Case and Research Letters
Etanercept for Psoriasis in a Renal Transplant Recipient
Uso de etanercept en un paciente trasplantado renal con psoriasis
E. García-Zamora
, E. Gómez de la Fuente, R. Miñano-Medrano, JL. López-Estebaranz
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Hospital Universitario Fundación Alcorcón, Servicio de Dermatología, Madrid, Spain
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García-Zamora, E. Gómez de la Fuente, R. Miñano-Medrano, JL. López-Estebaranz" "autores" => array:4 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "García-Zamora" "email" => array:1 [ 0 => "garciazamoraelena@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Gómez de la Fuente" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Miñano-Medrano" ] 3 => array:2 [ "nombre" => "JL." "apellidos" => "López-Estebaranz" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Universitario Fundación Alcorcón, Servicio de Dermatología, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Uso de etanercept en un paciente trasplantado renal con psoriasis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1224 "Ancho" => 1255 "Tamanyo" => 171041 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Residual erythematous patches on the torso and limbs. Major improvement of the nails with mild trachyonychia and some oil drop.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In the past decade, the advent of biologic drugs has led to major change in the treatment of patients with moderate-to-severe psoriasis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Traditionally, transplant patients have been excluded from clinical trials for safety reasons (risk of infection, risk of secondary cancer, and risk of induced autoimmunity) and there is therefore very little evidence regarding the use of these drugs in transplant patients; the information published to date consists of isolate clinical cases or case series.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> As a result, experience of their use in this group of patients is scarce.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We report the clinical case of a kidney-transplant patient with severe psoriasis and good response to treatment with etanercept.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was a 67-year-old man with severe psoriasis, who had received different treatments since adolescence: topical corticosteroids, acitretin, narrow-band ultraviolet (NB-UVB) phototherapy, cyclosporin A, and oral methotrexate. The patient’s personal history included hypertension and hyperlipidemia, both adequately controlled with treatment. The patient had undergone a kidney transplant in August 2003, due to chronic interstitial nephritis. Since then, he had been undergoing treatment with variable dosages of corticosteroids (10−20 mg/d) and topical corticosteroids, together with his immunosuppressant regimen (tacrolimus, 3 mg/12 h and mofetil mycophenolate, 1 g/24 h). In 2012, the patient underwent a transurethral resection of a high-grade (pT1G2) gallbladder tumor with subsequent intravesical instillation of mitomycin C; the tumor is currently in complete remission. Because of the poor control of his psoriasis lesions, with a Psoriasis Area and Severity Index (PASI) score of 15 and a Body Surface Area (BSA) of 8%, with impaired quality of life, treatment with etanercept at a dosage of 50 mg/wk was instated in August 2017; the mycophenolate was stopped and the oral tacrolimus was continued (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A significant improvement in the skin lesions was achieved 12 weeks after starting treatment with etanercept, with a reduction of the PASI score to 2 and the BSA to 1% (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Currently, after a year of follow-up, the patient continues in treatment with etanercept at a dosage of 50 mg/wk, with adequate control of the disease (PASI, 0; BSA, 0%) and no evidence of adverse effects or signs of rejection (estimated CKD glomerular filtration rate >60 mL/min/1.73 m<span class="elsevierStyleSup">2</span>; urea, 38 mg/dL; and creatinine, 1.15 mg/dL [0.70–1.30]).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">To date, very few cases have been reported in the literature of transplant patients in treatment with biologic drugs. In most of them, biologic drugs have been used in these patients to control inflammatory bowel disease (Crohn disease or ulcerative colitis) or rheumatologic diseases (rheumatoid arthritis or ankylosing spondylitis).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">We found only 4 cases in the literature of patients with a solid-organ transplant in treatment with biologic drugs to control psoriasis. These cases are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. In all cases, the drug used was etanercept, probably due to the extensive experience with its use and its good safety profile, which allowed for good clinical control, good tolerance, and no evidence of rejection; however, follow-up was limited in all cases (5–24 months).<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> In 1 case, the treatment with the drug had to be interrupted on several occasions due to recurrent episodes of cholangitis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">In the largest series published to date of kidney-transplant patients in treatment with anti-TNFα drugs, the authors report a high rate of severe infections (50%); this has not been reported in other case series.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Garrouste et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> report a particularly high risk of infection in patients undergoing immunosuppressant treatment combined with corticosteroids at doses above 10 mg/d for the first 3 months after starting the anti-TNFα drug.</p><p id="par0040" class="elsevierStylePara elsevierViewall">We found no reports in the literature of patients with a solid-organ transplant in treatment with non-anti–TNFα biologic drugs to control psoriasis. Only 1 case has been reported, of a 44-year-old man with Crohn disease and recipient of a liver transplant due to cryptogenic cirrhosis, who was treated with ustekinumab to control the inflammatory bowel disease, with a good response and no adverse effects after 12 months of follow-up.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The literature contains little evidence of the need to modify the immunosuppressant regimen in these patients when the biologic drug is introduced. Many of the reported cases do not mention any modification of the immunosuppressant treatment. In our case, we decided to suspend the mofetil mycophenolate and maintain the tacrolimus at 3 mg/12 h, together with the etanercept. Furthermore, anti-TNF drugs are being used off-label as immunosuppressants in recipients of solid-organ transplants.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In conclusion, with this new case, we provide additional information on the use of biologic drugs in transplant patients. Biologic drugs may be used in this type of patient provided that the patients are carefully selected and closely observed for potential infections, although we believe that more cases and studies are needed to corroborate this.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0055" 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 "fechaRecibido" => "2018-06-28" "fechaAceptado" => "2018-07-11" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Zamora E., Gómez de la Fuente E., Miñano-Medrano R., López-Estebaranz JL. Uso de etanercept en un paciente trasplantado renal con psoriasis. Actas Dermosifiliogr. 2020;111:169–171.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1135 "Ancho" => 1255 "Tamanyo" => 190874 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous plaques with thick, moderately infiltrated scale on the torso and upper and lower limbs. Periungual inflammation with ungual involvement in the form of trachyonychia, hyperkeratosis, oil drop, and onycholysis.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1224 "Ancho" => 1255 "Tamanyo" => 171041 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Residual erythematous patches on the torso and limbs. Major improvement of the nails with mild trachyonychia and some oil drop.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Abbreviation: MMP indicates mofetil mycophenolate.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\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">Reference \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">Organ Transplanted \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">Immunosuppressant RegimenBiologic DrugClinical Rregimen \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">Biologic drug \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">Clinical response \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">Complications \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">Follow-up duration \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">Hoover et al., 2007 \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">Liver \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">Tacrolimus/sirolimus \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">Etanercept \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">Yes \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">6 mo \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">Collazo et al., 2008 \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">Liver \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">Tacrolimus/MMP/corticosteroids \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">Etanercept \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">Yes \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">5 mo \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">Brodakali et al., 2012<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> \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">Pancreas-kidney \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">Tacrolimus/MMP/corticosteroids \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">Etanercept \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">Yes \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">2 y \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">Madankumar et al., 2015 <a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> \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">Liver \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">Tacrolimus/everolimus/corticosteroids \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">Etanercept \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">Yes \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">Recurrent cholangitis \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">1 y \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">García-Zamora et al., 2018<span class="elsevierStyleSup">8,9</span> \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">Kidney \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">Tacrolimus/MMP/corticosteroids \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">Etanercept \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">Yes \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">10 mo \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2273253.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">With Solid-Organ Transplant and Psoriasis Treated with Anti-TNFα to Control the Psoriasis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "[1]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anti-TNFα therapy for chronic inflammatory disease in kidney transplant recipients: Clinical outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 11 | 9 | 20 |
| 2024 Octubre | 85 | 50 | 135 |
| 2024 Septiembre | 96 | 27 | 123 |
| 2024 Agosto | 103 | 68 | 171 |
| 2024 Julio | 93 | 40 | 133 |
| 2024 Junio | 80 | 27 | 107 |
| 2024 Mayo | 78 | 35 | 113 |
| 2024 Abril | 88 | 20 | 108 |
| 2024 Marzo | 85 | 33 | 118 |
| 2024 Febrero | 60 | 36 | 96 |
| 2024 Enero | 67 | 28 | 95 |
| 2023 Diciembre | 65 | 15 | 80 |
| 2023 Noviembre | 69 | 31 | 100 |
| 2023 Octubre | 68 | 24 | 92 |
| 2023 Septiembre | 51 | 34 | 85 |
| 2023 Agosto | 52 | 17 | 69 |
| 2023 Julio | 71 | 32 | 103 |
| 2023 Junio | 83 | 27 | 110 |
| 2023 Mayo | 92 | 30 | 122 |
| 2023 Abril | 51 | 14 | 65 |
| 2023 Marzo | 69 | 29 | 98 |
| 2023 Febrero | 86 | 12 | 98 |
| 2023 Enero | 71 | 36 | 107 |
| 2022 Diciembre | 65 | 33 | 98 |
| 2022 Noviembre | 38 | 23 | 61 |
| 2022 Octubre | 33 | 28 | 61 |
| 2022 Septiembre | 25 | 40 | 65 |
| 2022 Agosto | 31 | 35 | 66 |
| 2022 Julio | 24 | 36 | 60 |
| 2022 Junio | 27 | 30 | 57 |
| 2022 Mayo | 47 | 47 | 94 |
| 2022 Abril | 53 | 23 | 76 |
| 2022 Marzo | 61 | 54 | 115 |
| 2022 Febrero | 34 | 33 | 67 |
| 2022 Enero | 54 | 40 | 94 |
| 2021 Diciembre | 51 | 37 | 88 |
| 2021 Noviembre | 53 | 36 | 89 |
| 2021 Octubre | 57 | 53 | 110 |
| 2021 Septiembre | 43 | 42 | 85 |
| 2021 Agosto | 26 | 38 | 64 |
| 2021 Julio | 40 | 20 | 60 |
| 2021 Junio | 31 | 22 | 53 |
| 2021 Mayo | 32 | 41 | 73 |
| 2021 Abril | 98 | 101 | 199 |
| 2021 Marzo | 43 | 29 | 72 |
| 2021 Febrero | 57 | 27 | 84 |
| 2021 Enero | 40 | 13 | 53 |
| 2020 Diciembre | 35 | 24 | 59 |
| 2020 Noviembre | 54 | 25 | 79 |
| 2020 Octubre | 37 | 13 | 50 |
| 2020 Septiembre | 26 | 14 | 40 |
| 2020 Agosto | 37 | 19 | 56 |
| 2020 Julio | 37 | 12 | 49 |
| 2020 Junio | 21 | 21 | 42 |
| 2020 Mayo | 45 | 18 | 63 |
| 2020 Abril | 56 | 22 | 78 |
| 2020 Marzo | 7 | 10 | 17 |
| 2020 Febrero | 1 | 2 | 3 |
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