array:23 [
  "pii" => "S157821901730210X"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2016.12.024"
  "estado" => "S300"
  "fechaPublicacion" => "2017-07-01"
  "aid" => "1580"
  "copyright" => "Elsevier España, S.L.U. and AEDV"
  "copyrightAnyo" => "2017"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Actas Dermosifiliogr. 2017;108:603-4"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 370
    "formatos" => array:3 [
      "EPUB" => 29
      "HTML" => 250
      "PDF" => 91
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:19 [
      "pii" => "S0001731017300145"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2016.12.004"
      "estado" => "S300"
      "fechaPublicacion" => "2017-07-01"
      "aid" => "1580"
      "copyright" => "AEDV"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "crp"
      "cita" => "Actas Dermosifiliogr. 2017;108:603-4"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 874
        "formatos" => array:3 [
          "EPUB" => 41
          "HTML" => 332
          "PDF" => 501
        ]
      ]
      "en" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>"
        "titulo" => "Split doses of Methotrexate in patients with moderate to severe Psoriasis"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "603"
            "paginaFinal" => "604"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "es" => array:1 [
            "titulo" => "Dosis divididas de metotrexato en pacientes con psoriasis moderada a severa"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M&#46;J&#46;M&#46; Rodr&#237;guez-Z&#250;&#241;iga, F&#46; Cortez-Franco, E&#46; Qujiano-Gomero"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "M&#46;J&#46;M&#46;"
                "apellidos" => "Rodr&#237;guez-Z&#250;&#241;iga"
              ]
              1 => array:2 [
                "nombre" => "F&#46;"
                "apellidos" => "Cortez-Franco"
              ]
              2 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Qujiano-Gomero"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S157821901730210X"
          "doi" => "10.1016/j.adengl.2016.12.024"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901730210X?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017300145?idApp=UINPBA000044"
      "url" => "/00017310/0000010800000006/v3_201707250313/S0001731017300145/v3_201707250313/en/main.assets"
    ]
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1578219017302093"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2016.12.023"
    "estado" => "S300"
    "fechaPublicacion" => "2017-07-01"
    "aid" => "1603"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and AEDV"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Actas Dermosifiliogr. 2017;108:601-3"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 331
      "formatos" => array:3 [
        "EPUB" => 27
        "HTML" => 223
        "PDF" => 81
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>"
      "titulo" => "Expanding the Genotype of Sj&#246;gren&#8211;Larsson Syndrome&#58; A New Case Due to Two Novel Mutations"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "601"
          "paginaFinal" => "603"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Ampliando el genotipo del s&#237;ndrome de Sj&#246;gren-Larsson&#58; un nuevo caso causado por dos nuevas mutaciones"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1716
              "Ancho" => 1980
              "Tamanyo" => 1335406
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A skin biopsy from an armpit revealed hyperkeratosis&#44; psoriasiform epidermal hyperplasia and slightly thickened granular layer in epidermis&#44; and mild perivascular inflammatory infiltrate of mononuclear cells in papillary dermis &#40;H&#38;E 4&#215;&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "E&#46; Garc&#237;a-Peris, I&#46; Latour-&#193;lvarez, M&#46; Pestana-Eliche, R&#46; S&#225;nchez"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Garc&#237;a-Peris"
            ]
            1 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Latour-&#193;lvarez"
            ]
            2 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Pestana-Eliche"
            ]
            3 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "S&#225;nchez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S0001731017300595"
        "doi" => "10.1016/j.ad.2016.12.015"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017300595?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017302093?idApp=UINPBA000044"
    "url" => "/15782190/0000010800000006/v1_201706300050/S1578219017302093/v1_201706300050/en/main.assets"
  ]
  "en" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>"
    "titulo" => "Split doses of Methotrexate in patients with moderate to severe Psoriasis"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#44;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "603"
        "paginaFinal" => "604"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "M&#46;J&#46;M&#46; Rodr&#237;guez-Z&#250;&#241;iga, F&#46; Cortez-Franco, E&#46; Qujiano-Gomero"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "M&#46;J&#46;M&#46;"
            "apellidos" => "Rodr&#237;guez-Z&#250;&#241;iga"
            "email" => array:2 [
              0 => "milton&#95;rz&#64;hotmail&#46;com"
              1 => "mijomax&#64;gmail&#46;com"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "F&#46;"
            "apellidos" => "Cortez-Franco"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "E&#46;"
            "apellidos" => "Qujiano-Gomero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a del Hospital Nacional Daniel Alcides Carri&#243;n&#44; Callao&#44; Peru"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Universidad Nacional Mayor de San Marcos&#44; Lima&#44; Peru"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Dosis divididas de metotrexato en pacientes con psoriasis moderada a severa"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Psoriasis is the most common inflammatory skin condition with a worldwide prevalence of 2&#37;&#46; Systemic or topical treatment is decided according to the severity of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> For systemic treatment&#44; Methotrexate &#40;MTX&#41; remains effective and medically accessible&#58; it is widely used in hospitals in Latin America&#44; where biological therapy is still limited for economic reasons&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The article&#58; &#8220;Methotrexate in Moderate to Severe Psoriasis&#58; Review of the Literature and Expert Recommendations&#8221;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> outlines very important and interesting recommendations on the use of this drug in Psoriasis&#46; However&#44; one point that has not been taken into account is the split of MTX in two or three weekly doses&#44; with the benefit of both efficacy and reduced side effects&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The benefits of fractional doses are listed below&#46; As indicated in the article&#44; MTX has significant gastrointestinal adverse effects that hinder its use&#44; and increases with higher oral doses&#59; but can be avoided or reduced with parenteral route&#44; and with folates&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In addition&#44; a divided dose of MTX is an alternative for reducing gastrointestinal side effects in patients with Psoriasis&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Second&#44; with high MTX enteral doses&#44; bioavailability decreases &#40;for limiting absorption&#41;&#59; therefore it is beneficial to divide MTX into smaller doses and thus increase its concentration systemically&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> increasing efficiency without worsening adverse effects&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although MTX experience with divided doses for Psoriasis has been well known and accepted<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> for several decades&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> it is based on a limited number of studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5&#44;9</span></a> Thus&#44; further experience with divided doses of MTX has been carried out in rheumatologic patients&#44; but these are also limited&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Weinstein and Frost<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> first proposed the divided dose of MTX for Psoriasis in 1971&#46; They showed that small doses of 2&#46;5&#8211;7&#46;5<span class="elsevierStyleHsp" style=""></span>mg of MTX given at intervals of 12<span class="elsevierStyleHsp" style=""></span>h for a total of three doses every week had an improvement from 75&#37; to 100&#37; in 26 patients with severe Psoriasis&#44; with minimal adverse effects &#40;nausea&#44; oral ulcers and hives&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Chladek et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> conducted a study that related the pharmacodynamics and pharmacokinetics of divided doses &#40;2&#46;5<span class="elsevierStyleHsp" style=""></span>mg and 5<span class="elsevierStyleHsp" style=""></span>mg three times a week&#41; and weekly full doses &#40;7&#46;5<span class="elsevierStyleHsp" style=""></span>mg and 15<span class="elsevierStyleHsp" style=""></span>mg&#41; of MTX with the Psoriasis Area Severity Index of 41 patients with severe disease&#46; They concluded that split doses of MTX were associated with greater efficacy and lower risk of acute adverse effects during anti-psoriatic therapy&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the rheumatology field&#44; Dhaon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> randomly divided 135 patients with rheumatoid arthritis into three groups&#58; group 1 on split 7&#46;5<span class="elsevierStyleHsp" style=""></span>mg doses of oral MTX two or three times weekly&#59; group 2 on single 15&#8211;22&#46;5<span class="elsevierStyleHsp" style=""></span>mg of oral MTX weekly&#59; and group 3 on single intramuscular 15&#8211;22&#46;5<span class="elsevierStyleHsp" style=""></span>mg dose of MTX weekly&#46; Clinical efficacy of split and intramuscular doses was superior to single oral dose&#44; but intramuscular administration lead to greater discomfort on patients&#46; In addition&#44; split doses group showed the lowest rates of gastrointestinal side effects&#44; with higher levels of alopecia&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Pharmacokinetic studies demonstrate enhanced bioavailability of the drug with multiple dosing&#44; supporting the clinical superiority of divided doses compared to single oral dose&#46; Hoekstra et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> compared blood samples of 10 rheumatoid arthritis patients with fluorescence polarization immunoassay technique who received a single oral dose of 25&#8211;35<span class="elsevierStyleHsp" style=""></span>mg MTX&#44; and after one week&#44; divided two or three doses every 8<span class="elsevierStyleHsp" style=""></span>h&#46; Bioavailability of split doses was 28&#37; significantly higher than single doses and similar to that of subcutaneous doses&#44; obtained from a previous study&#46; The authors concluded that when high-dose of MTX is needed&#44; the divided dose is an effective and comparable alternative to subcutaneous administration&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">After demonstrating and bringing up the efficacy and safety of MTX split oral doses in patients with Psoriasis&#44; it is important to remember that there are limitations and drawbacks in their use&#44; mainly with delivery errors&#46; Because patients must take three weekly doses of 2&#46;5<span class="elsevierStyleHsp" style=""></span>mg or 5<span class="elsevierStyleHsp" style=""></span>mg&#44; and MTX tablets are mainly available at 2&#46;5<span class="elsevierStyleHsp" style=""></span>mg and 10<span class="elsevierStyleHsp" style=""></span>mg in this region&#44; patients may accidentally fail in both&#58; reduncing or increasing the dose&#46; However&#44; in our experience this accident is very uncommon&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion&#44; MTX remains as a first-line treatment for severe Psoriasis&#44; and accessible in many Latin American countries&#46; Enteral and parenteral weekly divided doses of MTX show similar efficacy and safety in several studies both in psoriatic and rheumatologic patients&#46; Therefore&#44; we should continue proposing low split oral doses in future guidelines and consensus&#44; in comparison to the single oral dose&#44; with the benefit of achieving greater adherence by reducing adverse effects&#44; taking into account their limitations&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:2 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Conflict of interest"
        ]
        1 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global epidemiology of psoriasis&#58; a systematic review of incidence and prevalence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46; Parisi"
                            1 => "D&#46;P&#46; Symmons"
                            2 => "C&#46;E&#46; Griffiths"
                            3 => "D&#46;M&#46; Ashcroft"
                            4 => "Identification and Management of Psoriasis and Associated ComorbidiTy &#40;IMPACT&#41; project team"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/jid.2012.339"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Invest Dermatol"
                        "fecha" => "2013"
                        "volumen" => "133"
                        "paginaInicial" => "377"
                        "paginaFinal" => "385"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23014338"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Current practice of methotrexate use for psoriasis&#58; results of a worldwide survey among dermatologists"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Gyulai"
                            1 => "M&#46; Bagot"
                            2 => "C&#46;E&#46; Griffiths"
                            3 => "T&#46; Luger"
                            4 => "L&#46; Naldi"
                            5 => "C&#46; Paul"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jdv.12495"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2015"
                        "volumen" => "29"
                        "paginaInicial" => "224"
                        "paginaFinal" => "231"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24731093"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Methotrexate in moderate to severe psoriasis&#58; review of the literature and expert recommendations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Carrascosa"
                            1 => "P&#46; de la Cueva"
                            2 => "M&#46; Ara"
                            3 => "L&#46; Puig"
                            4 => "X&#46; Bordas"
                            5 => "G&#46; Carretero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2015.10.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2016"
                        "volumen" => "107"
                        "paginaInicial" => "194"
                        "paginaFinal" => "206"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26614486"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metotrexato&#58; guia de uso en psoriasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Carretero"
                            1 => "L&#46; Puig"
                            2 => "L&#46; Dehesa"
                            3 => "J&#46;M&#46; Carrascosa"
                            4 => "M&#46; Ribera"
                            5 => "M&#46; Sanchez-Regana"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2010"
                        "volumen" => "101"
                        "paginaInicial" => "600"
                        "paginaFinal" => "613"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20858386"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Low-dose methotrexate pharmacokinetics and pharmacodynamics in the therapy of severe psoriasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Chladek"
                            1 => "J&#46; Grim"
                            2 => "J&#46; Martinkova"
                            3 => "M&#46; Simkova"
                            4 => "J&#46; Vaneckova"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1742-7843.2005.pto960318.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Basic Clin Pharmacol Toxicol"
                        "fecha" => "2005"
                        "volumen" => "96"
                        "paginaInicial" => "247"
                        "paginaFinal" => "248"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15733224"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oral Methotrexate in split dose weekly versus oral or parenteral Methotrexate once weekly in Rheumatoid Arthritis&#58; a short-term study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46; Dhaon"
                            1 => "S&#46;K&#46; Das"
                            2 => "R&#46; Srivastava"
                            3 => "G&#46; Agarwal"
                            4 => "A&#46; Asthana"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Int J Rheum Dis"
                        "fecha" => "2016"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The possibilities and principles of methotrexate treatment of psoriasis &#8211; the updated knowledge"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Czarnecka-Operacz"
                            1 => "A&#46; Sadowska-Przytocka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5114/pdia.2014.47121"
                      "Revista" => array:6 [
                        "tituloSerie" => "Postepy Dermatol Alergol"
                        "fecha" => "2014"
                        "volumen" => "31"
                        "paginaInicial" => "392"
                        "paginaFinal" => "400"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25610355"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Methotrexate in psoriasis&#58; consensus conference"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46;H&#46; Roenigk Jr&#46;"
                            1 => "R&#46; Auerbach"
                            2 => "H&#46; Maibach"
                            3 => "G&#46; Weinstein"
                            4 => "M&#46; Lebwohl"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1998"
                        "volumen" => "38"
                        "paginaInicial" => "478"
                        "paginaFinal" => "485"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9520032"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Methotrexate for psoriasis&#46; A new therapeutic schedule"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46;D&#46; Weinstein"
                            1 => "P&#46; Frost"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "1971"
                        "volumen" => "103"
                        "paginaInicial" => "33"
                        "paginaFinal" => "38"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5539502"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Splitting high-dose oral methotrexate improves bioavailability&#58; a pharmacokinetic study in patients with rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Hoekstra"
                            1 => "C&#46; Haagsma"
                            2 => "C&#46; Neef"
                            3 => "J&#46; Proost"
                            4 => "A&#46; Knuif"
                            5 => "M&#46; van de Laar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2006"
                        "volumen" => "33"
                        "paginaInicial" => "481"
                        "paginaFinal" => "485"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16463431"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000010800000006/v1_201706300050/S157821901730210X/v1_201706300050/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6157"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Case and Research Letters"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010800000006/v1_201706300050/S157821901730210X/v1_201706300050/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901730210X?idApp=UINPBA000044"
]
Compartir
Información de la revista

Estadísticas

Siga este enlace para acceder al texto completo del artículo

Case and Research Letter
Split doses of Methotrexate in patients with moderate to severe Psoriasis
Dosis divididas de metotrexato en pacientes con psoriasis moderada a severa
M.J.M. Rodríguez-Zúñigaa,b,
Autor para correspondencia
, F. Cortez-Francoa, E. Qujiano-Gomeroa
a Servicio de Dermatología del Hospital Nacional Daniel Alcides Carrión, Callao, Peru
b Universidad Nacional Mayor de San Marcos, Lima, Peru
Leído
8064
Veces
se ha leído el artículo
1843
Total PDF
6221
Total HTML
Compartir estadísticas
 array:23 [
  "pii" => "S157821901730210X"
  "issn" => "15782190"
  "doi" => "10.1016/j.adengl.2016.12.024"
  "estado" => "S300"
  "fechaPublicacion" => "2017-07-01"
  "aid" => "1580"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and AEDV"
  "copyrightAnyo" => "2017"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Actas Dermosifiliogr. 2017;108:603-4"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 370
    "formatos" => array:3 [
      "EPUB" => 29
      "HTML" => 250
      "PDF" => 91
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:19 [
      "pii" => "S0001731017300145"
      "issn" => "00017310"
      "doi" => "10.1016/j.ad.2016.12.004"
      "estado" => "S300"
      "fechaPublicacion" => "2017-07-01"
      "aid" => "1580"
      "copyright" => "AEDV"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "crp"
      "cita" => "Actas Dermosifiliogr. 2017;108:603-4"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 874
        "formatos" => array:3 [
          "EPUB" => 41
          "HTML" => 332
          "PDF" => 501
        ]
      ]
      "en" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>"
        "titulo" => "Split doses of Methotrexate in patients with moderate to severe Psoriasis"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "603"
            "paginaFinal" => "604"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "es" => array:1 [
            "titulo" => "Dosis divididas de metotrexato en pacientes con psoriasis moderada a severa"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M&#46;J&#46;M&#46; Rodr&#237;guez-Z&#250;&#241;iga, F&#46; Cortez-Franco, E&#46; Qujiano-Gomero"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "M&#46;J&#46;M&#46;"
                "apellidos" => "Rodr&#237;guez-Z&#250;&#241;iga"
              ]
              1 => array:2 [
                "nombre" => "F&#46;"
                "apellidos" => "Cortez-Franco"
              ]
              2 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Qujiano-Gomero"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S157821901730210X"
          "doi" => "10.1016/j.adengl.2016.12.024"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901730210X?idApp=UINPBA000044"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017300145?idApp=UINPBA000044"
      "url" => "/00017310/0000010800000006/v3_201707250313/S0001731017300145/v3_201707250313/en/main.assets"
    ]
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1578219017302093"
    "issn" => "15782190"
    "doi" => "10.1016/j.adengl.2016.12.023"
    "estado" => "S300"
    "fechaPublicacion" => "2017-07-01"
    "aid" => "1603"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and AEDV"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Actas Dermosifiliogr. 2017;108:601-3"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 331
      "formatos" => array:3 [
        "EPUB" => 27
        "HTML" => 223
        "PDF" => 81
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>"
      "titulo" => "Expanding the Genotype of Sj&#246;gren&#8211;Larsson Syndrome&#58; A New Case Due to Two Novel Mutations"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "601"
          "paginaFinal" => "603"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Ampliando el genotipo del s&#237;ndrome de Sj&#246;gren-Larsson&#58; un nuevo caso causado por dos nuevas mutaciones"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1716
              "Ancho" => 1980
              "Tamanyo" => 1335406
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A skin biopsy from an armpit revealed hyperkeratosis&#44; psoriasiform epidermal hyperplasia and slightly thickened granular layer in epidermis&#44; and mild perivascular inflammatory infiltrate of mononuclear cells in papillary dermis &#40;H&#38;E 4&#215;&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "E&#46; Garc&#237;a-Peris, I&#46; Latour-&#193;lvarez, M&#46; Pestana-Eliche, R&#46; S&#225;nchez"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Garc&#237;a-Peris"
            ]
            1 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Latour-&#193;lvarez"
            ]
            2 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Pestana-Eliche"
            ]
            3 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "S&#225;nchez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S0001731017300595"
        "doi" => "10.1016/j.ad.2016.12.015"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731017300595?idApp=UINPBA000044"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219017302093?idApp=UINPBA000044"
    "url" => "/15782190/0000010800000006/v1_201706300050/S1578219017302093/v1_201706300050/en/main.assets"
  ]
  "en" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letter</span>"
    "titulo" => "Split doses of Methotrexate in patients with moderate to severe Psoriasis"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#44;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "603"
        "paginaFinal" => "604"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "M&#46;J&#46;M&#46; Rodr&#237;guez-Z&#250;&#241;iga, F&#46; Cortez-Franco, E&#46; Qujiano-Gomero"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "M&#46;J&#46;M&#46;"
            "apellidos" => "Rodr&#237;guez-Z&#250;&#241;iga"
            "email" => array:2 [
              0 => "milton&#95;rz&#64;hotmail&#46;com"
              1 => "mijomax&#64;gmail&#46;com"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "F&#46;"
            "apellidos" => "Cortez-Franco"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "E&#46;"
            "apellidos" => "Qujiano-Gomero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Dermatolog&#237;a del Hospital Nacional Daniel Alcides Carri&#243;n&#44; Callao&#44; Peru"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Universidad Nacional Mayor de San Marcos&#44; Lima&#44; Peru"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Dosis divididas de metotrexato en pacientes con psoriasis moderada a severa"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Psoriasis is the most common inflammatory skin condition with a worldwide prevalence of 2&#37;&#46; Systemic or topical treatment is decided according to the severity of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> For systemic treatment&#44; Methotrexate &#40;MTX&#41; remains effective and medically accessible&#58; it is widely used in hospitals in Latin America&#44; where biological therapy is still limited for economic reasons&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The article&#58; &#8220;Methotrexate in Moderate to Severe Psoriasis&#58; Review of the Literature and Expert Recommendations&#8221;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> outlines very important and interesting recommendations on the use of this drug in Psoriasis&#46; However&#44; one point that has not been taken into account is the split of MTX in two or three weekly doses&#44; with the benefit of both efficacy and reduced side effects&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The benefits of fractional doses are listed below&#46; As indicated in the article&#44; MTX has significant gastrointestinal adverse effects that hinder its use&#44; and increases with higher oral doses&#59; but can be avoided or reduced with parenteral route&#44; and with folates&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In addition&#44; a divided dose of MTX is an alternative for reducing gastrointestinal side effects in patients with Psoriasis&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Second&#44; with high MTX enteral doses&#44; bioavailability decreases &#40;for limiting absorption&#41;&#59; therefore it is beneficial to divide MTX into smaller doses and thus increase its concentration systemically&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> increasing efficiency without worsening adverse effects&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although MTX experience with divided doses for Psoriasis has been well known and accepted<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> for several decades&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> it is based on a limited number of studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5&#44;9</span></a> Thus&#44; further experience with divided doses of MTX has been carried out in rheumatologic patients&#44; but these are also limited&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Weinstein and Frost<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> first proposed the divided dose of MTX for Psoriasis in 1971&#46; They showed that small doses of 2&#46;5&#8211;7&#46;5<span class="elsevierStyleHsp" style=""></span>mg of MTX given at intervals of 12<span class="elsevierStyleHsp" style=""></span>h for a total of three doses every week had an improvement from 75&#37; to 100&#37; in 26 patients with severe Psoriasis&#44; with minimal adverse effects &#40;nausea&#44; oral ulcers and hives&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Chladek et al&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> conducted a study that related the pharmacodynamics and pharmacokinetics of divided doses &#40;2&#46;5<span class="elsevierStyleHsp" style=""></span>mg and 5<span class="elsevierStyleHsp" style=""></span>mg three times a week&#41; and weekly full doses &#40;7&#46;5<span class="elsevierStyleHsp" style=""></span>mg and 15<span class="elsevierStyleHsp" style=""></span>mg&#41; of MTX with the Psoriasis Area Severity Index of 41 patients with severe disease&#46; They concluded that split doses of MTX were associated with greater efficacy and lower risk of acute adverse effects during anti-psoriatic therapy&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the rheumatology field&#44; Dhaon et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> randomly divided 135 patients with rheumatoid arthritis into three groups&#58; group 1 on split 7&#46;5<span class="elsevierStyleHsp" style=""></span>mg doses of oral MTX two or three times weekly&#59; group 2 on single 15&#8211;22&#46;5<span class="elsevierStyleHsp" style=""></span>mg of oral MTX weekly&#59; and group 3 on single intramuscular 15&#8211;22&#46;5<span class="elsevierStyleHsp" style=""></span>mg dose of MTX weekly&#46; Clinical efficacy of split and intramuscular doses was superior to single oral dose&#44; but intramuscular administration lead to greater discomfort on patients&#46; In addition&#44; split doses group showed the lowest rates of gastrointestinal side effects&#44; with higher levels of alopecia&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Pharmacokinetic studies demonstrate enhanced bioavailability of the drug with multiple dosing&#44; supporting the clinical superiority of divided doses compared to single oral dose&#46; Hoekstra et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> compared blood samples of 10 rheumatoid arthritis patients with fluorescence polarization immunoassay technique who received a single oral dose of 25&#8211;35<span class="elsevierStyleHsp" style=""></span>mg MTX&#44; and after one week&#44; divided two or three doses every 8<span class="elsevierStyleHsp" style=""></span>h&#46; Bioavailability of split doses was 28&#37; significantly higher than single doses and similar to that of subcutaneous doses&#44; obtained from a previous study&#46; The authors concluded that when high-dose of MTX is needed&#44; the divided dose is an effective and comparable alternative to subcutaneous administration&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">After demonstrating and bringing up the efficacy and safety of MTX split oral doses in patients with Psoriasis&#44; it is important to remember that there are limitations and drawbacks in their use&#44; mainly with delivery errors&#46; Because patients must take three weekly doses of 2&#46;5<span class="elsevierStyleHsp" style=""></span>mg or 5<span class="elsevierStyleHsp" style=""></span>mg&#44; and MTX tablets are mainly available at 2&#46;5<span class="elsevierStyleHsp" style=""></span>mg and 10<span class="elsevierStyleHsp" style=""></span>mg in this region&#44; patients may accidentally fail in both&#58; reduncing or increasing the dose&#46; However&#44; in our experience this accident is very uncommon&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion&#44; MTX remains as a first-line treatment for severe Psoriasis&#44; and accessible in many Latin American countries&#46; Enteral and parenteral weekly divided doses of MTX show similar efficacy and safety in several studies both in psoriatic and rheumatologic patients&#46; Therefore&#44; we should continue proposing low split oral doses in future guidelines and consensus&#44; in comparison to the single oral dose&#44; with the benefit of achieving greater adherence by reducing adverse effects&#44; taking into account their limitations&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:2 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Conflict of interest"
        ]
        1 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global epidemiology of psoriasis&#58; a systematic review of incidence and prevalence"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46; Parisi"
                            1 => "D&#46;P&#46; Symmons"
                            2 => "C&#46;E&#46; Griffiths"
                            3 => "D&#46;M&#46; Ashcroft"
                            4 => "Identification and Management of Psoriasis and Associated ComorbidiTy &#40;IMPACT&#41; project team"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/jid.2012.339"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Invest Dermatol"
                        "fecha" => "2013"
                        "volumen" => "133"
                        "paginaInicial" => "377"
                        "paginaFinal" => "385"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23014338"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Current practice of methotrexate use for psoriasis&#58; results of a worldwide survey among dermatologists"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Gyulai"
                            1 => "M&#46; Bagot"
                            2 => "C&#46;E&#46; Griffiths"
                            3 => "T&#46; Luger"
                            4 => "L&#46; Naldi"
                            5 => "C&#46; Paul"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jdv.12495"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2015"
                        "volumen" => "29"
                        "paginaInicial" => "224"
                        "paginaFinal" => "231"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24731093"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Methotrexate in moderate to severe psoriasis&#58; review of the literature and expert recommendations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Carrascosa"
                            1 => "P&#46; de la Cueva"
                            2 => "M&#46; Ara"
                            3 => "L&#46; Puig"
                            4 => "X&#46; Bordas"
                            5 => "G&#46; Carretero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ad.2015.10.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2016"
                        "volumen" => "107"
                        "paginaInicial" => "194"
                        "paginaFinal" => "206"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26614486"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Metotrexato&#58; guia de uso en psoriasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Carretero"
                            1 => "L&#46; Puig"
                            2 => "L&#46; Dehesa"
                            3 => "J&#46;M&#46; Carrascosa"
                            4 => "M&#46; Ribera"
                            5 => "M&#46; Sanchez-Regana"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Actas Dermosifiliogr"
                        "fecha" => "2010"
                        "volumen" => "101"
                        "paginaInicial" => "600"
                        "paginaFinal" => "613"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20858386"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Low-dose methotrexate pharmacokinetics and pharmacodynamics in the therapy of severe psoriasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Chladek"
                            1 => "J&#46; Grim"
                            2 => "J&#46; Martinkova"
                            3 => "M&#46; Simkova"
                            4 => "J&#46; Vaneckova"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1742-7843.2005.pto960318.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Basic Clin Pharmacol Toxicol"
                        "fecha" => "2005"
                        "volumen" => "96"
                        "paginaInicial" => "247"
                        "paginaFinal" => "248"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15733224"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oral Methotrexate in split dose weekly versus oral or parenteral Methotrexate once weekly in Rheumatoid Arthritis&#58; a short-term study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46; Dhaon"
                            1 => "S&#46;K&#46; Das"
                            2 => "R&#46; Srivastava"
                            3 => "G&#46; Agarwal"
                            4 => "A&#46; Asthana"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Int J Rheum Dis"
                        "fecha" => "2016"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The possibilities and principles of methotrexate treatment of psoriasis &#8211; the updated knowledge"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Czarnecka-Operacz"
                            1 => "A&#46; Sadowska-Przytocka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5114/pdia.2014.47121"
                      "Revista" => array:6 [
                        "tituloSerie" => "Postepy Dermatol Alergol"
                        "fecha" => "2014"
                        "volumen" => "31"
                        "paginaInicial" => "392"
                        "paginaFinal" => "400"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25610355"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Methotrexate in psoriasis&#58; consensus conference"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46;H&#46; Roenigk Jr&#46;"
                            1 => "R&#46; Auerbach"
                            2 => "H&#46; Maibach"
                            3 => "G&#46; Weinstein"
                            4 => "M&#46; Lebwohl"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "1998"
                        "volumen" => "38"
                        "paginaInicial" => "478"
                        "paginaFinal" => "485"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9520032"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Methotrexate for psoriasis&#46; A new therapeutic schedule"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46;D&#46; Weinstein"
                            1 => "P&#46; Frost"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dermatol"
                        "fecha" => "1971"
                        "volumen" => "103"
                        "paginaInicial" => "33"
                        "paginaFinal" => "38"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5539502"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Splitting high-dose oral methotrexate improves bioavailability&#58; a pharmacokinetic study in patients with rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Hoekstra"
                            1 => "C&#46; Haagsma"
                            2 => "C&#46; Neef"
                            3 => "J&#46; Proost"
                            4 => "A&#46; Knuif"
                            5 => "M&#46; van de Laar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2006"
                        "volumen" => "33"
                        "paginaInicial" => "481"
                        "paginaFinal" => "485"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16463431"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15782190/0000010800000006/v1_201706300050/S157821901730210X/v1_201706300050/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "6157"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Case and Research Letters"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010800000006/v1_201706300050/S157821901730210X/v1_201706300050/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821901730210X?idApp=UINPBA000044"
]
Información del artículo
ISSN: 15782190
Idioma original: Inglés
Datos actualizados diariamente
año/Mes Html Pdf Total
2024 Noviembre 15 10 25
2024 Octubre 176 44 220
2024 Septiembre 198 46 244
2024 Agosto 220 72 292
2024 Julio 210 37 247
2024 Junio 185 35 220
2024 Mayo 173 32 205
2024 Abril 124 22 146
2024 Marzo 118 26 144
2024 Febrero 83 30 113
2024 Enero 115 37 152
2023 Diciembre 88 22 110
2023 Noviembre 93 34 127
2023 Octubre 112 25 137
2023 Septiembre 127 33 160
2023 Agosto 122 16 138
2023 Julio 168 31 199
2023 Junio 108 20 128
2023 Mayo 199 28 227
2023 Abril 118 18 136
2023 Marzo 144 24 168
2023 Febrero 46 26 72
2023 Enero 40 34 74
2022 Diciembre 57 50 107
2022 Noviembre 26 30 56
2022 Octubre 36 19 55
2022 Septiembre 20 36 56
2022 Agosto 22 27 49
2022 Julio 19 40 59
2022 Junio 27 28 55
2022 Mayo 140 31 171
2022 Abril 129 36 165
2022 Marzo 148 52 200
2022 Febrero 108 26 134
2022 Enero 151 50 201
2021 Diciembre 116 47 163
2021 Noviembre 137 47 184
2021 Octubre 129 56 185
2021 Septiembre 122 40 162
2021 Agosto 134 28 162
2021 Julio 107 41 148
2021 Junio 138 28 166
2021 Mayo 127 46 173
2021 Abril 254 62 316
2021 Marzo 149 31 180
2021 Febrero 97 22 119
2021 Enero 106 22 128
2020 Diciembre 93 10 103
2020 Noviembre 83 19 102
2020 Octubre 76 13 89
2020 Septiembre 60 15 75
2020 Agosto 48 19 67
2020 Julio 34 17 51
2020 Junio 36 30 66
2020 Mayo 19 6 25
2020 Abril 23 14 37
2020 Marzo 14 12 26
2020 Febrero 5 0 5
2020 Enero 4 0 4
2019 Diciembre 4 0 4
2019 Noviembre 4 0 4
2019 Septiembre 4 0 4
2019 Agosto 4 0 4
2019 Julio 4 0 4
2019 Junio 4 0 4
2019 Mayo 4 0 4
2019 Abril 3 0 3
2019 Marzo 1 0 1
2019 Febrero 2 0 2
2018 Diciembre 3 0 3
2018 Octubre 3 0 3
2018 Septiembre 4 0 4
2018 Marzo 0 1 1
2018 Febrero 12 4 16
2018 Enero 22 6 28
2017 Diciembre 31 10 41
2017 Noviembre 15 4 19
2017 Octubre 21 10 31
2017 Septiembre 18 7 25
2017 Agosto 34 19 53
2017 Julio 44 29 73
2017 Junio 4 1 5
Mostrar todo

Siga este enlace para acceder al texto completo del artículo

Idiomas
Actas Dermo-Sifiliográficas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?