span class="elsevierStyleItalic">Diabetes</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;13&#46;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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dyslipidemia</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39 &#40;44&#46;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="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Metabolic syndrome</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;29&#46;5&#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><span class="elsevierStyleItalic">Non-fatty liver disease</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;21&#46;7&#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><span class="elsevierStyleItalic">Cancer history</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;3&#46;5&#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><span class="elsevierStyleItalic">Latent tuberculosis infection</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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;18&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:1.0px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Time since psoriasis diagnosis &#40;years&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;86 &#40;10&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:1.0px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Previous biologic treatment</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Treatments</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><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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;29&#46;6&#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><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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;31&#46;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="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Infliximab&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;1&#46;1&#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><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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;18&#46;7&#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><span class="elsevierStyleHsp" style=""></span>Secukinumab&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;12&#46;1&#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><span class="elsevierStyleHsp" style=""></span>Ixekizumab&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;5&#46;4&#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><span class="elsevierStyleHsp" style=""></span>Brodalumab&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#46;1&#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><span class="elsevierStyleHsp" style=""></span>Guselkumab&nbsp;\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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Lines of treatment</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><span class="elsevierStyleHsp" style=""></span>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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;30&#46;7&#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><span class="elsevierStyleHsp" style=""></span>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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41 &#40;45&#46;1&#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><span class="elsevierStyleHsp" style=""></span>&#8805;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;32&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                            0 => "C&#46;E&#46;M&#46; Griffiths"
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                            2 => "J&#46;E&#46; Gudjonsson"
                            3 => "J&#46;N&#46;W&#46;N&#46; Barker"
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                      "doi" => "10.1016/S0140-6736(20)32549-6"
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                        "tituloSerie" => "Lancet"
                        "fecha" => "2021"
                        "volumen" => "397"
                        "paginaInicial" => "1301"
                        "paginaFinal" => "1315"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33812489"
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                    0 => array:2 [
                      "titulo" => "Retrospective analysis in patients with moderate to severe plaque psoriasis treated with tildrakizumab&#58; real-life clinical data"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46;W&#46; Wei"
                            1 => "S&#46; Chi"
                            2 => "M&#46;G&#46; Lebwohl"
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                      ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Psoriasis Psoriatic Arthritis"
                        "fecha" => "2022"
                        "volumen" => "7"
                        "paginaInicial" => "55"
                        "paginaFinal" => "59"
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