Mercè Alsina-Gibert

The Role of Fcγ Receptor Polymorphisms in the Response to Anti–Tumor Necrosis Factor Therapy in Psoriasis: A Pharmacogenetic Study

IMPORTANCE Variability in genes encoding proteins involved in the immunological pathways of biological therapy may account for the differences observed in outcomes of anti–tumor necrosis factor (TNF) treatment of psoriasis. OBJECTIVE To assess the role of 2 Fcγ receptor (FcγR) polymorphisms in the response to anti-TNF therapy in psoriasis. DESIGN Retrospective series of patients with psoriasis who received anti-TNF therapy(infliximab, adalimumab, or etanercept) from January 1, 2007, through December 31, 2010. Patients were followed up for 12 weeks. SETTING Two psoriasis referral centers. PARTICIPANTS Seventy treatment-naive patients with moderate to severe psoriasis who received anti-TNF agents. INTERVENTION Patients underwent FcγRIIA-H131R and FcγRIIIA-V158F polymorphism genotyping. MAIN OUTCOMES AND MEASURES The Psoriasis Area and Severity Index and the body surface area were assessed at baseline and at treatment weeks 6 to 8 and 12. The polymorphism genotypes were correlated with the treatment outcomes. RESULTS Bivariate analysis showed a nonsignificant association between FcγR low-affinity genotypes and greater improvement in the Psoriasis Area and Severity Index and body surface area at the end of treatment. Conversely, patients harboring high-affinity alleles presented a greater reduction in body surface area at the intermediate point, which remained independent in the multivariate analysis. We also detected an additive effect of both polymorphisms in the multivariate analysis. High-affinity alleles may contribute to a quicker response owing to a more efficient removal of relevant cells expressing TNF. CONCLUSIONS AND RELEVANCE Preliminary results of this pilot study on the pharmacogenetics of FcγR and biological therapy in psoriasis suggest a role with clinical implications for FcγRIIA-H131R and FcγRIIIA-V158F polymorphisms in the outcome of anti-TNF treatment of psoriasis. These results might help dermatologists in guiding therapeutic decisions, especially in very severe cases where a quick response is needed.

New human papillomavirus (HPV) types involved in epidermodysplasia verruciformis (EV) in 3 HIV-infected patients: Response to topical cidofovir

To the Editor: Epidermodysplasia verruciformis (EV) is a rare genodermatosis conferring abnormal susceptibility to human b-papillomavirus (b-HPV) infection. To date, 18 cases of EV-like eruptions have been reported associated with HIV infection worldwide. We report 3 new cases of HIV patients with EV-like eruption diagnosed according to clinical, histologic, and virological features. Our first patient developed EV in 1992 and presented with common warts, perianal condylomas with squamous cell carcinoma (SCC), and oral invasive SCC. Treatment with acitretin (50 mg/d) and interferon alfa-2a (3 MU subcutaneously 3 days/wk) achieved complete clearance of common warts but only partial improvement of EV. Our second patient developed EV in 2002, and imiquimod therapy was ineffective. The third patient who had had EV since 1983 was treated with emollients without response.

Emergencia de la sífilis: Estudio descriptivo de pacientes diagnosticados de sífilis en un hospital de tercer nivel entre 2011 y 2015

BACKGROUND AND OBJECTIVE In the last decade, the incidence of syphilis has increased in our health area. Our objective is to describe the epidemiological and clinical characteristics of patients diagnosed with syphilis at our centre and their relationship with HIV. PATIENTS AND METHODS The clinical and epidemiological variables of patients diagnosed with syphilis in a third-level hospital over a period of 4.5 years, as well as their HIV status, were analysed through a descriptive study. RESULTS There was a significant increase in the incidence of syphilis in the period 2011-2015. We included 220 patients, 98% men (94% MSM). 62% were HIV+ and 89% came in early/infectious stages of the disease. 7% were concomitantly diagnosed with HIV. There was a high number of sexual partners and frequent use of drugs associated with sexual activity (46%). CONCLUSIONS The incidence of syphilis has increased in our centre in the last 2 years. The most affected group is MSM, with high HIV prevalence and risk behaviours for STI acquisition.

Sífilis maligna, una presentación de sífilis a tener en cuenta

Malignant syphilis is an uncommon form of secondary syphilis associated with HIV infection. Clinically, it is characterized by necrotic nodules and generalized ulcerated lesions. We present 4 cases of malignant syphilis diagnosed after evaluating syphilis cases diagnosed at our hospital between 2012 and 2016. We describe the epidemiologic, clinical, histiopathologic, and serologic characteristics of malignant syphilis and explore its response to treatment and association with HIV infection. Although malignant syphilis is uncommon, there has been an increase in the number of cases published in recent years, particularly in young HIV-positive patients. Malignant syphilis must be contemplated in the differential diagnosis of HIV patients with ulcerated, necrotic lesions.

Remission Time after Rituximab Treatment for Autoimmune Bullous Disease: A Proposed Update Definition

A therapeutic endpoint is a very important tool to evaluate response in clinical trials. In 2005, a consensus statement identified two late endpoints of disease activity in pemphigus: complete remission off therapy and complete remission on therapy, both definitions applying to patients without lesions for at least 2 months. The same period of time was considered for partial remission off/on therapy. These definitions were later applied to bullous pemphigoid and are considered in most studies on autoimmune bullous disease. These endpoints were established for different adjuvant agents, but at that moment, rituximab was not considered. Rituximab is known for the long duration of its effect, and in most studies relapses have been reported later than 6 months after treatment. In our opinion, time to remission after rituximab treatment should be redefined.