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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La psoriasis en pediatr&#237;a no es una enfermedad infrecuente&#44; sin embargo existen pocos datos acerca de sus caracter&#237;sticas epidemiol&#243;gicas y de su manejo con tratamientos sist&#233;micos<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">En los diferentes trabajos sobre psoriasis en edad pedi&#225;trica&#44; en torno al 8&#37; de los pacientes presentan enfermedad moderada-grave y requieren tratamiento con fototerapia o f&#225;rmacos sist&#233;micos<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a>&#46; El curso cr&#243;nico de la psoriasis y el planteamiento de reg&#237;menes de tratamiento prolongados hace necesaria una selecci&#243;n cuidadosa de las diferentes opciones terap&#233;uticas&#44; considerando el mejor perfil de efectividad y seguridad&#44; especialmente en estas edades tempranas<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Nuestro objetivo principal consisti&#243; en describir qu&#233; tratamientos sist&#233;micos se emplean en pr&#225;ctica cl&#237;nica en psoriasis moderada-grave en edad pedi&#225;trica&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Secundariamente se trat&#243; de describir la efectividad y el perfil de seguridad de dichos tratamientos&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Material y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Estudio descriptivo transversal multic&#233;ntrico realizado en los servicios de Dermatolog&#237;a pertenecientes a las 7 Estructuras de Gesti&#243;n Integrada de las que consta la red del Servizo Galego de Sa&#250;de &#40;SERGAS&#41;&#46; Se incluyeron pacientes con psoriasis moderada-grave&#44; que siendo menores de 18 a&#241;os estuviesen recibiendo o hubieran recibido tratamiento sist&#233;mico &#40;cl&#225;sico o biol&#243;gico&#41; o fototerapia&#44; en el periodo de enero de 2005 a agosto de 2017&#46; Se extendi&#243; el estudio a una edad menor de 18 a&#241;os &#40;y no meramente pedi&#225;trica &#8211;hasta los 12-14 a&#241;os&#8211;&#41;&#44; ya que es la edad a partir de la cual se considera a un paciente como adulto&#46; Tambi&#233;n los 18 a&#241;os son el punto de corte a partir del cual la mayor&#237;a de los tratamientos sist&#233;micos &#40;a excepci&#243;n del etanercept<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a>&#44; y m&#225;s recientemente el adalimumab<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> y el ustekinumab<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a>&#41; cuentan con aprobaci&#243;n &#40;su empleo en ni&#241;os se considera &#171;fuera de ficha t&#233;cnica&#187;&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">De cada uno de los pacientes incluidos se recogieron datos cl&#237;nico-demogr&#225;ficos&#44; par&#225;metros anal&#237;ticos b&#225;sicos&#44; caracter&#237;sticas de la psoriasis y gravedad de la misma &#40;seg&#250;n el <span class="elsevierStyleItalic">Psoriasis Area and Severity Index</span> &#91;PASI&#93; o seg&#250;n el &#225;rea de superficie corporal&#58; <span class="elsevierStyleItalic">Body Surface Index</span> &#91;BSA&#93;&#41;&#44; y presencia de comorbilidades&#46; Se consider&#243; psoriasis moderada-grave si el PASI era igual o superior a 10&#44; con extensi&#243;n a aquellos casos en los que el PASI era menor de 10&#44; pero no respond&#237;an a un tratamiento correctamente indicado&#46; Con relaci&#243;n al BSA&#44; el punto de corte para psoriasis moderada-grave fue el 10&#37;&#46; Con respecto a los tratamientos sist&#233;micos realizados&#44; se recogi&#243; la duraci&#243;n&#44; la posolog&#237;a&#44; la respuesta&#44; la presencia de efectos indeseables&#44; la tolerancia y el motivo de suspensi&#243;n&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La evaluaci&#243;n de la respuesta se realiz&#243; en la semana 12 y&#47;o 24 para todos los tratamientos con excepci&#243;n de la fototerapia &#40;evaluada &#250;nicamente en la semana 12&#41;&#46; Esto se explica por el modo de proceder en la pr&#225;ctica cl&#237;nica diaria en nuestros centros&#44; donde tras la fototerapia no se suele programar una reevaluaci&#243;n estandarizada en la semana 24&#44; a diferencia de lo que se hace ante el tratamiento con f&#225;rmacos sist&#233;micos&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Teniendo en cuenta el PASI&#44; el BSA y otra informaci&#243;n descriptiva reflejada por el dermat&#243;logo en la historia cl&#237;nica&#44; se establecieron definiciones para clasificar a los pacientes como buenos respondedores&#44; respondedores parciales y no respondedores&#46; Se defini&#243; buena respuesta si se alcanzaba un PASI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>75 &#40;mejor&#237;a del 75&#37; o superior con respecto al PASI basal&#41; en el momento de la evaluaci&#243;n &#40;semana 12&#44; semana 24&#41;&#46; Se incluyeron tambi&#233;n en este grupo a los pacientes en cuya historia cl&#237;nica se indicase&#58; &#171;evoluci&#243;n muy buena o excelente&#187;&#44; psoriasis &#171;pr&#225;cticamente aclarada&#187;&#44; &#171;remisi&#243;n total o pr&#225;cticamente total&#187;&#44; o &#171;suspensi&#243;n del tratamiento por buena respuesta&#187;&#46; Un valor de BSA de 0 o 1&#37; en ausencia del valor PASI tambi&#233;n se consider&#243; buena respuesta&#46; Se defini&#243; respuesta parcial si en el momento de la evaluaci&#243;n el paciente se situaba entre un PASI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>50 y PASI<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>75&#44; o si en la historia cl&#237;nica se indicaba&#58; &#171;mejor&#237;a parcial&#187;&#44; &#171;aclaramiento parcial&#187;&#44; &#171;remisi&#243;n parcial&#187;&#46; Aquellos que no alcanzaban el PASI50&#44; o en cuya historia se recog&#237;a &#171;mejor&#237;a escasa&#187;&#44; &#171;m&#237;nimo efecto&#187;&#44; &#171;ausencia de mejor&#237;a&#187;&#44; &#171;estabilidad de las lesiones con respecto al momento del inicio del tratamiento&#187;&#44; o &#171;suspensi&#243;n del tratamiento por falta de respuesta&#187;&#44; se consideraron no respondedores&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se diferenci&#243; &#171;efecto indeseable&#187; &#40;signos cl&#237;nicos o alteraciones en estudios complementarios observados por el facultativo y reflejados en la historia cl&#237;nica&#44; relacionados con el tratamiento en cuesti&#243;n&#44; habiendo o no derivado en la suspensi&#243;n del mismo&#41;&#44; de intolerancia &#40;cualquier sintomatolog&#237;a subjetiva u otras molestias que reportasen el paciente o sus padres con respecto a la toma del f&#225;rmaco&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Los motivos que llevaron a la suspensi&#243;n de un tratamiento se dividieron en buena respuesta&#44; escasa respuesta&#47;ausencia de respuesta&#44; p&#233;rdida de respuesta &#40;fallo secundario&#41;&#44; pauta de tratamiento intermitente&#44; deseo expreso del paciente o sus padres&#44; mal cumplimiento terap&#233;utico&#44; pauta limitada por ensayo cl&#237;nico&#44; o si se suspendi&#243; debido a motivo m&#233;dico &#40;como intervenci&#243;n quir&#250;rgica&#44; infecci&#243;n activa o necesidad de otros tratamientos que interaccionasen o estuviesen contraindicados con el f&#225;rmaco que se recib&#237;a&#41;&#44; o por presencia de efectos indeseables&#47;intolerancia&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">El protocolo de este trabajo fue evaluado&#44; con dictamen favorable&#44; por el Comit&#233; &#201;tico de Investigaci&#243;n Cl&#237;nica de Galicia&#46; Asimismo&#44; fue clasificado por la Agencia Espa&#241;ola de Medicamentos y Productos Sanitarios &#40;AEMPS&#41;&#44; como estudio postautorizaci&#243;n con otros dise&#241;os diferentes al de seguimiento prospectivo &#40;EPA-OD&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">An&#225;lisis estad&#237;stico</span><p id="par0060" class="elsevierStylePara elsevierViewall">Los datos se recogieron en una hoja de c&#225;lculo del programa Excel y se analizaron con el programa R Statistics &#40;versi&#243;n R i386 3&#46;4&#46;2&#41;&#46; Se calcul&#243; la distribuci&#243;n de frecuencias para las variables cualitativas&#44; y la media y desviaci&#243;n est&#225;ndar de las variables cuantitativas&#46; Se utiliz&#243; el test Chi cuadrado &#40;o el test exacto de Fisher en caso necesario seg&#250;n el n&#250;mero de observaciones&#41; para determinar las relaciones entre las diferentes variables cualitativas&#46; Para la comparaci&#243;n entre variables cuantitativas seg&#250;n grupos de tratamiento se emple&#243; el test de la T de Student&#46; Se consider&#243; estad&#237;sticamente significativo un valor de p<span class="elsevierStyleHsp" style=""></span>¿<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">Se obtuvieron datos de 40 pacientes &#40;60&#37; sexo femenino&#44; edad media al inicio del primer tratamiento 13 a&#241;os&#44; 65&#37; con psoriasis en placas&#41;&#44; que realizaron 63 ciclos de tratamiento&#46; Las caracter&#237;sticas de la poblaci&#243;n de estudio se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Teniendo en cuenta el primer tratamiento &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;&#44; la fototerapia fue la terapia m&#225;s frecuentemente empleada &#40;68&#37;&#41;&#44; seguida de acitretino &#40;15&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; En la semana 12&#44; en donde se incluye la evaluaci&#243;n de la fototerapia&#44; el 66&#37; &#40;25&#47;38&#41; y el 24&#37; &#40;9&#47;38&#41; fueron buenos respondedores o respondedores parciales&#44; respectivamente&#46; En la semana 24 &#40;evaluaci&#243;n de sist&#233;micos cl&#225;sicos y biol&#243;gicos exclusivamente&#41;&#44; el 25&#37; &#40;3&#47;12&#41; alcanzaron buena respuesta y el 50&#37; &#40;6&#47;12&#41; presentaron respuestas parciales&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Considerando el total de ciclos de tratamiento realizados &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>63&#41;&#44; el tratamiento m&#225;s frecuente fue la fototerapia&#44; suponiendo el 57&#37; de los ciclos&#44; seguida de metotrexato&#44; que fue indicado en el 16&#37; de los casos &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; En la semana 12&#44; el 66&#37; &#40;38&#47;58&#41; y el 22&#37; &#40;13&#47;58&#41; fueron buenos respondedores o respondedores parciales&#44; respectivamente&#46; En la semana 24 &#40;an&#225;lisis de sist&#233;micos cl&#225;sicos y biol&#243;gicos exclusivamente&#41;&#44; el 36&#37; &#40;8&#47;22&#41; continu&#243; con buena respuesta y el 32&#37; &#40;7&#47;22&#41; con respuestas parciales&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a> se especifican los datos de respuesta para las diferentes opciones terap&#233;uticas&#44; en las semanas 12 y 24&#44; teniendo en cuenta solo el primer tratamiento &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;&#44; o todos los ciclos de tratamiento &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>63&#41;&#46; La fototerapia&#44; la ciclosporina y los f&#225;rmacos biol&#243;gicos consiguieron los mejores resultados en el corto plazo &#40;semana 12&#41;&#46; En la semana 24 las respuestas m&#225;s favorables se obtuvieron con los f&#225;rmacos biol&#243;gicos&#44; seguidos de metotrexato&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">En el material suplementario se especifican las pautas empleadas y los datos de tolerancia y efectos indeseables&#44; considerando todos los ciclos de tratamiento &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>63&#41;&#46; Etanercept y acitretino fueron los tratamientos m&#225;s prolongados &#40;media de 26 y 23 meses&#44; respectivamente&#41;&#46; En referencia a la fototerapia &#40;94&#37; ultravioleta B de banda estrecha&#41;&#44; la duraci&#243;n media de un ciclo de tratamiento fue de 2 meses&#46; El tipo de psoriasis &#40;placas <span class="elsevierStyleItalic">versus</span> gotas&#41;&#44; no se relacion&#243; con el tiempo de tratamiento ni con el n&#250;mero de sesiones &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Los tratamientos fueron bien tolerados &#40;97&#37;&#41; y los efectos indeseables escasos &#40;11&#37;&#41;&#44; y en ning&#250;n caso motivaron la suspensi&#243;n del f&#225;rmaco&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#fig0015">figura 3</a> se muestra la distribuci&#243;n de las razones que llevaron al cese del tratamiento&#46; El motivo m&#225;s frecuente fue la buena respuesta &#40;47&#37; de los casos&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discusi&#243;n</span><p id="par0095" class="elsevierStylePara elsevierViewall">Los trabajos que eval&#250;an los tratamientos en psoriasis moderada-grave en edad pedi&#225;trica y adolescente difieren metodol&#243;gicamente y muestran resultados dispares &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Un primer grupo de estudios descriptivos analizan datos cl&#237;nico-epidemiol&#243;gicos de ni&#241;os con psoriasis de cualquier gravedad&#44; y sin que sea su objetivo principal&#44; indican los tipos de tratamientos utilizados&#46; Kwon et al&#46; evaluaron a 358 ni&#241;os y adolescentes&#46; El 26&#37; recibieron tratamiento sist&#233;mico&#46; Fototerapia y acitretino fueron las opciones m&#225;s empleadas&#44; seguidas de ciclosporina<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&#46; Tovar-Garza et al&#46; muestran resultados similares con relaci&#243;n al porcentaje de tratamiento sist&#233;mico&#44; que fue pautado en el 25&#37; de 280 casos analizados&#46; Sin embargo&#44; los tratamientos empleados no coinciden con las recomendaciones de los documentos de consenso seguidos en nuestro medio&#44; pues la dapsona fue el f&#225;rmaco m&#225;s frecuentemente utilizado&#44; y los antibi&#243;ticos&#44; indicados ante psoriasis <span class="elsevierStyleItalic">guttata</span>&#44; ocupaban el segundo lugar<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a>&#46; El estudio m&#225;s numeroso incluye a 842 ni&#241;os y adolescentes &#40;edad media 7 a&#241;os&#44; el 2&#37; con BSA<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>10&#41;&#44; de los cuales solo 3 recibieron tratamiento sist&#233;mico &#40;2 ciclosporina y uno metotrexato en combinaci&#243;n con etanercept&#41;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Otros estudios&#44; m&#225;s parejos a la metodolog&#237;a seguida en nuestro trabajo&#44; analizan &#250;nicamente los casos de psoriasis en edad pedi&#225;trica en tratamiento con f&#225;rmacos sist&#233;micos&#46; Destacan 5 trabajos &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#44; con poblaciones de entre 27 y 390 pacientes&#46; Al igual que nuestro estudio&#44; 3 de ellos incluyen la fototerapia entre las opciones de tratamiento evaluadas<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#8211;12</span></a>&#46; Metotrexato seguido de etanercept<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;13</span></a>&#44; etanercept seguido de metroxato<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a>&#44; acitretino<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> o ciclosporina<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a>&#44; son los f&#225;rmacos mayoritarios seg&#250;n cada una de las series&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">La posolog&#237;a de los citados tratamientos es similar en los distintos trabajos&#58; fototerapia &#40;ultravioleta B de banda estrecha o PUVA&#41;&#44; 2-3 veces&#47;semana&#59; acitretino en dosis de 0&#44;2-1<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#237;a&#44; metotrexato en dosis de 0&#44;2-0&#44;7<span class="elsevierStyleHsp" style=""></span>mg&#47;semana&#44; ciclosporina en dosis de 2&#44;5-5<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;d&#237;a y etanercept seg&#250;n ficha t&#233;cnica &#40;0&#44;8<span class="elsevierStyleHsp" style=""></span>mg&#47;kg&#47;semana hasta un m&#225;ximo de 50<span class="elsevierStyleHsp" style=""></span>mg&#47;semana&#41;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">3&#44;12&#44;15&#44;16</span></a>&#46; Estos datos son concordantes con las pautas seguidas en los pacientes de nuestro estudio&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">En los trabajos descriptivos previamente citados<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#8211;12&#44;14</span></a>&#44; aunque con disparidad en el dise&#241;o y en el modo de expresar los resultados&#44; se indican de modo general&#44; para todos los grupos de tratamientos&#44; respuestas satisfactorias&#46; En cuanto a los f&#225;rmacos m&#225;s efectivos&#44; Garber et al&#46; observan mejores respuestas con f&#225;rmacos biol&#243;gicos frente a sist&#233;micos convencionales y fototerapia&#44; mientras que Charbit et al&#46; indican una mayor tasa de respuestas para la combinaci&#243;n de fototerapia y acitretino&#44; si bien solo 10 de 261 ciclos de tratamiento correspondieron a esta modalidad &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;11</span></a>&#46; En nuestra poblaci&#243;n de estudio&#44; el porcentaje de buenos respondedores fue del 66&#37; en la semana 12&#44; disminuyendo al 32&#37; en la semana 24&#46; Los porcentajes ascienden si se a&#250;nan respuestas buenas y parciales &#40;88&#37; en semana 12&#44; 68&#37; en semana 24&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">En la mayor&#237;a de las series&#44; los efectos indeseables son leves y escasos&#46; El porcentaje de efectos indeseables que motiva suspensi&#243;n del tratamiento oscila entre un 4 y un 11&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#8211;14</span></a>&#46; Recientemente&#44; Bronckers et al&#46;&#44; en un estudio retrospectivo de 390 menores de 18 a&#241;os&#44; observaban que el porcentaje de efectos indeseables era menor con agentes biol&#243;gicos que con metotrexato&#44; aunque la presencia de infecciones era mayor con los primeros&#46; Con relaci&#243;n a los f&#225;rmacos biol&#243;gicos destacaban las reacciones en el &#225;rea de inyecci&#243;n &#40;20&#47;106&#41; y con relaci&#243;n a metotrexato&#44; las alteraciones gastrointestinales &#40;67&#47;270&#41;&#46; El porcentaje de efectos indeseables graves fue del 2&#37; &#40;3 asociados a metotrexato&#44; 2 a &#233;steres del &#225;cido fum&#225;rico y uno a adalimumab&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Otros estudios revelan datos de efectividad y efectos indeseables evaluando un &#250;nico f&#225;rmaco o pocos f&#225;rmacos &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; El momento de evaluaci&#243;n de la respuesta&#44; la escala utilizada para medir la efectividad y el n&#250;mero de pacientes son heterog&#233;neos&#44; pero se extraen porcentajes de buenos respondedores de en torno al 40&#37; tanto para metotrexato&#44; como para acitretino y ciclosporina<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#44;17&#44;18</span></a>&#46; Trabajos menos recientes evidenciaban respuestas m&#225;s favorables para metotrexato<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">19&#44;20</span></a>&#46; Del mismo modo&#44; se han indicado porcentajes de respuesta del 62&#37; para ciclosporina<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a>&#46; Este dato debe ser tenido en cuenta con cautela&#44; ya que se trata de una poblaci&#243;n de 10 pacientes&#44; en los que la efectividad de ciclosporina se eval&#250;a en la semana 4&#46; Di Lernia et al&#46; analizan datos de efectividad de etanercept en poblaci&#243;n menor de 18 a&#241;os&#44; en pr&#225;ctica cl&#237;nica&#46; Observan que el 65&#37; de los pacientes alcanzan un PASI75 en la semana 24<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Todos estos trabajos coinciden nuevamente en la presencia de efectos indeseables escasos&#44; con necesidad de suspensi&#243;n del f&#225;rmaco en menos del 4&#37; de los casos<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#8211;21</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Con respecto a la fototerapia&#44; se ha documentado aclaramiento total o mejor&#237;a mayor del 70&#37; en m&#225;s del 60&#37; de los casos&#44; y se describen efectos secundarios menores &#40;eritema&#44; prurito o quemaz&#243;n&#44; presencia de ampollas&#44; o reactivaci&#243;n del virus herpes simple&#41;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">22&#8211;30</span></a>&#46; En la poblaci&#243;n del estudio que presentamos&#44; la fototerapia alcanz&#243; buenas respuestas en m&#225;s del 80&#37; de los ciclos de tratamiento&#44; siendo m&#237;nimos los efectos secundarios&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Nuestro trabajo no est&#225; exento de limitaciones&#46; Contamos con un n&#250;mero peque&#241;o de pacientes y los datos se analizan con car&#225;cter retrospectivo&#44; por lo que dependen de lo previamente registrado en las historias cl&#237;nicas&#46; Son pues necesarios m&#225;s estudios&#44; preferentemente de car&#225;cter prospectivo y con mayor n&#250;mero de pacientes&#44; para confirmar y a&#241;adir informaci&#243;n a nuestros hallazgos&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusi&#243;n</span><p id="par0145" class="elsevierStylePara elsevierViewall">En nuestro medio&#44; en la poblaci&#243;n menor de 18 a&#241;os con psoriasis&#44; la fototerapia fue el tratamiento m&#225;s utilizado&#44; seguida de metotrexato&#46; Los tratamientos evaluados consiguen un porcentaje de buenos respondedores del 66&#37; en la semana 12 &#40;incluida fototerapia&#41;&#44; y del 32&#37; en la semana 24 &#40;f&#225;rmacos sist&#233;micos sin fototerapia&#41;&#44; presentando un buen perfil de seguridad&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicto de intereses</span><p id="par0150" class="elsevierStylePara elsevierViewall">Ana Batalla&#58; actividades de formaci&#243;n patrocinadas por Abbvie&#44; LeoPharma&#44; Novartis y Pierre-Fabre&#46; Investigadora de ensayos cl&#237;nicos promovidos por Lilly y Novartis&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Rosa Fern&#225;ndez-Torres&#58; actividades de formaci&#243;n patrocinadas por Abbvie&#44; LeoPharma&#44; Janssen&#44; Novartis y Pfizer&#46; Investigadora de ensayos cl&#237;nicos promovidos por Janssen y Novartis&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Laura Rodr&#237;guez-Pazos&#58; investigadora de ensayos cl&#237;nicos promovidos por Novartis&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Romina Rodr&#237;guez Lojo&#58; actividades de formaci&#243;n patrocinadas por Abbvie&#44; Brystol-Myers y Roche&#46; Investigadora de ensayos cl&#237;nicos promovidos por Janssen y Novartis&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">&#193;nder Zulaica&#58; actividades formativas&#44; ensayos cl&#237;nicos o de consultor&#237;a patrocinados o promovidos por Abbvie&#44; Almirall&#44; Celgene&#44; Janssen&#44; Leo-Pharma&#44; MSD&#44; Novartis y Pfizer&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Miguel Cabanillas&#58; actividades de formaci&#243;n patrocinadas por Abbvie&#44; Janssen&#44; Leo-Pharma y Pfizer&#46; Investigador de ensayos cl&#237;nicos promovidos por Abbvie y Novartis&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Eduardo Fonseca Capdevila ha participado en actividades de formaci&#243;n o ensayos cl&#237;nicos patrocinados o promovidos por Abbvie&#44; Almirall&#44; Celgene&#44; Janssen&#44; Novartis y Pfizer&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">&#193;lvaro Le&#243;n&#58; actividades de formaci&#243;n patrocinadas por LeoPharma&#44; Novartis y Pierre-Fabre&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Luisa Fern&#225;ndez-D&#237;az&#58; actividades de formaci&#243;n&#44; investigaci&#243;n o asesoramiento patrocinadas por Abbvie&#44; Celgene&#44; Gebro-Pharma&#44; Janssen&#44; LeoPharma&#44; Lilly&#44; MSD&#44; Novartis y Pfizer&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Mar&#237;a Jos&#233; Seoane-Pose&#58; investigadora de ensayos cl&#237;nicos promovidos por Abbvie y Novartis&#46;</p><p id="par0240" class="elsevierStylePara elsevierViewall">Hugo V&#225;zquez-Veiga&#58; proyectos de investigaci&#243;n&#44; actividades formativas y de consultor&#237;a patrocinadas por Almirall&#44; Celgene&#44; Leo-Pharma&#44; Lilly&#44; Janssen&#44; MSD y Novartis&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Teresa Abalde&#58; actividades de formaci&#243;n patrocinadas por Celgene&#44; LeoPharma&#44; Janssen&#44; MSD&#44; Novartis&#44; Pfizer&#46; Investigadora de ensayos cl&#237;nicos promovidos por Almirall&#44; Janssen y Novartis&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Laura Salgado-Boquete&#58; actividades de formaci&#243;n o asesor&#237;a cient&#237;fica patrocinadas por Abbvie&#44; Celgene&#44;Janssen&#44; Lilly&#44; Medea&#44; MSD&#59; Novartis&#44; Pfizer&#46; Investigadora de ensayos cl&#237;nicos promovidos por Abbvie&#44; Almirall&#44; Janssen y Novartis&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Ignacio Su&#225;rez-Conde&#58; investigador en ensayo cl&#237;nico promovido por Novartis&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">&#193;ngeles Fl&#243;rez&#58; proyectos de investigaci&#243;n&#44; actividades formativas y de consultor&#237;a patrocinadas por Almirall&#44; Celgene&#44; Leo-Pharma&#44; Lilly&#44; Janssen&#44; MSD y Novartis&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Los restantes autores no refieren conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Antecedentes y objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los trabajos sobre el tratamiento sist&#233;mico de la psoriasis en edad pedi&#225;trica son escasos&#46; El objetivo principal de este trabajo consisti&#243; en describir qu&#233; tratamientos sist&#233;micos se emplean en pr&#225;ctica cl&#237;nica en psoriasis moderada-grave en edad pedi&#225;trica&#46; Secundariamente se describi&#243; la efectividad y perfil de seguridad de dichos tratamientos&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materiales y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo transversal multic&#233;ntrico&#44; de los pacientes con psoriasis moderada-grave&#44; que siendo menores de 18 a&#241;os estuviesen recibiendo o hubieran recibido tratamiento sist&#233;mico &#40;cl&#225;sico o biol&#243;gico&#41; o fototerapia&#46; Se recogieron datos cl&#237;nico-demogr&#225;ficos&#44; tipo de tratamiento recibido&#44; y tolerancia&#44; efectos indeseables y respuesta al mismo&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se obtuvieron datos de 40 pacientes &#40;60&#37; sexo femenino&#44; edad media 13 a&#241;os&#41;&#44; que realizaron 63 ciclos de tratamiento&#46; Teniendo en cuenta el primer tratamiento &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;&#44; la fototerapia fue la opci&#243;n m&#225;s frecuente &#40;68&#37;&#41;&#44; seguida de acitretino &#40;15&#37;&#41;&#46; Considerando el total de ciclos de tratamiento &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>63&#41;&#44; el tratamiento m&#225;s frecuentemente empleado fue la fototerapia &#40;57&#37;&#41;&#44; seguida de metotrexato &#40;16&#37;&#41;&#46; En la semana 12 &#40;incluye evaluaci&#243;n de fototerapia&#41;&#44; el 66&#37; y el 22&#37; fueron buenos respondedores o respondedores parciales&#44; respectivamente&#46; En la semana 24 &#40;datos exclusivos sobre f&#225;rmacos sist&#233;micos&#41;&#44; el 36&#37; y el 32&#37; continuaron con respuestas buenas y parciales&#46; Los tratamientos fueron bien tolerados &#40;97&#37;&#41; y los efectos indeseables escasos &#40;11&#37;&#41;&#44; sin que en ning&#250;n caso motivasen la suspensi&#243;n del f&#225;rmaco&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En la poblaci&#243;n menor de 18 a&#241;os con psoriasis moderada-grave evaluada la fototerapia fue el tratamiento m&#225;s utilizado&#44; seguida de metotrexato&#46; Los tratamientos consiguieron porcentajes de buenos respondedores del 66&#37; en la semana 12 &#40;incluida fototerapia&#41;&#44; y del 36&#37; en la semana 24 &#40;f&#225;rmacos sist&#233;micos sin fototerapia&#41;&#44; presentando un buen perfil de seguridad&#46;</p></span>"
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            "titulo" => "Antecedentes y objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Materiales y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Background and objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Studies on the use of systemic therapy for psoriasis in pediatric patients are scarce&#46; The main aim of this study was to describe the systemic treatments used for moderate to severe psoriasis in pediatric clinical settings&#46; The second aim was to describe the effectiveness and safety of these treatments&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Material and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Descriptive&#44; cross-sectional&#44; multicenter study of patients under 18 years of age with moderate to severe psoriasis who were being treated or had been treated with a systemic drug &#40;conventional or biologic&#41; or phototherapy&#46; We recorded demographic and clinical information&#44; treatments received&#44; tolerance&#44; adverse effects&#44; and response to treatment&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Data were collected for 40 patients &#40;60&#37; female&#59; mean age&#44; 13 years&#41; who had received 63 treatments in total&#46; The most common first treatment &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41; was phototherapy &#40;administered to 68&#37; of patients&#41;&#44; followed by acitretin &#40;15&#37;&#41;&#46; The most common treatments overall &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>63&#41; were phototherapy &#40;57&#37;&#41; and methotrexate &#40;16&#37;&#41;&#46; At week 12 &#40;evaluation of systemic treatment and phototherapy&#41;&#44; 66&#37; of the patients were classified as good responders and 22&#37; as partial responders&#46; The respective rates for week 24 &#40;evaluation of systemic treatment only&#41; were 36&#37; and 32&#37;&#46; The treatments were well tolerated &#40;97&#37;&#41; and adverse effects were reported in just 11&#37; of cases&#46; There were no treatment discontinuations because of adverse effects&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Phototherapy&#44; followed by methotrexate&#44; was the most common treatment for moderate to severe psoriasis in this series of patients under 18 years&#46; The treatments showed a favorable safety profile and were associated with a good response rate of 66&#37; at week 12 &#40;systemic treatment and phototherapy&#41; and 36&#37; at week 24 &#40;systemic treatment only&#41;&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Background and objective"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0230" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Anexo A"
            "titulo" => "Material suplementario"
            "identificador" => "sec0045"
          ]
        ]
      ]
    ]
    "multimedia" => array:13 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n de tratamientos en menores de 18 a&#241;os con psoriasis moderada-grave&#46; A&#46; Considerando el primer tratamiento realizado &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;&#46; B&#46; Considerando todos los ciclos de tratamiento &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>63&#41;&#46; A la izquierda de cada barra se indica el valor absoluto de pacientes con cada uno de los tratamientos&#46;</p>"
        ]
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      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2002
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            "Tamanyo" => 248743
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        "descripcion" => array:1 [
          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n de buenos respondedores&#44; respondedores parciales y no respondedores para cada uno de los tratamientos&#46; A&#46; Considerando el primer tratamiento realizado &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;&#46; B&#46; Considerando todos los ciclos de tratamiento &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>63&#41;&#46; Sobre cada una de las barras se indica el valor absoluto de pacientes en cada uno de los grupos de respuesta&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figura 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 957
            "Ancho" => 2069
            "Tamanyo" => 83199
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n de las causas que motivaron la suspensi&#243;n del tratamiento &#40;considerando todos los ciclos de tratamiento&#41;&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
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            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">BSA&#58; <span class="elsevierStyleItalic">body surface area</span>&#59; F&#58; sexo femenino&#59; IMC&#58; &#237;ndice de masa corporal&#59; M&#58; sexo masculino&#59; PASI&#58; <span class="elsevierStyleItalic">Psoriasis Area and Severity Index</span>&#46;</p>"
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                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">Sexo &#40;F&#58; M&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;60&#37;&#41;&#58; 16 &#40;40&#37;&#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">Edad al primer tratamiento &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;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">Edad de inicio psoriasis &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;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">Tiempo de evoluci&#243;n &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;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">Tipo&#58; placas&#47;gotas&#47;invertida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;65&#37;&#41;&#47;12 &#40;30&#37;&#41;&#47;2 &#40;5&#37;&#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">Antecedentes familiares psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#47;39 &#40;51&#44;3&#37;&#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">PASI m&#225;ximo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BSA m&#225;ximo &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;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">PASI previo a tratamiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;0<span class="elsevierStyleHsp" style=""></span>&#177; 5&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BSA previo a tratamiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;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">Onicopat&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#47;32 &#40;15&#44;6&#37;&#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">Artritis psori&#225;sica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;39 &#40;0&#37;&#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">Uve&#237;tis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;40 &#40;0&#37;&#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">Otras enfermedades inflamatorias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;40 &#40;10&#37;&#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">Hipertensi&#243;n arterial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;40 &#40;0&#37;&#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">Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;40 &#40;0&#37;&#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">Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;40 &#40;5&#37;&#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">Obesidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;40 &#40;10&#37;&#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">IMC &#40;kg&#47;cm<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&#44;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">S&#237;ndrome metab&#243;lico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;40 &#40;2&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas de los pacientes menores de 18 a&#241;os con psoriasis moderada-grave con tratamiento sist&#233;mico &#40;incluida fototerapia&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;</p>"
        ]
      ]
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        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabla "
            "rol" => "short"
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        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">&#9792;&#58; sexo femenino&#59; BSA<span class="elsevierStyleItalic">&#58; Body Surface Area</span>&#59; n&#58; n&#250;mero de pacientes&#59; PASI&#58; <span class="elsevierStyleItalic">Psoriasis Area and Severity Index</span>&#59; PGA&#58; <span class="elsevierStyleItalic">Physician Global Assessmen</span>t&#59; PUVA&#58; ultravioleta A y psoraleno&#59; UVBBE&#58; ultravioleta B de banda estrecha&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span>Edad media al inicio del tratamiento&#44; expresada en a&#241;os&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Referencia&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">Poblaci&#243;n&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">Resultados&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kwon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>358 &#40;&#8804;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;<br><br>49&#37; &#9792;&#46; Edad media 14 a&#241;os&#46; PASI medio&#58; 17 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#37; tratamiento sist&#233;mico<br>&#8226; UVBBE &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#59; 7&#44;3&#37;&#41;&#44; PUVA &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#59; 4&#44;2&#37;&#41;<br>&#8226; Acitretino &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#59; 11&#44;2&#37;&#41;<br>&#8226; Ciclosporina &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#59; 4&#44;2&#37;&#41;<br>&#8226; Corticoides orales &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#59; 3&#44;6&#37;&#41;<br>&#8226; Metotrexato &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#59; 2&#37;&#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">Moustouet al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>842 &#40;&#60;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;<br><br>52&#37; &#9792;&#46; Edad media 7 a&#241;os&#46; 1&#44;7&#37; BSA<span class="elsevierStyleHsp" style=""></span>&#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">3 &#40;0&#44;4&#37;&#41; tratamiento sist&#233;mico<br>&#8226; Ciclosporina &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#41;<br>&#8226; Metotrexato<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>etanercept &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;<br>&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">Tovar-Garza et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>280 &#40;&#8804;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;<br><br>60&#37; &#9792;&#46; Edad media 11 a&#241;os&#46; 31&#37; PASI<span class="elsevierStyleHsp" style=""></span>&#62;<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">70 &#40;25&#37;&#41; tratamiento sist&#233;mico<br>&#8226; Dapsona &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>35&#59; 12&#44;5&#37;&#41;<br>&#8226; Antibi&#243;ticos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&#59; 11&#37;&#41;<br>&#8226; Psoralenos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#59; 2&#37;&#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">Garber et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27 &#40;56 ciclos&#41;<br>&#40;&#8804;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;<br><br>70&#37; &#9792;&#59; 96&#37; placas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><elsevierMultimedia ident="201810020616272681"></elsevierMultimedia>&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">Klufas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a><br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51 &#40;80 ciclos&#41;<br>&#40;&#8804;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;<br><br>63&#37; &#9792;&#59; edad media&#42;&#58; 14&#59; 80&#37; placas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><elsevierMultimedia ident="201810020616272682"></elsevierMultimedia>&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">Charbit et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a><br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>154 &#40;261 ciclos&#41;<br>&#40;&#60;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;<br><br>50&#37; &#9792;&#59; edad media<span class="elsevierStyleSup">a</span>&#58; 10&#59; 56&#37; placas&#59; PGA<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>4&#58; 50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><elsevierMultimedia ident="201810020616272683"></elsevierMultimedia>&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">DI Lernia et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a><br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>58 &#40;92 ciclos&#41;<br>&#40;&#60;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;<br><br>53&#37; &#9792;&#59; edad media<span class="elsevierStyleSup">a</span>&#58; 12&#59; 100&#37; placas&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><elsevierMultimedia ident="201810020616272684"></elsevierMultimedia>&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">Bronckerset al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>390 &#40;482 ciclos&#41;<br>&#40;&#60;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;<br><br>52&#37; &#9792;&#46; Edad media<span class="elsevierStyleSup">a</span>&#58; 11&#46; PASI medio&#58; 14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><elsevierMultimedia ident="201810020616272685"></elsevierMultimedia>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Tratamientos sist&#233;micos en psoriasis moderada-grave en ni&#241;os y adolescentes&#58; datos de estudios descriptivos<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#8211;14</span></a></p>"
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Acitret&#58; acitretino&#59; Ada&#58; adalimumab&#59; CsA&#58; ciclosporina&#59; BSA<span class="elsevierStyleItalic">&#58; Body Surface Area</span>&#59; Cr&#58; creatinina&#59; EAF&#58; &#233;steres del &#225;cido fum&#225;rico&#59; Etan&#58; etanercept&#59; GI&#58; gastrointestinales&#59; Mtx&#58; metotrexato&#59; n&#58; n&#250;mero de pacientes&#59; PASI&#58; <span class="elsevierStyleItalic">Psoriasis Area and Severity Index</span>&#59; PFH&#58; pruebas de funci&#243;n hep&#225;tica&#59; PGA&#58; <span class="elsevierStyleItalic">Physician Global Assessmen</span>t&#59; PUVA&#58; ultravioleta A y psoraleno&#59; S-MAPA&#58; <span class="elsevierStyleItalic">simple measure for assessing psoriasis activity</span>&#58; medida que resulta del producto del BSA y el PGA&#59; Tg&#58; triglic&#233;ridos&#59; TNF&#58; <span class="elsevierStyleItalic">tumoral necrosis factor</span> &#40;factor de necrosis tumoral&#41;&#59; Ust&#58; ustekinumab&#59; UVB&#58; ultravioleta B&#59; UVBBE&#58; ultravioleta B de banda estrecha&#59; VHS&#58; virus herpes simple&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span><span class="elsevierStyleItalic">As treated</span> &#40;por tratamiento&#41;&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">b</span><span class="elsevierStyleItalic">Last observation carried forward</span> &#40;traslaci&#243;n de los datos seg&#250;n la &#250;ltima observaci&#243;n disponible&#41;&#46;</p><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">c</span>2&#47;18 &#40;11&#44;1&#37;&#41; si se consideran todos los ciclos de tratamiento &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#41;&#46;</p><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">d&#44;e&#44;f</span>Trabajos que incluyen pacientes con psoriasis y otras dermatosis &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>113<span class="elsevierStyleSup">d</span>&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>77<span class="elsevierStyleSup">e</span>&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>116<span class="elsevierStyleSup">f</span>&#41;&#59; los efectos indeseables corresponden al total de los pacientes incluidos en dichos estudios &#40;no se indican los datos espec&#237;ficos del grupo de psoriasis&#41;&#46;</p>"
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                  \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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Referencia&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">Poblaci&#243;n&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">Efectividad&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">Efectos indeseables&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-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Garber et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27<br>&#40;56 ciclos&#41;<br>&#40;&#8804;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aclaramiento&#58;<br>- Ada &#40;4&#47;6&#41; y Etan &#40;6&#47;9&#41;&#58; 66&#44;7&#37;<br>- Ust &#40;1&#47;3&#41;&#58; 33&#44;3&#37;<br>- Convencionales&#58; 0&#47;28 &#40;0&#37;&#41;<br>S-MAPA 50&#37;&#58;<br>- UVBBE 3&#47;3 &#40;100&#37;&#41;&#44; Mtx 4&#47;11 &#40;36&#44;4&#37;&#41;&#44; CsA 2&#47;3 &#40;66&#44;7&#37;&#41;&#44; Ada 6&#47;6 &#40;100&#37;&#41;&#44; Etan 7&#47;9 &#40;77&#44;8&#37;&#41;&#44; Ust 2&#47;3 &#40;66&#44;7&#41;&#44; combinaciones &#40;biol&#243;gico<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Mtx&#47;CsA&#41;&#58; 4&#47;4 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#225;s frecuentes&#58;<br>- Mtx&#58; 16&#37; infecciones menores&#44; 16&#37; GI&#44; 11&#37; alteraci&#243;n PFH<br>- Ada&#58; 25&#37; infecciones menores<br>- Etan&#58; 33&#37; infecciones menores<br>Motivaron suspensi&#243;n&#58; 2&#47;56 &#40;3&#44;6&#37;&#41;<br>- Mtx 1&#47;19 &#40;5&#37;&#41;<br>- Ust 1&#47;3 &#40;33&#37;&#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">Klufas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">14</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>51<br>&#40;80 ciclos&#41;<br>&#40;&#8804;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PGA&#44; 5-7 meses y 12 meses<br>- Todos los grupos de tratamiento alcanzan respuesta positiva&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&#47;80 &#40;36&#37;&#41;&#44; menores y subjetivos&#46;<br>Efecto indeseable m&#225;s frecuente&#58; fatiga &#40;7&#44;5&#37;&#41;&#46;<br>&#171;Pocos ciclos de tratamiento suspendidos por efectos indeseables&#187; &#40;no dan porcentaje exacto&#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">Charbit et al&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a><br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>154<br>&#40;261 ciclos&#41;<br>&#40;&#60;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PASI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>50&#58; 59&#37; de los sist&#233;micos<br>- Fototerapia<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>actitret mejores tasas de respuesta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&#47;261 &#40;33&#44;7&#37;&#41;<br>- M&#225;s frecuentes&#58; acitret &#40;52&#47;116&#59; 45&#37;&#41;<br>Motivaron suspensi&#243;n&#58; 15&#47;261&#40;5&#44;7&#37;&#41;<br>- CsA&#58; 5&#47;25 &#40;20&#37;&#41;<br>- Mtx&#58; 4&#47;48 &#40;8&#44;3&#37;&#41;<br>- Acitret&#58; 6&#47;142 &#40;4&#44;2&#37;&#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">Di Lernia et al&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a><br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>58<br>&#40;92 ciclos&#41;<br>&#40;&#60;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No claramente especificada<br>Se indican datos de suspensi&#243;n por remisi&#243;n completa&#44; pero no se mide efectividad directamente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Motivaron suspensi&#243;n&#58; 19&#47;92&#40;10&#44;9&#37;&#41;<br>- PUVA&#58; ninguno<br>- Mtx&#58; 1&#47;13 &#40;7&#44;7&#37;&#41;&#58; elevaci&#243;n transaminasas<br>- CsA&#58; 8&#47;38 &#40;21&#44;1&#37;&#41;&#58; GI&#44; cefalea&#44; elevaci&#243;n de Cr o Tg&#44; piodermitis&#44; hipertricosis<br>- Acitret&#58; 1&#47;18 &#40;5&#44;6&#37;&#41;&#58; artralgias<br>- Etan&#58; ninguno&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">Bronckers et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">13</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>390 &#40;482 ciclos&#41;<br>&#40;&#60;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">La evaluaci&#243;n de la efectividad no es un objetivo de este trabajo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Menos frecuentes con anti-TNF que con Mtx<br>- Mtx&#58; 130&#47;270 &#40;48&#44;1&#37;&#41;&#58; &#8805;<span class="elsevierStyleHsp" style=""></span>1 &#40;GI&#58; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>67&#41;<br>- Biol&#243;gicos&#58; 41&#47;106 &#40;38&#44;7&#37;&#41;&#58; 20&#47;106 &#40;18&#44;9&#37;&#41;&#58; reacci&#243;n local<br>- Acitret 38&#47;57 &#40;66&#44;7&#37;&#41;<br>- Fumaratos 13&#47;19 &#40;68&#44;4&#37;&#41;<br>- CsA 11&#47;30 &#40;36&#44;7&#37;&#41;<br>Graves&#58;<br>- Mtx&#58; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#59; EAF n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#59; Ada&#58; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1<br>Motivaron suspensi&#243;n&#58; 47&#47;390 &#40;9&#44;75&#37;&#41;&#58;<br>- Mtx&#58; 33&#47;270 &#40;12&#44;2&#37;&#41;<br>- CsA&#58; 3&#47;30 &#40;10&#37;&#41;<br>- Acitret&#58; 6&#47;57 &#40;10&#44;5&#37;&#41;<br>- Biol&#243;gicos&#58; 3&#47;106 &#40;2&#44;8&#37;&#41;<br>- Fumaratos&#58; 2&#47;19 &#40;10&#44;5&#37;&#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">Van Geel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25<br>Mtx<br>&#40;&#60;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PASI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>75&#58;<br>- Semana 12&#58; 4&#44;3&#37;<span class="elsevierStyleSup">a</span>&#47;4&#37;<span class="elsevierStyleSup">b</span><br>- Semana 24&#58; 33&#44;3&#37;<span class="elsevierStyleSup">a</span>&#47;32&#37;<span class="elsevierStyleSup">b</span><br>- Semana 36&#58; 40&#37;<span class="elsevierStyleSup">a</span>&#47;40&#37;<span class="elsevierStyleSup">b</span><br>- Semana 48&#58; 28&#44;6&#37;<span class="elsevierStyleSup">a</span>&#47;28&#44;6&#37;<span class="elsevierStyleSup">b</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#225;s frecuentes&#58; n&#225;useas graves &#40;5&#47;25&#44; 20&#37;&#41;&#44; infecciones &#40;5&#47;25&#44; 20&#37;&#41; y astenia &#40;4&#47;25&#44; 16&#37;&#41;<br>Suspensi&#243;n&#58; 6&#47;25 &#40;24&#37;&#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">Kaur et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">19</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24<br>Mtx<br>&#40;&#60;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PASI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>75&#58;<br>- 22&#47;24 &#40;91&#44;7&#37;&#41;<br>PASI50-75<br>- 2&#47;24 &#40;8&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#47;24 &#40;37&#44;5&#37;&#41; efectos indeseables leves&#58; n&#225;useas&#44; v&#243;mitos&#44; p&#233;rdida de apetito<br>No derivaron en suspensi&#243;n&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">Collin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13<br>Mtx<br>&#40;3-15 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Buena respuesta &#40;definida como aclaramiento dejando m&#237;nima enfermedad residual&#41;<br>- 11&#47;13 &#40;84&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#225;s frecuentes&#58; GI&#58; 6&#47;13 &#40;46&#44;2&#37;&#41;<br>Suspensi&#243;n&#58; 1&#47;13 &#40;7&#44;7&#37;&#41;<span class="elsevierStyleSup">c</span>&#58; alteraci&#243;n de PFH&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">Di Lernia et al&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18<br>Acitret<br>&#40;&#60;<span class="elsevierStyleHsp" style=""></span>17 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PASI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>75&#58;<br>- 8&#47;18 &#40;44&#44;4&#37;&#41; semana 16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#225;s frecuentes mucocut&#225;neos&#58; 18&#47;18 &#40;100&#37;&#41;&#58; se manejaron con ajuste de dosis<br>Suspensi&#243;n&#58; 1&#47;18 &#40;5&#44;5&#37;&#41;&#58; artralgias&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">Dogra et al&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10<br>CsA<br>&#40;&#60;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PASI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>75&#58;<br>- 5&#47;8 &#40;62&#44;5&#37;&#41; semana 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;8 &#40;25&#37;&#41;&#58; dolor abdominal&#44; elevaci&#243;n Cr<br>No motivaron suspensi&#243;n&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">Ergun et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">18</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>226<br>Acitret &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>61&#41;<br>Mtx &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>85&#41;<br>CsA &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>80&#41;<br>&#40;&#60;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PASI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>75&#58;<br>- 29&#47;61 &#40;47&#44;5&#37;&#41; acitret<br>- 29&#47;85 &#40;34&#44;1&#37;&#41; Mtx<br>- 32&#47;80 &#40;40&#37;&#41; CsA<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Efectos indeseables menores&#58;<br>- Acitret&#58; 29&#44;3&#37;&#58; mucocut&#225;neos &#40;25&#44;9&#37;&#41;&#44; hiperlipidemia &#40;1&#44;7&#37;&#41;&#44; n&#225;useas &#40;1&#44;7&#37;&#41;<br>- Mtx&#58; 9&#44;2&#37;&#58; n&#225;useas&#44; v&#243;mitos &#40;8&#37;&#41;&#44; alteraci&#243;n de PFH &#40;1&#44;1&#37;&#41;<br>- CsA&#58; 22&#44;5&#37;&#58; hiperlipidemia &#40;3&#44;8&#37;&#41;&#44; elevaci&#243;n Cr &#40;1&#44;3&#37;&#41;&#44; GI &#40;1&#44;3&#37;&#41; y citopenia &#40;1&#44;3&#37;&#41;<br>Suspensi&#243;n&#58;<br>- 1&#47;61 &#40;1&#44;7&#37;&#41; acitret<br>- 1&#47;85 &#40;1&#44;1&#37;&#41; Mtx<br>- 2&#47;80 &#40;2&#44;5&#37;&#41; CsA&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">Di Lernia et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23<br>Etan<br>&#40;&#60;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PASI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>75&#58;<br>- 56&#44;5&#37; semana 12<br>- 65&#44;2&#37; semana 24<br>- 52&#44;1&#37; semana 52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&#225;s frecuentes&#58;<br>- 2&#47;23 &#40;8&#44;7&#37;&#41;&#58; reacci&#243;n lugar inyecci&#243;n<br>- 8&#47;23 &#40;34&#44;7&#37;&#41;&#58; dolor leve &#225;rea de inyecci&#243;n<br>No motivaron suspensi&#243;n&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">Ersoy-Evans et al&#46;<span class="elsevierStyleSup">d</span><a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>28<br>UVBBE<br>&#40;&#60;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mejor&#237;a mayor del 75&#37;&#58; 26&#47;28 &#40;92&#44;9&#37;&#41;<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Eritema 51&#44;6&#37;<span class="elsevierStyleSup">d</span><br>Prurito 18&#37;<span class="elsevierStyleSup">d</span><br>Quemaz&#243;n 9&#37;<span class="elsevierStyleSup">d</span><br>&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">Ersoy-Evans et al&#46;<span class="elsevierStyleSup">d</span><a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30<br>UVB<br>&#40;&#60;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mejor&#237;a mayor del 75&#37;&#58; 28&#47;30 &#40;93&#44;3&#37;&#41;<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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">Ersoy-Evans et al&#46;<span class="elsevierStyleSup">d</span><a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7<br>PUVA<br>&#40;&#60;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mejor&#237;a mayor del 75&#37;&#58; 5&#47;7 &#40;71&#44;4&#37;&#41;<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><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">Jain et al&#46; <a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20<br>UVBBE<br>&#40;6-14 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Semana 12&#58;<br>- PASI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90&#58; 12&#47;20 &#40;60&#37;&#41;<br>- PASI70-90&#58; 3&#47;20 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Eritema leve&#58; 2&#47;20 &#40;10&#37;&#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">Pasi&#263; et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a><br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20<br>UVBBE<br>&#40;6-14 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PASI<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90&#58; 9&#47;20 &#40;45&#37;&#41;<br>PASI70-90&#58; 4&#47;20 &#40;20&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ninguno&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">Zamberk et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">25</span></a><br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20<br>UVBBE<br>&#40;5-17 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">PASI90&#58; 52&#44;2&#37;<br>PASI75-90&#58; 17&#44;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#37;&#58; mayoritariamente eritema &#40;no indican valor exacto&#41;<br>No motivaron suspensi&#243;n&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">Pavlovsky et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">26</span></a><br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>79<br>UVBBE<br>&#40;&#8804;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aclaramiento&#58; 40&#47;79 &#40;50&#44;6&#37;&#41;<br>Mejor&#237;a<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>75&#37;&#58; 33&#47;79 &#40;41&#44;8&#37;&#41;<br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#47;79 &#40;22&#44;8&#37;&#41;&#58;<br>- Eritema leve &#40;13&#47;18&#44; 72&#44;2&#37;&#41;&#44; prurito &#40;2&#47;18&#44; 11&#44;1&#37;&#41;&#44; quemadura de primer grado &#40;3&#47;18&#44; 16&#44;7&#37;&#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">Jury et al&#46;<span class="elsevierStyleSup">e</span><a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>35<br>UVBBE<br>&#40;&#8804;<span class="elsevierStyleHsp" style=""></span>16 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aclaramiento o enfermedad residual m&#237;nima&#58; 22&#47;35 &#40;62&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Eritema &#40;23&#47;77&#59; 28&#44;6&#37;&#41;&#44; ampollas &#40;5&#47;77&#59; 6&#44;5&#37;&#41;&#44; herpes z&#243;ster &#40;1&#47;77&#59; 1&#44;3&#37;&#41;&#44; ansiedad &#40;5&#47;77&#59; 6&#44;5&#37;&#41;<span class="elsevierStyleSup">e</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">Tan et al&#46;<span class="elsevierStyleSup">f</span><a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a><br>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38<br>UVBBE<br>&#40;&#60;16 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mejor&#237;a del 75&#37; o aclaramiento&#58; 90&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Eritema leve &#40;36&#37;&#41;<span class="elsevierStyleSup">f</span><br>No motivaron suspensi&#243;n&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">Eustace et al&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21<br>UVBBE<br>&#40;&#8804;<span class="elsevierStyleHsp" style=""></span>17 a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aclaramiento &#40;PASI90 o PGA 0-1&#41;&#58; 86&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Eritema &#40;5&#47;21&#59; 23&#44;8&#37;&#41;&#44; VHS &#40;2&#47;21&#59; 9&#44;5&#37;&#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">Wong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12<br>UVBBE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mejor&#237;a en BSA<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>90&#37;&#58; 5&#47;10 &#40;50&#37;&#41;<br>Mejor&#237;a en BSA 70-90&#37;&#58; 4&#47;10 &#40;40&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Quemadura leve &#40;1&#47;12&#59; 8&#44;3&#37;&#41;&#44; quemaz&#243;n &#40;1&#47;12&#59; 8&#44;3&#37;&#41;&#44; prurito &#40;2&#47;12&#59; 16&#44;7&#37;&#41;&#44; dolor &#40;2&#47;12&#59; 16&#44;7&#37;&#41;&#44; eritema 2&#47;12&#59; 16&#44;7&#37;&#41;&#46;<br>Suspensi&#243;n&#58; 1&#47;12 &#40;8&#44;3&#37;&#41;&#58; aumento progresivo de eritema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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