Case and Research Letters
An Analysis of Drug Survival, Effectiveness, and Safety in Moderate to Severe Psoriasis Treated With Ustekinumab: An Observational Study of 69 Patients in Routine Clinical Practice
Análisis de supervivencia, eficacia y seguridad en psoriasis moderada–grave tratada con ustekinumab. Estudio observacional de 69 pacientes en la práctica clínica habitual
I. Salgüero Fernández
, M. Hospital Gil, M. Sigüenza Sanz, G. Roustan Gullón
Corresponding author
Dermatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid
Read
4265
Timeswas read the article
1737
Total PDF
2528
Total HTML
Share statistics
array:24 [ "pii" => "S157821901930054X" "issn" => "15782190" "doi" => "10.1016/j.adengl.2019.02.015" "estado" => "S300" "fechaPublicacion" => "2019-04-01" "aid" => "1987" "copyright" => "Elsevier España, S.L.U. and AEDV" "copyrightAnyo" => "2018" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:244-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4 "formatos" => array:2 [ "EPUB" => 1 "HTML" => 3 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0001731018302515" "issn" => "00017310" "doi" => "10.1016/j.ad.2018.02.019" "estado" => "S300" "fechaPublicacion" => "2019-04-01" "aid" => "1987" "copyright" => "AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:244-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 153 "formatos" => array:2 [ "HTML" => 98 "PDF" => 55 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científico-clínica</span>" "titulo" => "Análisis de supervivencia, eficacia y seguridad en psoriasis moderada–grave tratada con ustekinumab. Estudio observacional de 69 pacientes en la práctica clínica habitual" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "244" "paginaFinal" => "246" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "An analysis of Drug Survival, Effectiveness, and Safety in Moderate to Severe Psoriasis Treated With Ustekinumab: An Observational Study of 69 Patients in Routine Clinical Practice" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2258 "Ancho" => 2500 "Tamanyo" => 226394 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Análisis de supervivencia Kaplan-Meier (tiempo en meses, 8,3 años de seguimiento).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Salgüero Fernández, M. Hospital Gil, M. Sigüenza Sanz, G. Roustan Gullón" "autores" => array:4 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Salgüero Fernández" ] 1 => array:2 [ "nombre" => "M. Hospital" "apellidos" => "Gil" ] 2 => array:2 [ "nombre" => "M. Sigüenza" "apellidos" => "Sanz" ] 3 => array:2 [ "nombre" => "G. Roustan" "apellidos" => "Gullón" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S157821901930054X" "doi" => "10.1016/j.adengl.2019.02.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901930054X?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018302515?idApp=UINPBA000044" "url" => "/00017310/0000011000000003/v1_201904030618/S0001731018302515/v1_201904030618/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S1578219019300551" "issn" => "15782190" "doi" => "10.1016/j.adengl.2019.02.016" "estado" => "S300" "fechaPublicacion" => "2019-04-01" "aid" => "1986" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:247-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7 "formatos" => array:3 [ "EPUB" => 1 "HTML" => 4 "PDF" => 2 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Ultrasound Morphology of Stiff Skin Syndrome with Clinical and Histological Correlation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "247" "paginaFinal" => "248" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Morfología ecográfica de síndrome de Stiff cutáneo con correlación clínica e histológica" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 422 "Ancho" => 750 "Tamanyo" => 26919 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical image. Skin of the lower trunk, hip, and right buttock, with plaques with a mammillated surface, indurated to touch, with no changes in color or hair follicle loss.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V. Kaplan, C. Bolte, I. Sazunic, X. Wortsman" "autores" => array:4 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "Kaplan" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Bolte" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Sazunic" ] 3 => array:2 [ "nombre" => "X." "apellidos" => "Wortsman" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018302503" "doi" => "10.1016/j.ad.2017.12.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018302503?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019300551?idApp=UINPBA000044" "url" => "/15782190/0000011000000003/v1_201904030645/S1578219019300551/v1_201904030645/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1578219019300526" "issn" => "15782190" "doi" => "10.1016/j.adengl.2019.02.013" "estado" => "S300" "fechaPublicacion" => "2019-04-01" "aid" => "2036" "copyright" => "Elsevier España, S.L.U. and AEDV" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Actas Dermosifiliogr. 2019;110:243-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8 "formatos" => array:3 [ "EPUB" => 2 "HTML" => 4 "PDF" => 2 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Allergic Contact Dermatitis to Kojic Acid" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "243" "paginaFinal" => "244" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatitis alérgica de contacto al ácido kójico" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 599 "Ancho" => 900 "Tamanyo" => 86635 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Eczematous lesions at the application sites of the skin lightening product.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Tejera-Vaquerizo, J. García-Gavín" "autores" => array:2 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Tejera-Vaquerizo" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "García-Gavín" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731018303557" "doi" => "10.1016/j.ad.2018.03.021" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731018303557?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219019300526?idApp=UINPBA000044" "url" => "/15782190/0000011000000003/v1_201904030645/S1578219019300526/v1_201904030645/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "An Analysis of Drug Survival, Effectiveness, and Safety in Moderate to Severe Psoriasis Treated With Ustekinumab: An Observational Study of 69 Patients in Routine Clinical Practice" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "244" "paginaFinal" => "246" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "I. Salgüero Fernández, M. Hospital Gil, M. Sigüenza Sanz, G. Roustan Gullón" "autores" => array:4 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Salgüero Fernández" "email" => array:1 [ 0 => "irenebsf@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Hospital Gil" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Sigüenza Sanz" ] 3 => array:2 [ "nombre" => "G." "apellidos" => "Roustan Gullón" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Dermatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis de supervivencia, eficacia y seguridad en psoriasis moderada–grave tratada con ustekinumab. Estudio observacional de 69 pacientes en la práctica clínica habitual" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2258 "Ancho" => 2500 "Tamanyo" => 215575 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier analysis of treatment survival (duration in months, 8.3 years of follow-up).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Psoriasis is a chronic disease with a prevalence of between 1% and 3%. Its clinical manifestations and associated comorbidities have a considerable impact on affected patients.</p><p id="par0010" class="elsevierStylePara elsevierViewall">While the advent of biologic therapy has greatly improved the control of moderate to severe psoriasis,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> the treatment of this disease is still complicated. We have data on the patients who participated in clinical trials of biologic drugs, but these cases are often unlike those we encounter in clinical practice, as shown by a study of data from the Spanish BIOBADADERM registry.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> That study, which analyzed data from 1042 patients on systemic therapy (classic and biologic), reported that 30% of those patients would have been excluded from clinical trials. The patients who would not have been eligible for inclusion in a clinical trial had a higher risk of developing severe adverse reactions to systemic treatment.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Since we consider that it is important to report data on patients being treated in routine clinical practice, we designed a study to evaluate the efficacy, safety, and survival of treatment with ustekinumab in our hospital. We studied patients with moderate to severe psoriasis who started treatment with ustekinumab in our specialized psoriasis clinic between 1 January 2010 and 30 April 2017.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The characteristics of the patients included in the study are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Patients weighing 100 kg or less started treatment with an initial dose of ustekinumab 45<span class="elsevierStyleHsp" style=""></span>mg followed by a second dose at 4 weeks and then 45<span class="elsevierStyleHsp" style=""></span>mg every 12 weeks for at least 12 months. At 1 year, treatment optimization was considered, taking into account the efficacy achieved. In 2 patients who weighed over 100<span class="elsevierStyleHsp" style=""></span>kg, a dose of 90<span class="elsevierStyleHsp" style=""></span>mg was administered initially followed by another at 4 weeks and 90<span class="elsevierStyleHsp" style=""></span>mg every 12 weeks thereafter. Informed consent was obtained from all of the patients before start of treatment.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Treatment survival was calculated as the number of days a patient continued on ustekinumab during follow-up. The longest interval between two injections of the drug considered not to constitute loss to follow-up or treatment interruption was 180 days. We performed 2 analyses: one of the dataset as a whole and the other differentiating between patients who had previously received biologic therapy (naive) and those who had not (non-naive). The data was analyzed using the Kaplan-Meier method.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Treatment resulted in an improvement from the mean baseline Psoriasis Area and Severity Index (PASI) of 13.3 to a final mean PASI score of 3.5, which represents an 83% reduction in absolute PASI.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The treatment survival rate at the end of the 8.3 years of follow-up was 75.3%, and the rate was higher in the group of patients who had not previously been treated with a biologic agent than in the non-naive group (80% vs 60%) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> includes the patients who continued on ustekinumab and those in whom treatment was withdrawn. In this series, 6 patients reported adverse events, most of which were considered to be mild and did not lead to cessation of treatment. Treatment was withdrawn due to an adverse event in 2 patients: one who presented with infectious spondylodiscitis and another who developed severe palmoplantar pustulosis. A patient who developed psoriatic arthritis 3 months after starting ustekinumab continued on treatment, achieving a good response in terms of both skin lesions and joint involvement.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Tuberculin skin test conversion occurred in 12 patients, who were prescribed 6 to 9 months of treatment with isoniazid. No cases of active tuberculosis were recorded.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Several recent studies, including the PSOLAR<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> and BABDIR<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> studies, have collected data on the survival of biologic therapy in clinical practice. The findings of the Spanish ORBIT<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> study—based on data from 427 patients collected over a 4-year period—highlight the efficacy and safety of long-term biologic therapy.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The treatment survival rate in this series was high (76.3% at 100 months). The 83% decline in absolute PASI score was similar to results reported by other authors in the literature. Puig et al.,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> in a 3-year study of 67 patients receiving ustekinumab, reported a PASI 75 response at 1 year in 86% of the patients. Also of interest is the study by Molina-Leyva et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> of 30 patients treated with ustekinumab, in which the PASI 75 response at 1 year was 81.5%.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In the present series, we should note that the baseline PASI was probably underestimated because none of the patients underwent a washout period before start of treatment with ustekinumab.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Withdrawal of treatment due to lack of efficacy (both primary and secondary treatment failure) was 13%. This low percentage may be due to the practice in our clinic of having a “watch and wait” period before deciding on loss of efficacy or withdrawal of treatment and to our patient's high degree of satisfaction with the efficacy achieved.</p><p id="par0070" class="elsevierStylePara elsevierViewall">In the literature we reviewed, we found no cases of paradoxical psoriatic reactions associated with the use of IL-23 inhibitors. By contrast, their use as an alternative treatment for such reactions is reported.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> We did, however, find a report of a case in which paradoxical psoriasis worsened following treatment with ustekinumab.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">9</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The limitations of this study include its retrospective design and the use of the treatment survival rate as a measure of treatment success because this endpoint does not provide any information on how patients were included or take into account cases in which treatment was discontinued because the lesions had cleared.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0080" class="elsevierStylePara elsevierViewall">Irene Salgüero has participated in clinical trials and has been invited to give papers by Janssen, Abbvie, and Novartis.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "Références" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Salgüero Fernández I, Gil MH, Sanz MS, Gullón GR. Análisis de supervivencia, eficacia y seguridad en psoriasis moderada–grave tratada con ustekinumab. Estudio observacional de 69 pacientes en la práctica clínica habitual. Actas Dermosifiliogr. 2019;110:244–246.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2258 "Ancho" => 2500 "Tamanyo" => 215575 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier analysis of treatment survival (duration in months, 8.3 years of follow-up).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total number of patients n=69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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">Women, 31.88% (21); Men, 69.57% (48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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">Naive patients, 39% (28); Non-naive patients, 61% (41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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 = 1 prior biologic, 34.78%; > 1 prior biologic, 23.18% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \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"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Mean</span></span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Median</span></span> \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">Age on starting ustekinumab, y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49 \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">Baseline PASI score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 \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">Final PASI score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \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">Number of prior biologic therapies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 \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">Duration of follow-up, mo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23.79 \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"><span class="elsevierStyleBold">Patients Still on Therapy and Reasons for Withdrawal</span></span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Number</span></span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">%</span></span> \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 still on UST \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75.36 \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">Withdrawal due to adverse events \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.90 \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">Withdrawal due to lack of efficacy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13.04 \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">Withdrawal due to good response \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.35 \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">Withdrawal because patient was lost to follow-up \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.35 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2003845.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patient Characteristics.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Références" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Accumulated disability in the life course: the scar of psoriasis in the patient's life" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Ros" 1 => "L. Puig" 2 => "J.M. Carrascosa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ad.2013.02.009" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr." "fecha" => "2014 Mar" "volumen" => "105" "paginaInicial" => "128" "paginaFinal" => "134" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23668623" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0050" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk of serious adverse events associated with biologic and nonbiologic psoriasis systemic therapy: patients ineligible vs eligible for randomized controlled trials" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Garcia-Doval" 1 => "G. Carretero" 2 => "F. Vanaclocha" 3 => "C. Ferrandiz" 4 => "E. Daudén" 5 => "J.L. Sánchez-Carazo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archdermatol.2011.2768" "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol." "fecha" => "2012 Apr" "volumen" => "148" "paginaInicial" => "463" "paginaFinal" => "470" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22508869" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0055" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Drug survival of biologic therapy in a large, disease-based registry of patients with psoriasis: results from the Psoriasis Longitudinal Assessment and Registry (PSOLAR)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Menter" 1 => "K.A. Papp" 2 => "M. Gooderham" 3 => "D.M. Pariser" 4 => "M. Augustin" 5 => "F.A. Kerdel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jdv.13611" "Revista" => array:6 [ "tituloSerie" => "J Eur Acad Dermatol Venereol." "fecha" => "2016 Jul" "volumen" => "30" "paginaInicial" => "1148" "paginaFinal" => "1158" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27027388" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0060" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differential drug survival of biologic therapies for the treatment of psoriasis: A prospective observational cohort study from the British Association of Dermatologists Biologic Interventions Register (BADBIR)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.B. Warren" 1 => "C.H. Smith" 2 => "Z.Z.N. Yiu" 3 => "D.M. Ashcroft" 4 => "J.N.W.N. Barker" 5 => "A.D. Burden" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/jid.2015.208" "Revista" => array:6 [ "tituloSerie" => "J Invest Dermatol." "fecha" => "2015 Nov" "volumen" => "135" "paginaInicial" => "2632" "paginaFinal" => "2640" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26053050" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0065" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ORBIT (Outcome and Retention Rate of Biologic Treatments for Psoriasis): A retrospective observational study on biologic drug survival in daily practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E. Vilarrasa" 1 => "J. Notario" 2 => "X. Bordas" 3 => "A. López-Ferrer" 4 => "I.J. Gich" 5 => "L. Puig" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaad.2016.01.037" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol." "fecha" => "2016 Jun" "volumen" => "74" "paginaInicial" => "1066" "paginaFinal" => "1072" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27004803" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0070" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term efficacy, safety and drug survival of ustekinumab in a Spanish cohort of patients with moderate to severe plaque psoriasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Puig" 1 => "V. Ruiz-Salas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000366499" "Revista" => array:6 [ "tituloSerie" => "Dermatology." "fecha" => "2015" "volumen" => "230" "paginaInicial" => "46" "paginaFinal" => "54" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25572820" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0075" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety and effectiveness of ustekinumab for treatment of moderate to severe psoriasis: a prospective study in a clinical setting" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Molina-Leyva" 1 => "H. Husein-Elahmed" 2 => "R. Naranjo-Sintes" 3 => "J.C. Ruiz-Carrascosa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Drugs Dermatol." "fecha" => "2014 Aug" "volumen" => "13" "paginaInicial" => "971" "paginaFinal" => "974" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0085" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of systemic therapies for moderate-to-severe psoriasis: a systematic review and meta-analysis of long-term treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T.C. Lucka" 1 => "D. Pathirana" 2 => "A. Sammain" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2012.04492.x" "Revista" => array:7 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2012" "volumen" => "26" "paginaInicial" => "1331" "paginaFinal" => "1344" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22404617" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022202X16310442" "estado" => "S300" "issn" => "0022202X" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0080" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psoriasiform eruption and worsening of pustulosis palmoplantaris after treatment with two anti-TNF-α inhibitors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N.A. Bogaards" 1 => "M.A. de Rie" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s13555-016-0151-4" "Revista" => array:6 [ "tituloSerie" => "followed by successful treatment with ustekinumab. Dermatol Ther (Heidelb)." "fecha" => "2016 Dec" "volumen" => "6" "paginaInicial" => "683" "paginaFinal" => "688" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27783331" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011000000003/v1_201904030645/S157821901930054X/v1_201904030645/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011000000003/v1_201904030645/S157821901930054X/v1_201904030645/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901930054X?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 9 | 19 |
| 2024 October | 58 | 49 | 107 |
| 2024 September | 69 | 34 | 103 |
| 2024 August | 87 | 65 | 152 |
| 2024 July | 65 | 43 | 108 |
| 2024 June | 70 | 38 | 108 |
| 2024 May | 57 | 41 | 98 |
| 2024 April | 65 | 29 | 94 |
| 2024 March | 64 | 44 | 108 |
| 2024 February | 47 | 42 | 89 |
| 2024 January | 54 | 41 | 95 |
| 2023 December | 60 | 21 | 81 |
| 2023 November | 63 | 34 | 97 |
| 2023 October | 65 | 22 | 87 |
| 2023 September | 51 | 38 | 89 |
| 2023 August | 47 | 25 | 72 |
| 2023 July | 44 | 32 | 76 |
| 2023 June | 54 | 25 | 79 |
| 2023 May | 53 | 23 | 76 |
| 2023 April | 25 | 21 | 46 |
| 2023 March | 45 | 23 | 68 |
| 2023 February | 36 | 25 | 61 |
| 2023 January | 33 | 34 | 67 |
| 2022 December | 56 | 41 | 97 |
| 2022 November | 32 | 34 | 66 |
| 2022 October | 30 | 29 | 59 |
| 2022 September | 20 | 38 | 58 |
| 2022 August | 23 | 55 | 78 |
| 2022 July | 22 | 43 | 65 |
| 2022 June | 21 | 38 | 59 |
| 2022 May | 37 | 41 | 78 |
| 2022 April | 73 | 44 | 117 |
| 2022 March | 76 | 55 | 131 |
| 2022 February | 84 | 24 | 108 |
| 2022 January | 67 | 47 | 114 |
| 2021 December | 46 | 45 | 91 |
| 2021 November | 51 | 34 | 85 |
| 2021 October | 41 | 52 | 93 |
| 2021 September | 34 | 36 | 70 |
| 2021 August | 32 | 23 | 55 |
| 2021 July | 53 | 12 | 65 |
| 2021 June | 47 | 28 | 75 |
| 2021 May | 32 | 40 | 72 |
| 2021 April | 76 | 31 | 107 |
| 2021 March | 35 | 21 | 56 |
| 2021 February | 48 | 18 | 66 |
| 2021 January | 38 | 14 | 52 |
| 2020 December | 20 | 9 | 29 |
| 2020 November | 20 | 18 | 38 |
| 2020 October | 19 | 11 | 30 |
| 2020 September | 20 | 9 | 29 |
| 2020 August | 26 | 22 | 48 |
| 2020 July | 18 | 13 | 31 |
| 2020 June | 30 | 23 | 53 |
| 2020 May | 32 | 12 | 44 |
| 2020 April | 19 | 13 | 32 |
| 2020 March | 21 | 6 | 27 |
| 2020 February | 4 | 0 | 4 |
| 2019 May | 2 | 0 | 2 |
| 2019 April | 1 | 0 | 1 |
Show all
