Case and Research Letters
Pyoderma Gangrenosum With Ulcerative Colitis Successfully Treated With Ustekinumab
Pioderma gangrenoso asociado a colitis ulcerosa con buena respuesta a ustekinumab
J. Piqueras-García
, A.J. Sahuquillo-Torralba, I. Torres-Navarro, R. Botella-Estrada
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Servicio de Dermatología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Piqueras-García, A.J. Sahuquillo-Torralba, I. Torres-Navarro, R. Botella-Estrada" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Piqueras-García" "email" => array:1 [ 0 => "jennipg_19@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A.J." "apellidos" => "Sahuquillo-Torralba" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Torres-Navarro" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Botella-Estrada" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario y Politécnico La Fe, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pioderma gangrenoso asociado a colitis ulcerosa con buena respuesta a ustekinumab" ] ] "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" => 521 "Ancho" => 905 "Tamanyo" => 53175 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Residual lesion on the left leg after treatment with ustekinumab and cyclosporin for 12 weeks.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pyoderma gangrenosum is a rare neutrophilic skin disease that may be idiopathic or associated with systemic disease such as inflammatory bowel disease, arthritis, paraproteinemia, or blood cancers. While it is true that topical or intralesional therapies can be used in patients with isolated lesions that have little impact on quality of life, in most cases, systemic immunosuppressant treatment is required. Corticosteroids and cyclosporin are used as the first line in systemic treatments. Other reported alternatives, although not approved for this indication, include mycophenolate mofetil, anti-TNF, intravenous immunoglobulins, interleukin (IL) 1 antagonists, and ustekinumab (anti-IL-12/23).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 33-year-old woman diagnosed with ulcerative colitis since the age of 17 years had presented multiple pyoderma gangrenosum lesions on the lower limbs throughout the course of the disease. The patient had been treated with multiple therapies that, in chronological order, included 6-mercaptopurine, cyclosporin at 3-5<span class="elsevierStyleHsp" style=""></span>mg/kg/d for 5 months, intravenous infliximab at 5<span class="elsevierStyleHsp" style=""></span>mg/kg every 4 weeks, subcutaneous adalimumab at 40<span class="elsevierStyleHsp" style=""></span>mg/wk, plasmapheresis every 15 days, tacrolimus oral at 8<span class="elsevierStyleHsp" style=""></span>mg/d, intravenous vedolizumab at 300<span class="elsevierStyleHsp" style=""></span>mg every 4 weeks, and subtotal colectomy. Cyclosporin, infliximab, adalimumab, and tacrolimus oral had been administered with the above treatments for the indication of pyoderma gangrenosum and topical treatment was associated with intralesional triamcinolone acetonide, and topical tacrolimus and clobetasol propionate. All previous treatments were associated with prednisone at doses of up to 50<span class="elsevierStyleHsp" style=""></span>mg/d. At one point in the course of the disease, the patient presented left pretibial pyoderma gangrenosum measuring 11<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>cm. The lesion, which had appeared 5 months earlier, was difficult to manage, corticosteroid-dependent (it worsened when prednisone was reduced to below 20<span class="elsevierStyleHsp" style=""></span>mg/d), and had a considerable impact on quality of life (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). At the time, the patient was undergoing treatment with intravenous vedolizumab at a dosage of 300<span class="elsevierStyleHsp" style=""></span>mg every 4 weeks, prednisone at 50<span class="elsevierStyleHsp" style=""></span>mg/d, and topical corticosteroids. In light of the refractory nature of the disease and as multiple lines of treatment had been exhausted, it was decided to instate treatment with subcutaneous ustekinumab 90<span class="elsevierStyleHsp" style=""></span>mg (week 0, 4, 10, and every 8 weeks thereafter) associated with cyclosporin at a dose of 3<span class="elsevierStyleHsp" style=""></span>mg/kg/d, with an excellent response of the pyoderma gangrenosum, which resolved completely in 12 weeks, making it possible to reduce the dosage of prednisone to 5<span class="elsevierStyleHsp" style=""></span>mg/d (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). After 10 months of follow-up, the patient has maintained treatment with ustekinumab every 8 weeks with very good results; this has made it possible to withdraw the cyclosporin and reduce the prednisone to 2.5<span class="elsevierStyleHsp" style=""></span>mg every 2 days.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In 2011, Guenova et al reported the first case of pyoderma gangrenosum successfully treated with ustekinumab.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Those authors suggested that IL-23 is implicated in the pathogenesis of immunologic diseases such as psoriasis and inflammatory bowel disease; they therefore studied the expression of this interleukin in the patient's lesion biopsy and observed overexpression of IL-23 compared to biopsies of healthy skin. Ustekinumab was therefore proposed as a targeted therapy for treatment of the pyoderma gangrenosum.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Since then, 5 more cases have been reported in the literature with good response to ustekinumab at doses ranging from 45-90<span class="elsevierStyleHsp" style=""></span>mg every 8 weeks to 135<span class="elsevierStyleHsp" style=""></span>mg every 6 weeks (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2–7</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion, we present a new case of pyoderma gangrenosum associated with ulcerative colitis, with good response to ustekinumab together with cyclosporin and oral corticosteroids following a lack of response to the 2 previous treatments, tacrolimus oral and anti-TNF (infliximab and adalimumab), administered together. We propose this alternative in difficult-to-manage cases of pyoderma gangrenosum that are refractory to other treatments. Further studies are required to determine the involvement of IL-23 in the pathogenesis of this disease.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Piqueras-García J, Sahuquillo-Torralba AJ, Torres-Navarro I, Botella-Estrada R. Pioderma gangrenoso asociado a colitis ulcerosa con buena respuesta a ustekinumab Eczema y urticaria en Portugal. 2019;110:776–778.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 589 "Ancho" => 905 "Tamanyo" => 95288 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Skin lesion compatible with pyoderma gangrenosum on the lower part of the left leg. Image prior to combined treatment with ustekinumab and cyclosporin.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 521 "Ancho" => 905 "Tamanyo" => 53175 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Residual lesion on the left leg after treatment with ustekinumab and cyclosporin for 12 weeks.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Author \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sex/Age, y \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Associated Disease \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Previous Treatment \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ustekinumab Dosage \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Response \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Guenova et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> (2011) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female/37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prednisolone and tacrolimus topical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45<span class="elsevierStyleHsp" style=""></span>mg/8 weeksAssociated with tacrolimus topical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complete response reached after 14 weeks \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fahmy et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> (2012) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female/34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ulcerative colitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Corticosteroids, azathioprine, infliximab, colectomy, adalimumab, and tacrolimus oral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90<span class="elsevierStyleHsp" style=""></span>mg/8 weeks \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complete response reached after 10 weeks \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Goldminz et al.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> (2012) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male/37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical, intralesional, and systemic corticosteroids, cyclosporin, azathioprine, methotrexate, adalimumab, infliximab, and golimumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90<span class="elsevierStyleHsp" style=""></span>mg/8 weeksAssociated with dapsone 100<span class="elsevierStyleHsp" style=""></span>mg/d and prednisone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complete response reached after 22 weeks \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cosgarea et al.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> (2016) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female/71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Renal cell carcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prednisone and cyclosporin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not reported \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complete response reached 12 weeks after reinstatement of ustekinumab following surgery for renal cell carcinoma (no response prior to surgery) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Greb et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> (2016) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male/50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Prednisone, cyclosporin, adalimumab, infliximab, and golimumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90<span class="elsevierStyleHsp" style=""></span>mg/8 weeks to 135<span class="elsevierStyleHsp" style=""></span>mg/6 weeksAssociated with dapsone 100<span class="elsevierStyleHsp" style=""></span>mg/d and prednisone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Response reached after 16 weeks following higher dosage of ustekinumab \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Benzaquen et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> (2017) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female/56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Psoriasis treated with adalimumab (induced by anti-TNF) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45<span class="elsevierStyleHsp" style=""></span>mg. Interval not specified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Complete response after 3 doses \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2169909.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Summary of Cases of Pyoderma Gangrenosum Treated With Ustekinumab Reported in the Literature.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment options for pyoderma gangrenosum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.R. Quist" 1 => "L. 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| 2021 Enero | 107 | 24 | 131 |
| 2020 Diciembre | 110 | 18 | 128 |
| 2020 Noviembre | 76 | 29 | 105 |
| 2020 Octubre | 56 | 23 | 79 |
| 2020 Septiembre | 32 | 20 | 52 |
| 2020 Agosto | 81 | 26 | 107 |
| 2020 Julio | 96 | 9 | 105 |
| 2020 Junio | 26 | 28 | 54 |
| 2020 Mayo | 28 | 12 | 40 |
| 2020 Abril | 16 | 10 | 26 |
| 2020 Marzo | 21 | 4 | 25 |
| 2020 Febrero | 13 | 4 | 17 |
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