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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Psoriasis is a chronic&#44; recurring skin disease that affects 2&#46;3&#37; of the Spanish population<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">1</span></a> and has been linked in recent years to various other diseases&#44; most notably arthritis&#46; As a result&#44; psoriasis has come to be viewed as a systemic disease in which cutaneous manifestations predominate<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">2</span></a> and patient characteristics must be taken into consideration ensure that treatment is appropriate&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">3&#8211;5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">More treatment options have become available with the introduction of biologic agents&#44; which generally give better results than traditional systemic drugs and which do not have organ-specific toxic effects&#46; Biologics have therefore changed expectations and treatment goals in moderate to severe disease&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">6</span></a> Clinical practice guidelines and consensus papers aim to provide dermatologists with a range of recommendations they can rely on in routine practice&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">3&#44;5&#8211;8</span></a> However&#44; information is still too incomplete or contradictory to help with decisions about certain aspects of treatment&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We currently have little information on how biologics are being used to manage moderate to severe psoriasis in actual clinical situations in Spain&#46; Likewise&#44; we do not know how well dermatologists adhere to recommendations published in the various Spanish<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">3&#44;4&#44;9</span></a> and European<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">10&#44;11</span></a> guidelines&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The main purposes of this opinion survey were to describe the prescribing criteria followed by Spanish dermatologists who are experts in managing moderate to severe psoriasis&#44; to evaluate Spanish clinical practices applied in various scenarios and types of patients&#44; and to analyze whether or not our practitioners&#8217; preferences are consistent with up-to-date guidelines&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Target Population and Setting</span><p id="par0025" class="elsevierStylePara elsevierViewall">We developed an online survey to distribute to a maximum of 75 Spanish dermatologists with recognized experience in managing moderate to severe psoriasis&#46; We targeted practitioners working in hospitals located throughout Spain&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Questionnaire Design</span><p id="par0030" class="elsevierStylePara elsevierViewall">Two Spanish coordinators collaborated to produce a 12-item questionnaire &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; specifically for this study&#46; The items&#44; which all had closed or numerical answers&#44; covered 4 basic areas&#58; a&#41;<span class="elsevierStyleHsp" style=""></span>current management of moderate to severe psoriasis in clinical practice&#59; b&#41;<span class="elsevierStyleHsp" style=""></span>transitioning from traditional systemic drugs to biologics&#59; c&#41;<span class="elsevierStyleHsp" style=""></span>aspects of management of patients on biologic treatments&#44; and d&#41;<span class="elsevierStyleHsp" style=""></span>assessments of first-line biologic agents according to different profiles of patients with moderate to severe plaque psoriasis&#46; Responses to items 4&#44; 9&#44; 10&#44; and 11 were given on a Likert-type scale from<span class="elsevierStyleHsp" style=""></span>1 &#40;least important&#41; to<span class="elsevierStyleHsp" style=""></span>5 &#40;most important&#41;&#46; Item 12&#44; in which respondents ranked biologic agents as candidates for use in various types of patients&#44; was also answered on a Likert-type scale&#8212;from 1<span class="elsevierStyleHsp" style=""></span>&#40;worst choice&#41; to<span class="elsevierStyleHsp" style=""></span>5 &#40;best choice&#41;&#46; The survey was sent to the dermatologists in October 2015 and data were collected for analysis in May and June 2016&#46; The findings were used to draft a report of expert opinion across Spain&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical Analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">The following statistics were compiled for quantitative variables&#58; number of available responses&#44; number of unavailable responses&#44; mean &#40;SD&#41; evaluations and 95&#37;<span class="elsevierStyleHsp" style=""></span>CI of the mean&#44; median &#40;interquartile range&#41;&#44; and highest and lowest evaluations &#40;range of responses on the scale&#41;&#46; Qualitative variables were described as frequencies and percentages&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Sociodemographic Characteristics of the Respondents</span><p id="par0040" class="elsevierStylePara elsevierViewall">Three of the 75 invited dermatologists did not respond &#40;response rate&#44; 96&#46;0&#37;&#41;&#46; The respondents were distributed across Spain as follows&#58; southern Spain &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41;&#59; central Spain and the Canary Islands &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41;&#59; northern Spain &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&#59; Catalonia &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41;&#59; and eastern coastal Spain &#40;the Levant region&#41; and the Balearic Islands &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&#46; Thirty-three of the 72 respondents were men &#40;45&#46;8&#37;&#41; and 39 were women &#40;54&#46;2&#37;&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">All were specialists who worked in hospitals in Spain&#39;s national public health system&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Use of Traditional Systemic Drugs and Transitioning to Biologic Therapy</span><p id="par0050" class="elsevierStylePara elsevierViewall">Answers to the first survey question&#44; about the percentage of patients with moderate to severe psoriasis being managed with a single therapy&#44; showed that biologics were the most widely accepted choice&#44; ranking ahead of traditional systemic drugs &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Ustekinumab was the biologic agent most prescribed by the largest group of respondents&#59; the next most often prescribed were adalimumab and etanercept &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">When the respondents considered transitioning a patient from a traditional systemic to a biologic therapy&#44; 35&#46;7&#37; thought that at least 2<span class="elsevierStyleHsp" style=""></span>or 3<span class="elsevierStyleHsp" style=""></span>conventional systemic alternatives or phototherapy should have failed&#44; whereas 64&#46;3&#37; did not share that opinion&#46; The main reason for transitioning to a biologic was unstable disease activity&#46; The second most important reason was that high doses of a conventional systemic therapy were required to control symptoms &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Patients stayed on conventional systemic treatments for 1<span class="elsevierStyleHsp" style=""></span>to 2<span class="elsevierStyleHsp" style=""></span>years before transitioning to a biologic according to 64&#46;3&#37; of the dermatologists and for 6<span class="elsevierStyleHsp" style=""></span>months to a year according to 21&#46;4&#37;&#46; Only 14&#46;3&#37; reported that patients were kept on traditional systemic therapies for more than 2<span class="elsevierStyleHsp" style=""></span>years&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Biologic Therapies</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Managing a Patient&#39;s Biologic Treatment</span><p id="par0065" class="elsevierStylePara elsevierViewall">Once a patient has begun to take a biologic agent&#44; 43&#46;5&#37; of the respondents reported that they order tests to monitor therapy every 3<span class="elsevierStyleHsp" style=""></span>months and another 43&#46;5&#37; test every 6<span class="elsevierStyleHsp" style=""></span>months&#46; Yearly tests are ordered by 4&#46;3&#37;&#44; while another 4&#46;3&#37; test every 2<span class="elsevierStyleHsp" style=""></span>to 3<span class="elsevierStyleHsp" style=""></span>years and yet another 4&#46;3&#37; order tests only when clinical manifestations raise suspicion&#46; Half the respondents test for latent tuberculosis only when starting treatment&#44; 21&#46;4&#37; do so annually&#44; and 28&#46;6&#37; test every 2<span class="elsevierStyleHsp" style=""></span>to 3<span class="elsevierStyleHsp" style=""></span>years&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The dermatologists refer their patients to other specialists for evaluation of concurrent conditions &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; Referrals were most often to rheumatologists&#46; Referrals to gastroenterologists and endocrinologists were the next most frequent&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Biologic Treatment Objectives</span><p id="par0075" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> summarizes the therapeutic objectives the dermatologists prioritize&#44; ranked on a scale of 1 &#40;least important&#41; to 5 &#40;most important&#41;&#46; An optimal response of at least 90&#37; improvement in the PASI score was highly valued by 78&#46;6&#37; of the respondents &#40;highly important for 28&#46;6&#37; and very highly important &#91;maximum score&#93; for 50&#37;&#41;&#46; Importance was placed on achievement of a PASI score less than 3 by 85&#46;7&#37; &#40;judged highly important by 35&#46;7&#37; and very highly important by 50&#37;&#41;&#46; Patient satisfaction was a highly important aim for 50&#37; of the respondents and a very highly important one &#40;maximum score&#41; for 35&#46;7&#37;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The conditions considered important when deciding to start treatment with a biologic agent in patients with moderate to severe psoriasis are also summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; All the dermatologists &#40;100&#37;&#41; agreed that a PASI score of 10 or higher and the involvement of over 10&#37; of the body surface area were the important criteria &#40;highly important for 42&#46;9&#37; and very highly important for 57&#46;1&#37;&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Factors Leading to Change of Treatment</span><p id="par0085" class="elsevierStylePara elsevierViewall">The factors the dermatologists considered important when deciding that a patient was experiencing failure of a biologic therapy and needed to be switched were as follows&#58; loss of response &#40;a 50&#37; to 75&#37; change PASI score&#41;&#44; a PASI score greater than 5&#44; or a Physician&#39;s Global Assessment score of 3 or more &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Biologic of Choice According to Patient Profile</span><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> summarizes the dermatologists&#8217; ranking of biologic agents according to patient profile on a scale of 1 &#40;worst choice&#41; to 5 &#40;best choice&#41;&#46; The preference was most often etanercept &#40;78&#46;6&#37;&#41; for pediatric patients&#59; etanercept &#40;64&#46;3&#37;&#41; or adalimumab &#40;64&#46;3&#37;&#41; for patients with psoriatic arthritis&#59; and ustekinumab for patients who often travel &#40;78&#46;6&#37;&#41;&#44; had poor compliance &#40;71&#46;4&#37;&#41;&#44; or had a history of multiple sclerosis or demyelinating disease &#40;64&#46;3&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Half the respondents &#40;50&#37;&#41; also thought that ustekinumab was the best choice for patients with grade III to IV congestive heart failure&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In patients at risk for exacerbation of latent infection&#44; apremilast &#40;first choice&#41; and etanercept &#40;second choice&#41; were thought to be the most appropriate biologics&#46; Apremilast was preferred for patients with chronic human immunodeficiency virus &#40;HIV&#41; infection by 42&#46;8&#37; of the respondents&#44; 21&#46;4&#37; considering it the best choice and 21&#46;4&#37; a good choice&#46; However half the respondents &#40;50&#37;&#41; considered etanercept to be the best &#40;14&#46;3&#37;&#41; or a good &#40;35&#46;7&#37;&#41; choice for such patients&#46;</p></span></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">An increasing number of publications have been based on surveys of dermatologists&#8217; use of treatments for patients with moderate to severe psoriasis&#44; probably in an attempt to promote consistent clinical practice and optimize treatment&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">This opinion survey aimed to ascertain the real situation of routine management of moderate to severe psoriasis in Spain by describing the preferences of Spanish dermatologists expert in this disease&#46; The results allow us to analyze whether their preferences are in keeping with current Spanish and European practice guidelines&#46; The survey also covered complex scenarios in which optimal treatment is not well defined because firmly evidence-based clinical protocols are not yet available&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The efficacy and safety of biologic treatments&#44; and their superiority over traditional systemic treatments&#44; have become increasingly clear&#44;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">12</span></a> leading to wider use of biologics in Spain&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">13</span></a> Monotherapy based on these drugs is being prescribed to an ever greater percentage of patients with moderate to severe disease&#46;</p><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Transition to Biologics</span><p id="par0120" class="elsevierStylePara elsevierViewall">Our data show that dermatologists are now keeping patients on conventional systemic treatments for less time than was reported in 2013 based on an online survey of members of the Psoriasis Working Group &#40;PsWG&#41; of the Spanish Academy of Dermatology and Venereology &#40;AEDV&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">14</span></a> Prescribers are also currently more likely to transition patients with unstable disease from traditional systemic therapy to biologics in order to optimize treatment&#46; The 2013 report found that 73&#37; of respondents waited 2<span class="elsevierStyleHsp" style=""></span>or more years to switch patients away from a traditional systemic treatment to a biologic&#44; even though a considerable percentage &#40;66&#37;&#41; thought the wait should be shorter&#46; Our survey results suggest that Spanish practice is changing&#44; as only 14&#46;3&#37; of patients now stay on conventional treatment for 2<span class="elsevierStyleHsp" style=""></span>years&#46; The consensus statement of the PsWG published in 2016 even reported the opinion that biologics should be considered first-line options for treating moderate to severe psoriasis&#44; alongside conventional systemics&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">9</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Change is also evident in the criteria dermatologists use to shorten the transition period&#46; Toxic effects of systemic treatment once reigned as the main criterion&#44; whereas loss of response or possible unevenness of response are now main concerns&#46; The experts continue to take scant account of concomitant conditions when making this decision&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Management of Therapy for Patients on Biologics</span><p id="par0130" class="elsevierStylePara elsevierViewall">Most respondents order tests every 3<span class="elsevierStyleHsp" style=""></span>to 6<span class="elsevierStyleHsp" style=""></span>months&#44; as advised by the UK&#39;s National Institute for Health and Care Excellence &#40;NICE&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">15</span></a> There is considerable variation in tuberculosis screening practices&#46; Screening only at the start of biologic treatment is the approach that predominates&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">16</span></a> even though the Spanish PsWG&#39;s 2016 consensus statement<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">9</span></a> recommends repeated screening while the patient is on such therapy&#46; However&#44; consensus for that statement was reached in 2012 and 2013&#44; several years before the 2016 publication date&#46; The results of the present survey&#44; therefore&#44; reflect the more up-to-date clinical practice opinions of dermatologists&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Criteria That Lead Specialists to Recommend Biologic Therapy</span><p id="par0135" class="elsevierStylePara elsevierViewall">The dermatologists surveyed considered the following criteria to be important when deciding to recommend biologic therapy&#58; PASI score<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10 or an affected body surface area of at least 5&#37; to 10&#37;&#59; patient perception of having severe disease &#40;Dermatology Life Quality Index<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>10&#41;&#59; and the presence of psoriatic arthritis&#44; consistent with an earlier PsWG consensus statement&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Therapeutic Objectives</span><p id="par0140" class="elsevierStylePara elsevierViewall">The introduction of biologic drugs in clinical practice has improved the efficacy of psoriasis treatment&#44; as shown by the opinion of 78&#46;6&#37; of our respondents that treatment should achieve at least a 90&#37; improvement in the PASI score&#8212;the equivalent of an absence of clinical signs &#40;clearing&#41; or minimal signs of disease&#8212;or even that a PASI score of 3 or less should be sought&#46; These goals are much more ambitious than the therapeutic objectives suggested by previously published guidelines&#44; which recommend seeking 75&#37; of more improvement in the score&#46; The response criterion of 90&#37; improvement also offers a more discriminating objective in terms of bettering patients&#8217; quality of life<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">17</span></a> than the lower goal of a 75&#37; change in PASI score&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Individualized Treatment</span><p id="par0145" class="elsevierStylePara elsevierViewall">In clinical scenarios in which there is still no firm evidence to guide the treatment of moderate to severe psoriasis&#44; therapy must be tailored to the patient&#39;s situation&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">5</span></a> The prescriber must therefore apply criteria based on experience gained by experts during routine clinical practice&#46; Our survey&#44; which provides data on the main criteria used by Spanish dermatologists when choosing a biologic&#44; sheds light on practice in such scenarios&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Most respondents chose etanercept for pediatric patients &#40;78&#46;6&#37;&#41;&#59; adalimumab or etanercept for patients who also have psoriatic arthritis &#40;64&#46;3&#37;&#41;&#59; and ustekinumab for patients who have to travel away from home often &#40;78&#46;6&#37;&#41;&#44; whose adherence is poor &#40;71&#46;4&#37;&#41;&#44; or who have a history of multiple sclerosis or demyelinating disease &#40;64&#46;3&#37;&#41;&#46; The first-choice biologics for other scenarios varied greatly&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Some of these findings are consistent with opinions reported previously<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">14</span></a> or with some guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">11</span></a> Our informants&#44; all experts in psoriasis&#44; expressed the novel opinions that secukinumab would be one of the biologics of choice for patients who are obese or have metabolic syndrome and that apremilast would be a good choice for patients with a history of neoplastic disease&#44; chronic infection&#44; or latent tuberculosis&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Warnings and contraindications are important to consider when choosing a biologic&#46; The panel named ustekinumab&#44; of which a maintenance dose is taken every 12<span class="elsevierStyleHsp" style=""></span>weeks&#44; as appropriate for scenarios in which there are adherence problems&#46; It was also considered a candidate for scenarios in which anti-tumor necrosis factor &#40;TNF&#41; therapy is contraindicated &#40;lupus erythematous and other autoimmune diseases&#44; advanced heart failure&#44; and demyelinating diseases&#41;&#44; a suggestion that has been noted in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Children and Adolescents</span><p id="par0165" class="elsevierStylePara elsevierViewall">Etanercept was chosen as the first-line biologic for pediatric populations&#46; The respondents&#8217; choice could be explained by the fact that etanercept was the first biologic approved by the European Medicines Agency &#40;EMA&#41; for the treatment of chronic severe plaque psoriasis in children aged 6<span class="elsevierStyleHsp" style=""></span>years or older&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">19</span></a> Alternative explanations are that etanercept is the biologic agent that has been most widely studied in randomized clinical trials in children and adolescents<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">20</span></a> to date&#44; and it is the only one for which long-term extension studies have been carried out&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">21</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Other biologics have begun to be subjected to such study&#46; Examples are adalimumab&#44; recently approved by the EMA for pediatric use and the subject of a trial in children and adolescents<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">22</span></a> and ustekinumab&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">23</span></a> The range of treatments available for pediatric use is increasing&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Advanced Age</span><p id="par0175" class="elsevierStylePara elsevierViewall">Previously published guidelines for treating patients aged 65<span class="elsevierStyleHsp" style=""></span>years or older recommend prioritizing safety&#44; suggesting intermittent treatment approaches and lower doses than those listed in product summaries&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">24</span></a> The group of experts we surveyed chose etanercept as their first choice&#44; presumably because of its short half-life&#44; good safety and efficacy profiles&#44;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">25</span></a> and tolerance in patients of advanced age&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">26</span></a> Recently published Italian guidelines point out that any of the biologics could possibly be used in this population if patients are monitored adequately&#44; since few studies of adalimumab&#44; etanercept&#44; and ustekinumab in the elderly have as yet appeared&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">27&#44;28</span></a></p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Risk of Infection and Reactivation of Infection</span><p id="par0180" class="elsevierStylePara elsevierViewall">The risk of reactivation of latent infection or of opportunistic or serious infection is lower in patients with psoriasis than in those with other inflammatory diseases because psoriasis patients have different characteristics and are not usually on additional immunosuppressant therapies&#46; However&#44; risk is slightly higher in patients on infliximab or adalimumab than in those on etanercept or ustekinumab&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">29</span></a> The recommendations published by the AEDV&#39;s PsWG<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">9</span></a> and the Italian group<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">11</span></a> suggest that the risk of reactivation is lower with etanercept&#44; based on wider experience using that biologic in patients with chronic hepatitis C and HIV infections&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">30&#44;31</span></a> However&#44; for this scenario our surveyed experts selected apremilast&#44; an oral biologic agent that has lower efficacy but that seemed to have less of an immunosuppressant effect in a recent trial&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">32</span></a></p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Psoriatic Arthritis</span><p id="par0185" class="elsevierStylePara elsevierViewall">The association of arthritis and psoriasis affects the choice of biologic&#44; and guidelines recommend the use of an anti-TNF agent as the first line of therapy&#46; These drugs have demonstrated efficacy in the 5<span class="elsevierStyleHsp" style=""></span>key domains of this scenario&#58; 1&#41; peripheral arthritis&#59; 2&#41; skin and nail lesions&#59; and the involvement of 3&#41; axillas&#44; 4&#41; joints of fingers or toes &#40;dactylitis&#41;&#44; and 5&#41; entheses &#40;evidence level 1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">33</span></a> Anti-TNF agents have also been shown to inhibit the radiologic progression of psoriatic arthritis&#46;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">34&#44;35</span></a> Our respondents&#8217; opinion that etanercept and adalimumab were the best choices could be due to reports of superior cost-effectiveness&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">36</span></a> However&#44; it is important to also bear in mind that when we collected data for this analysis &#40;in May&#8211;June 2016&#41; the experts had not yet accumulated much experience with new biologics&#44; especially secukinumab&#44; in psoriatic arthritis&#46; That drug is a well placed candidate at present&#44; given the observation of good results at even lower doses than those generally used in psoriasis &#40;see the FUTURE<span class="elsevierStyleHsp" style=""></span>1<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">37</span></a> and FUTURE<span class="elsevierStyleHsp" style=""></span>2<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">38</span></a> studies&#41;&#46;</p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Congestive Heart Failure</span><p id="par0190" class="elsevierStylePara elsevierViewall">Anti-TNF agents are contraindicated in patients with congestive heart failure &#40;grades<span class="elsevierStyleHsp" style=""></span>III&#8211;IV&#41;&#46; In patients with this concomitant condition ustekinumab could be considered the treatment of choice&#46;</p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0195">Intermittent Treatment Regimens</span><p id="par0195" class="elsevierStylePara elsevierViewall">The Spanish dermatologists who responded to our survey preferred etanercept for intermittent treatment regimens&#44; consistent with another survey<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">14</span></a> and European guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">11</span></a> Their choice could be due to the pharmacokinetic characteristics of this drug&#44; which has a shorter half-life and has proven effective in intermittent protocols and retreatments without causing additional adverse events&#46;<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">39&#44;40</span></a></p></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0200">Difficult Disease Locations</span><p id="par0200" class="elsevierStylePara elsevierViewall">Recently published Spanish guidelines point to the difficulty of managing psoriasis in certain locations&#8212;such as the scalp&#44; nails&#44; palms&#44; and plantar surfaces&#8212;and the scarcity of well organized information and high levels of evidence about such treatment difficulties&#46;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">41</span></a> Guidelines on the use of biologics in patients with psoriasis in difficult-to-treat locations published in 2015 named infliximab and etanercept as good choices in scalp psoriasis &#40;grade A recommendation&#44; evidence level 1&#41;&#46; The strength of recommendation is lower for adalimumab &#40;grade B&#44; level-1 evidence&#41; and lower still for ustekinumab &#40;grade C&#44; level-1 evidence&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">8</span></a> The ESTEEM<span class="elsevierStyleHsp" style=""></span>1 and 2<span class="elsevierStyleHsp" style=""></span>trials recently demonstrated the efficacy of apremilast in these types of psoriasis&#44;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">42</span></a> and the GESTURE trial concluded that secukinumab was very effective in the treatment of palmar-plantar psoriasis&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">43</span></a></p></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0205">Obesity</span><p id="par0205" class="elsevierStylePara elsevierViewall">Obesity plays a role in response to all biologic therapies&#44; although differences often fail to reach statistical significance&#46; The possibility of adjusting the dosage of infliximab according to weight offers the opportunity to achieve similar results in obese and nonobese patients&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">44</span></a></p></span><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0210">Pregnancy</span><p id="par0210" class="elsevierStylePara elsevierViewall">Tailored management is important in women who are pregnant or planning pregnancy&#44; when the drug&#39;s half-life and the severity of disease must be weighed in the balance&#46; Biologics used to treat psoriasis are category<span class="elsevierStyleHsp" style=""></span>B drugs&#46; In fact&#44; a biologic&#39;s average half-life must be factored in whenever a woman of childbearing age is treated&#46; Etanercept has the shortest half-life &#40;3<span class="elsevierStyleHsp" style=""></span>days&#41;&#44; infliximab the next shortest &#40;10<span class="elsevierStyleHsp" style=""></span>days&#41;&#44; followed by adalimumab &#40;15<span class="elsevierStyleHsp" style=""></span>days&#41; and ustekinumab &#40;3<span class="elsevierStyleHsp" style=""></span>weeks&#41;&#46; Contraceptives are recommended during treatment and up to 3<span class="elsevierStyleHsp" style=""></span>weeks after suspending treatment with etanercept&#44; 15<span class="elsevierStyleHsp" style=""></span>weeks after stopping ustekinumab&#44; 5<span class="elsevierStyleHsp" style=""></span>months after stopping adalimumab&#44; and 6<span class="elsevierStyleHsp" style=""></span>months after stopping infliximab&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">24</span></a> Because immunoglobulin<span class="elsevierStyleHsp" style=""></span>G is transported to the fetus during the second and third trimesters&#44; guidelines recommend interrupting treatment with infliximab and adalimumab during the last trimester to prevent neonatal immunosuppression&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">11</span></a> In a case series describing 5<span class="elsevierStyleHsp" style=""></span>pregnant women treated with ustekinumab&#44; 1<span class="elsevierStyleHsp" style=""></span>pregnancy resulted in miscarriage&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">45</span></a></p></span><span id="sec0145" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0215">Metabolic Syndrome</span><p id="par0215" class="elsevierStylePara elsevierViewall">A high prevalence of metabolic syndrome &#40;14&#37; to 40&#37;&#41; has been reported in psoriasis&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">46</span></a> An underlying inflammatory state is common to both conditions&#44;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">47</span></a> as evidenced by altered levels of secretory proteins such as adponectin and leptin&#44; which regulate the release of such mediators as TNF&#59; interleukins<span class="elsevierStyleHsp" style=""></span>6&#44; 7&#44; and 22&#59; and interferon-&#947;&#46; Drugs like acitretin&#44; ciclosporin&#44; and methotrexate can aggravate some components of metabolic syndrome&#44; so biologics&#44; which target more specific components of disease&#44; are considered the first line of therapy for patients with this condition&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">48</span></a> Our survey found that the dermatologists&#8217; choices for patients with moderate to severe psoriasis and metabolic syndrome were adalimumab&#44; ustekinumab&#44; and secukinumab&#46;</p></span><span id="sec0150" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0220">Limitations</span><p id="par0220" class="elsevierStylePara elsevierViewall">Because ours was an opinion survey of 73 specialists in different hospitals and geographic areas&#44; the highly variable results must be interpreted with caution&#46; Nonetheless&#44; the findings provide important information that reflects the professional experience and routine clinical practice of dermatologists&#46;</p></span></span><span id="sec0155" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0225">Conclusions</span><p id="par0225" class="elsevierStylePara elsevierViewall">This opinion survey provides a unique perspective on the views of a representative sample of expert dermatologists regarding the current management of psoriasis with biologics in Spain&#46;</p></span><span id="sec0160" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0230">Conflicts of Interest</span><p id="par0235" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">There is currently little information available on the management of patients with psoriasis in the routine clinical practice of dermatologists in Spain&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to survey a group of Spanish dermatologists with particular expertise in the management of psoriasis to determine their opinions on the protocols used in routine clinical practice&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional study based on an online survey about the management of psoriasis sent to 75 dermatologists&#46; The survey&#44; which was specifically designed for the study&#44; included 12<span class="elsevierStyleHsp" style=""></span>questions on different aspects of clinical practice in the treatment of moderate to severe psoriasis&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The response rate was 96&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>72&#41;&#46; Biologics were the most widely used monotherapy option&#46; In total&#44; 64&#46;3&#37; of respondents reported that their patients used conventional systemic therapies for 1 to 2<span class="elsevierStyleHsp" style=""></span>years before switching to a biologic drug and that the main reason for the switch was unstable control of disease activity&#46; Overall&#44; 85&#46;7&#37; assigned &#8220;high&#8221; or &#8220;very high&#8221; importance to the use of a Psoriasis Area Severity Index score of &#60;<span class="elsevierStyleHsp" style=""></span>3 as a treatment goal&#46; The drugs of choice among the respondents were etanercept for pediatric patients &#40;78&#46;6&#37;&#41;&#44; adalimumab and etanercept for patients with psoriatic arthritis &#40;64&#46;3&#37;&#41;&#44; and ustekinumab in patients frequently away from home &#40;78&#46;6&#37;&#41; and patients with a history of multiple sclerosis&#44; demyelinating diseases &#40;64&#46;3&#37;&#41;&#44; or poor adherence to treatment &#40;71&#46;4&#37;&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">This study provides a unique overview of the opinions of a representative sample of expert dermatologists on the current use of biologics for the treatment of psoriasis in Spain&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">En Espa&#241;a existe actualmente escasa informaci&#243;n sobre el manejo de los pacientes con psoriasis en la pr&#225;ctica cl&#237;nica diaria de los dermat&#243;logos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El objetivo de esta encuesta de opini&#243;n fue recoger informaci&#243;n de los dermat&#243;logos espa&#241;oles expertos en el manejo de los pacientes con psoriasis sobre los protocolos que realizan en su pr&#225;ctica cl&#237;nica habitual&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Encuesta de opini&#243;n realizada mediante cuestionario <span class="elsevierStyleItalic">on line</span> remitido a 75 dermat&#243;logos expertos en el manejo de la psoriasis&#46; El cuestionario&#44; dise&#241;ado espec&#237;ficamente para la encuesta de opini&#243;n&#44; inclu&#237;a 12<span class="elsevierStyleHsp" style=""></span>preguntas sobre diferentes aspectos de la pr&#225;ctica cl&#237;nica en el tratamiento de la psoriasis moderada-grave&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La tasa de respuesta fue del 96&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>72&#41;&#46; Los biol&#243;gicos fueron la opci&#243;n m&#225;s usada como monoterapia&#46; El 64&#44;3&#37; de los encuestados se&#241;al&#243; que sus pacientes permanecen 1-2<span class="elsevierStyleHsp" style=""></span>a&#241;os con terapias sist&#233;micas cl&#225;sicas antes de la transici&#243;n a biol&#243;gicos&#44; y el principal determinante para decidir la transici&#243;n fue el control inestable de la actividad de la enfermedad&#46; El 85&#44;7&#37; dio importancia &#171;alta&#187; o &#171;muy alta&#187; a considerar una puntuaci&#243;n PASI &#60;<span class="elsevierStyleHsp" style=""></span>3 como objetivo terap&#233;utico&#46; Los f&#225;rmacos de elecci&#243;n m&#225;s consensuados fueron etanercept en poblaci&#243;n pedi&#225;trica &#40;78&#44;6&#37;&#41;&#44; adalimumab y etanercept en artritis psori&#225;sica &#40;64&#44;3&#37;&#41; y ustekinumab en pacientes con frecuentes ausencias domiciliarias &#40;78&#44;6&#37;&#41;&#44; baja adherencia &#40;71&#44;4&#37;&#41; e historia de esclerosis m&#250;ltiple o enfermedades desmielinizantes &#40;64&#44;3&#37;&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusi&#243;n</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Esta encuesta de opini&#243;n proporciona una perspectiva &#250;nica sobre las opiniones de una muestra representativa de los dermat&#243;logos expertos en cuanto al tratamiento actual de la psoriasis con f&#225;rmacos biol&#243;gicos en Espa&#241;a&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as&#58; L&#243;pez-Estebaranz JL&#44; de la Cueva-Dobao P&#44; Fraga CdlT&#44; Guti&#233;rrez MG&#44; Guerra EG&#44; S&#225;nchez JM&#44; et al&#46; Manejo de la psoriasis moderada-grave en condiciones de pr&#225;ctica habitual en el &#225;mbito hospitalario espa&#241;ol&#46; Actas Dermosifiliogr&#46; 2018&#59;109&#58;631&#8211;642&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Percentage of patients managed with each approach alone &#40;x axis&#41; by the different percentages of dermatologists &#40;y axis&#41; expert in the treatment of moderate to severe psoriasis&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Percentages of patients currently treated with each biologic &#40;x axis&#41; by the different percentages of dermatologists &#40;y axis&#41;&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Factors that lead the dermatologists to transition a patient from a traditional systemic treatment to a biologic and to limit the amount of time a patient stays on a traditional systemic therapy&#46; The reasons were ranked on a scale of 1 &#40;least important&#41; to 5 &#40;most important&#41;&#46;</p>"
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Percentages of patients on biologic therapy who are referred to other specialists each year on average&#46;</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; BSA&#44; body surface area&#59; DLQI&#44; Dermatology Life Quality Index&#59; PASI&#44; Psoriasis Area and Severity Index&#59; PGA&#44; Physician&#39;s Global Assessment&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Current clinical management of moderate to severe psoriasis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">1&#46; Indicate what percentage of patients with moderate to severe psoriasis you manage only with each of the following treatments &#40;monotherapy&#41;&#58;</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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>a&#41; Topical treatments&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>b&#41; Phototherapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>c&#41; Traditional systemic therapy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>d&#41; Biologics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">2&#46; Indicate what percentages of your moderate to severe psoriasis patients on biologics are taking each of the following agents&#58;</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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>a&#41; Etanercept&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>b&#41; Adalimumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>c&#41; Infliximab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>d&#41; Ustekinumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>e&#41; Secukinumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>f&#41; Apremilast&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Transitioning from a systemic to a biologic treatment</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">3&#46; Do you think that 2 or 3 traditional systemic therapies or phototherapies should have failed before a patient transitions to a biologic&#63;</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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>a&#41; Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>b&#41; No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>c&#41; Don&#8217;t know&#47;no response&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><br><span class="elsevierStyleItalic">4&#46; Evaluate on a scale of 1 &#40;least important&#41; to 5 &#40;most important&#41; how much you would be influenced by each of the following factors when deciding how long a patient should stay on traditional systemic therapy&#58;</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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>a&#41; High doses are needed to control disease&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>b&#41; Unstable control of disease activity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>c&#41; Obesity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>d&#41; Advanced age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>e&#41; Childbearing age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>f&#41; Presence of cardiovascular&#44; endocrine or metabolic conditions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>g&#41; History of neoplastic disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><br><span class="elsevierStyleItalic">5&#46; Indicate how long you generally keep your patients on traditional systemic therapy before transitioning to a biologic&#58;</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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>a&#41; 0&#8211;6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>b&#41; 6 months&#8211;1 year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>c&#41; 1&#8211;2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>d&#41; &#62;<span class="elsevierStyleHsp" style=""></span>2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Managing treatment in the patient on biologics</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">6&#46; Once biologic treatment has started&#44; how often do you order follow-up testing&#63;</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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>a&#41; Every 3<span class="elsevierStyleHsp" style=""></span>months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>b&#41; Every 6 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>c&#41; Yearly&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>d&#41; Every 2&#8211;3<span class="elsevierStyleHsp" style=""></span>years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>e&#41; Only when risk is suspected&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><br><span class="elsevierStyleItalic">7&#46; Once biologic treatment has started&#44; how often do you screen for latent tuberculosis infection&#63;</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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>a&#41; Only on starting treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>b&#41; Yearly&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>c&#41; Every 2&#8211;3<span class="elsevierStyleHsp" style=""></span>years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>d&#41; Only in patients with risk factors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><br><span class="elsevierStyleItalic">8&#46; Indicate the percentage of patients on biologics you refer to specialists in each of the following departments every year on average&#58;</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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>a&#41; Internal medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>b&#41; Gastroenterology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>c&#41; Cardiology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>d&#41; Endocrinology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>e&#41; Psychiatry&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>f&#41; Rheumatology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>g&#41; Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Aims of biologic therapy</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">9&#46; Rank the importance you place on the following criteria when managing psoriatic skin lesions in patients on biologics&#46; Scale&#58; 1 &#40;least important&#41; to 5 &#40;most important&#41;&#58;</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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>a&#41; 75&#37; improvement in PASI score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>b&#41; 90&#37;&#8211;100&#37; improvement in PASI score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>c&#41; PASI score &#60;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>d&#41; PASI score &#60;<span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>e&#41; PGA&#44; 2-point improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>f&#41; PGA score&#44; 0&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>g&#41; DLQI &#60;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>h&#41; Clinical assessment without a scale&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>i&#41; Patient satisfaction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><br><span class="elsevierStyleItalic">10&#46; Rank how important you consider the following criteria when deciding to start a patient with psoriasis on biologic therapy&#46; Scale&#58; 1 &#40;least important&#41; to 5 &#40;most important&#41;&#58;</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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>a&#41; PASI score &#62;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>b&#41; Extensive skin involvement&#58; &#62;<span class="elsevierStyleHsp" style=""></span>10&#37; BSA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>c&#41; Significant impact on quality of life &#40;DLQI &#62;<span class="elsevierStyleHsp" style=""></span>10&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>d&#41; Psoriatic arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>e&#41; Localized psoriasis with nail involvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>f&#41; Localized psoriasis involving highly visible zones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>g&#41; Cost of treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>h&#41; Patient preference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><br><span class="elsevierStyleItalic">11&#46; Rank the importance of the factors you take into consideration when judging whether a patient on biologic therapy is experiencing failure and needs to be switched to another treatment&#46; Scale&#58; 1 &#40;least important&#41; to 5 &#40;most important&#41;&#46;</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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>a&#41; Loss of response &#40;50&#37; change in PASI score&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>b&#41; Loss of response &#40;75&#37; change in PASI score&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>c&#41; Loss of response &#40;90&#37; change in PASI score&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>d&#41; PASI score &#62;<span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>e&#41; PASI score &#62;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>f&#41; PGA score &#62;<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>g&#41; PGA score &#62;<span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>h&#41; DLQI &#62;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleBold">Selection of a biologic agent according to patient profile</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">12&#46; Rank the available biologics on a scale of 1 &#40;worst choice&#41; to 5 &#40;best choice&#41;&#46;</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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>a&#41; In children and adolescents aged under 18 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>b&#41; In women of childbearing age who are considering pregnancy in the medium term&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>c&#41; In adults of advanced age &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>65 years&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>d&#41; In obese patients &#40;body mass index &#62;<span class="elsevierStyleHsp" style=""></span>30 or weight &#62;<span class="elsevierStyleHsp" style=""></span>90<span class="elsevierStyleHsp" style=""></span>kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>e&#41; In patients with psoriatic arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>f&#41; In patients with a history of multiple sclerosis or demyelinating disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>g&#41; In patients with a history of lupus erythematosus or other autoimmune diseases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>h&#41; In patients with renal insufficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>i&#41; In patients with metabolic syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>j&#41; In patients with congestive heart failure&#44; grades III&#8211;IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>k&#41; In patients with a history of stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>l&#41; In patients with latent tuberculosis diagnosed by Mantoux skin test or interferon-&#947; release assay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>m&#41; In patients with chronic hepatitis<span class="elsevierStyleHsp" style=""></span>C infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>n&#41; In patients with chronic hepatitis<span class="elsevierStyleHsp" style=""></span>B infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>o&#41; In patients with chronic human immunodeficiency virus infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>p&#41; In patients with depression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>q&#41; In patients with a history of neoplastic disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>r&#41; In patients with an erythrodermic episode&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>s&#41; In patients with unstable disease and frequent exacerbations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>t&#41; In patients with localized diseases &#40;nail&#47;entheses involvement&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>u&#41; In patients with scalp psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>v&#41; In patients with poor adherence to treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>w&#41; In patients who travel from home often&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>x&#41; In patients who ask for treatment interruptions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; BSA&#44; body surface area&#59; DLQI&#44; Dermatology Life Quality Index&#59; PASI&#44; Psoriasis Area Severity Index&#59; PGA&#44; Physician Global Assessment&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Usual therapeutic objectives in the management of skin lesions in patients with psoriasis</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>75&#37; improvement in PASI score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>90&#37;&#8211;100&#37; improvement in PASI score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PASI score &#60;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PASI score &#60;<span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PGA&#44; 2-point improvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PGA score&#44; 0&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>DLQI &#60;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Clinical judgment&#44; without use of scales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Patient satisfaction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Conditions considered important when deciding to start a patient on a biologic</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PASI &#8805;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Extensive skin involvement&#58; &#8805;<span class="elsevierStyleHsp" style=""></span>10&#37; of BSA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Significant impact on quality of life&#58; DLQI &#8805;<span class="elsevierStyleHsp" style=""></span>10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Psoriatic arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Localized psoriasis with nail involvement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Localized psoriasis involving highly visible zones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Treatment cost&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Patient preference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Factors considered important when deciding a patient is experiencing biologic treatment failure and needs a change of treatment</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Loss of response &#40;50&#37; change in PASI score&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Loss of response &#40;75&#37; change in PASI score&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Loss of response &#40;90&#37; change in PASI score&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PASI score &#62;<span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PASI score &#62;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PGA &#8805;<span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PGA &#8805;<span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>DLQI &#62;<span class="elsevierStyleHsp" style=""></span>5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Patient dissatisfaction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Biologic Agent&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient Profile&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First Choice&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="7" align="left" valign="top">Etanercept</td><td class="td" title="table-entry  " align="left" valign="top">Patients with psoriatic arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients<span class="elsevierStyleHsp" style=""></span>&#8805;65 y &#40;advanced age&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Children and adolescents&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients planning pregnancy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients with renal insufficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients with scalp psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients who ask for interruptions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Adalimumab</td><td class="td" title="table-entry  " align="left" valign="top">Patients with psoriatic arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients with metabolic syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Infliximab</td><td class="td" title="table-entry  " align="left" valign="top">Patients with an erythrodermic episode&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Obese patients &#40;body mass index <span class="elsevierStyleHsp" style=""></span>&#62;30 or weight <span class="elsevierStyleHsp" style=""></span>&#62;90 kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients with localized disease &#40;nail&#47;entheses involvement&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="9" align="left" valign="top">Ustekinumab</td><td class="td" title="table-entry  " align="left" valign="top">Patients with a history of multiple sclerosis or demyelinating disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients with a history of lupus erythematosus or other autoimmune disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients with metabolic syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients with congestive heart failure&#44; grades III&#8211;IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients with a history of stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients with depression&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients with unstable disease and frequent exacerbations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients with poor adherence to treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients who travel from home often&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secukinumab&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Patients with metabolic syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">Apremilast</td><td class="td" title="table-entry  " align="left" valign="top">Patients with latent tuberculosis infection diagnosed by Mantoux skin test or an interferon-&#947; release assay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients with chronic hepatitis B infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients with chronic human immunodeficiency virus infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients with a history of neoplastic disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Patients with scalp psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Biologic of Choice According to Patient Profile&#46;</p>"
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