Isabel Belinchón

Risk of adverse events in psoriasis patients receiving classic systemic drugs and biologics in a 5-year observational study of clinical practice: 2008–2013 results of the Biobadaderm registry

Biobadaderm is the Spanish registry of psoriasis patients receiving systemic treatment in clinical practice.

Spanish Evidence-Based Guidelines on the Treatment of Psoriasis With Biologic Agents, 2013. Part 1: On Efficacy and Choice of Treatment

Biologic therapy is a well-established strategy for managing moderate and severe psoriasis. Nevertheless, the high cost of such therapy, the relatively short span of clinical experience with biologics, and the abundance of literature now available on these agents have made evidence-based and consensus-based clinical guidelines necessary. The ideal goal of psoriasis treatment is to achieve complete or nearly complete clearing of lesions and to maintain it over time. Failing that ideal, the goal would be to reduce involvement to localized lesions that can be controlled with topical therapy. Although current evidence allows us to directly or indirectly compare the efficacy or risk of primary or secondary failure of available biologics based on objective outcomes, clinical trial findings cannot be directly translated to routine practice. As a result, the prescribing physician must tailor the treatment regimen to the individual patient. This update of the clinical practice guidelines issued by the Spanish Academy of Dermatology and Venereology (AEDV) on biologic therapy for psoriasis incorporates information from the most recent publications on this topic.

Survival of classic and biological systemic drugs in psoriasis: results of the BIOBADADERM registry and critical analysis.

Few reported studies compare drug survival in moderate‐to‐severe psoriasis vulgaris.

Estudio epidemiológico de la patología cutánea en la población inmigrante de Alicante

BACKGROUND The influx of a large number of immigrants has altered the sociodemographic profile in Spain. To date, few studies of the skin diseases of immigrants to Spain have been done. OBJECTIVE To determine the frequency of visits by immigrants to our dermatology clinic, to describe their skin complaints, and to compare them to those of the autochthonous Spanish population. PATIENTS AND METHODS Prospective, descriptive, analytic study, with an observational substudy of cases and controls from a cross-section of the population. We included all immigrant patients seen at the dermatology clinic between February 2005 and February 2006. RESULTS Visits by immigrants to the dermatology clinic accounted for 4.1% of the caseload. Their most frequent complaints were eczematous dermatitis (18.4%), viral warts (6.4%), and acne (6.3%). Comparison between the immigrant and autochthonous patient populations showed that eczematous dermatitis, alopecia, melasma, ringworm, scabies, Herpes simplex infection, keratosis pilaris, and xerosis were significantly more frequent among immigrant patients, whereas viral warts, actinic keratosis, hidradenitis suppurativa, lupus, melanoma, and squamous cell carcinoma were significantly less frequent (P < .05). CONCLUSIONS The immigrant population consults the dermatologist about skin conditions that are already well represented in our routine practice. As the infectious skin diseases of immigrants are also common in our environment, these patients are unlikely to transmit serious tropical skin diseases to the local population.

Safety of classic and biologic systemic therapies for the treatment of psoriasis in elderly: an observational study from national BIOBADADERM registry.

Psoriasis patients over 65 years‐old (elderly) constitute a growing group, underrepresented in clinical trials, and likely to be more prone to adverse events.

Dermatological scientific production from European Union authors (1987-2000)

To evaluate the contribution to international dermatological literature made by authors from European Union (EU) countries. Using MedLine, a selection was made of articles by EU authors published between 1987 and 2000 in 32 dermatological journals, classified as such by the Institute for Scientific Information. Overall 19,225 documents were published by European authors in the selected dermatological journals from 1987 to 2000. The leading countries in terms of output were the United Kingdom, Germany, Italy and France. The leading countries in number of articles after taking into account the gross domestic product and the population were Denmark, Finland and Sweden. The main journals were the British Journal of Dermatology(14.5% of articles from European authors), Contact Dermatitis (13.7%), Journal of Investigative Dermatology (7.3%),Journal of American Academy of Dermatology (6.4%), andActa Dermato-Venereologica (6.1%). The country with the highest output of papers by journal was the United Kingdom (11 journals) followed by Germany (9 journals), Italy (6 journals), France (3 journals), Spain (2 journals) and Sweden (1 journal). In conclusions: the scientific production of European Union research on dermatology is highest in northern countries.

Disability profile in leprosy patients' diagnoses in a rural reference leprosy centre in Ethiopia during 1999-2009.

We assessed the epidemiology of disabilities in leprosy cases treated in a rural hospital over a 10-year period. This is a retrospective data collection using leprosy registers and treatment cards in a rural private mission hospital. Over the 10-year period, 210 patients with leprosy were registered for treatment. One hundred and twenty-eight (61.5%) had disabilities (26.0% grade 1 and 35.6% grade 2): 13.5% ocular disabilities, 44.5% disabilities in hands and 44.7% foot impairment. Patients >19 years had more disabilities (66.7% versus 50.7%) (P = 0.03), especially ocular disabilities (16.7% in >20 versus 6.0% in <20 years) (P = 0.03). This study detected a high prevalence of disabilities.

Successful response to narrow-band UVB in a patient undergoing concomitant treatment with adalimumab for psoriasis.

Combinations of therapeutic modalities are commonly used to treat psoriasis. However, the combination of biologic agents with other conventional therapies for psoriasis, such as phototherapy, has been relatively unexplored. We present a patient who responded to the combination of adalimumab and narrowband UVB. A 38-year-old woman presented with an 18-year history of cutaneous psoriasis and psoriatic arthropathy that had been diagnosed 3 years previously. The patient had used multiple topical and systemic therapies including oral acitretin, cyclosporin and methotrexate. She presented with pain and tumefaction of the elbows, knees, ankles and proximal interphalangeal joints of the fingers of both hands, with dactylitis of the second and third finger of the right hand. The Psoriasis Area and Severity Index (PASI) score was 17. Intravenous infliximab (5 mg/kg administered at 0, 2 and 6 weeks and thereafter every 8 weeks) was started to treat the articular and cutaneous disease. During the second infusion the patient suffered a moderate acute reaction consisting of dyspnoea, palpitations and urticaria. The reaction rapidly resolved after administration of chlorpheniramine and prednisone. Infliximab treatment was suspended and subcutaneous etanercept 50 mg twice each week begun. The cutaneous and articular symptoms almost disappeared with this treatment for 1 year (PASI score 3 and asymptomatic joints). However, the treatment lost its efficacy and the patient re-presented with a PASI score of 21 and swelling of several joints. Treatment was therefore changed to adalimumab 40 mg s.c. every 2 weeks. Although there was an initial slight improvement in the skin disease, after 2 months the PASI score was still 17 with generalized plaques of psoriasis (Fig. 1). Her arthropathy was asymptomatic. At this point, the options were to try another anti-tumour necrosis factor agent or to add a conventional therapy. As there was an improvement in the patient’s arthropathy, it was decided to continue treatment with adalimumab and add phototherapy. Whole body narrowband UVB was given three times each week in walk-in phototherapy units (Waldmann, Germany) containing a vertical array of Philips TL01 100 W fluorescent tubes. The initial treatment dose was 0.3 J/cm UVB (311 nm), according to her phototype III. The dose was increased at every treatment by 0.1 J/cm to a maximal UVB dose of 2.5 J/cm. After 18 treatment sessions (total cumulative dose of 19.3 J/cm) the patient had a PASI score of 1 and there was only residual hyperpigmentation of previously affected areas (Fig. 2). Six months later the skin disease and joint symptoms remained well controlled with adalimumab as monotherapy, with a PASI score of 6. There are few published reports of the efficacy and safety of combining a biologic agent with phototherapy. An

Estudio bibliométrico de la revista Actas Dermo-Sifiliográficas (1984-2003). Análisis de la producción (I)

Resumen Objetivo Analizar los articulos cientificos publicados en actas dermo-sifiliograficas (AD) entre 1984 y 2003. Los principales parametros bibliometricos analizados han sido: numero de articulos, extension y tipologia documental, areas tematicas fundamentales, autoria de los documentos, principales centros productores, areas departamentales y distribucion geografica de los articulos. Material y metodos Se revisaron manualmente todos los articulos cientificos publicados en los numeros ordinarios de la revista AD entre 1984 y 2003 (dos decadas), lo que corresponde a los volumenes 75 a 94. Resultados En el periodo de estudio se publicaron en la revista AD un total de 2.604 articulos, con una media anual de 130. El caso clinico o nota clinica fue el principal tipo documental (66,2 %), seguido de los articulos originales (23,5 %) y los articulos de revision (4,7 %). La extension de los documentos vario entre 1 y 33 paginas, con una media de 4,55 paginas. Las cuestiones mas abordadas en los documentos del periodo fueron dermatopatologia (15,9 %) y tratamiento (15,4 %). Se contabilizo un total de 11.667 autorias, y el numero de autores distintos fue de 2.907. El indice de colaboracion medio del periodo se situo en el 4,48. Un 56,7 % de autores lo fue de forma ocasional (firmo un unico documento), mientras a un 3,5% se les considero maximos productores por haber firmado 20 o mas trabajos a lo largo del periodo. Siete comunidades autonomas concentraron el 85,5 % de la produccion. La comunidad de Madrid fue, con diferencia, la gran productora (917 documentos; 35,2%), seguida de Andalucia (422; 16,2 %), Cataluna (240; 9,2 %) y Castilla y Leon (221; 8,5 %). Un total de 293 centros distintos firmaron los 2.604 documentos del estudio y dieron lugar a 2.977 colaboraciones. La mayoria de estas colaboraciones pertenecian a grandes hospitales o complejos hospitalarios entre los que destacaron los madrilenos Hospital 12 de Octubre (281 colaboraciones) y Hospital Clinico San Carlos (153), asi como el Hospital Universitario San Cecilio de Granada (149). La dermatologia fue la especialidad que firmo un mayor numero de documentos (90,8% como primer firmante). La gran colaboradora de la dermatologia fue la anatomia patologica que participo en un 28,5 % de articulos. Conclusiones El analisis de la productividad de la revista AD durante dos decadas permite aproximarnos a la actividad cientifica dermatologica nacional dada la importancia cuantitativa y cualitativa de la revista en el contexto de la dermatologia espanola.

Adherence, satisfaction and preferences for treatment in patients with psoriasis in the European Union: a systematic review of the literature

Background and objective Adherence to treatment in patients with psoriasis is often poor. An investigation of patient preferences and satisfaction with treatment may be important, based on the expected correlation with therapy compliance. This paper aims to examine and describe the current literature on patient preferences, satisfaction and adherence to treatment for psoriasis in the European Union (EU). Methods Electronic searches were conducted using PubMed, ISI Web of Knowledge, Scopus, Spanish databases and Google Scholar. European studies published in English or Spanish between January 1, 2009 and December 31, 2014 regarding patient-reported outcomes in psoriatic patients were included. Studies conducted in non-EU countries, letters to the editor, editorials, experts’ opinions, case studies, congress proceedings, publications that did not differentiate between patients with psoriasis and psoriatic arthritis or studies related to specific treatment were excluded. Results A total of 1,769 titles were identified, of which 1,636 were excluded as they were duplicates or did not provide any relevant information. After a full-text reading and application of the inclusion/exclusion criteria, 46 publications were included. This paper will describe publications on adherence (n=4), preferences (n=5) and satisfaction with treatment (n=7). Results related to health-related quality of life articles (n=30) have been published elsewhere. Adherence rates are generally low in psoriasis patients regardless of the type of treatment, severity of disease or methods used to measure adherence. Biologic therapy is associated with greater clinical improvement. There is a direct association between physician recommendations, patient preferences and several domains of treatment satisfaction. Conclusion The results of this review support the conclusion that adherence rates in patients with psoriasis are suboptimal and highlight the need to improve patient compliance and satisfaction with treatment. Patients’ preferences should be taken into account in the treatment decision-making process in order to improve patients’ clinical outcomes by ensuring satisfaction and adherence.