Efficacy and Safety of bimekizumab in elderly patients: real-world multicenter retrospective study - IL PSO (Italian Landscape Psoriasis)

Purpose of the article: The aim of this multicenter observational study is to report data from real world on the use of bimekizumab in patients aged ≥ 65 years with moderate-to-severe plaque psoriasis. Elderly patients are poorly represented in clinical trials on bimekizumab for plaque psoriasis, and real-world studies are important to guide clinical choices. Materials and methods: A retrospective multicenter study was conducted in 33 dermatological outpatient clinics in Italy. Patients aged ≥ 65 years, with moderate-to-severe plaque psoriasis and treated with bimekizumab were enrolled. No exclusion criteria were applied. Bimekizumab was administered following the Italian Guidelines for the management of plaque psoriasis and according to the summary of product characteristics, in adult patients who were candidates for systemic treatments. Overall, 98 subjects were included, and received bimekizumab up to week 36. Clinical and demographic data were collected before the initiation of treatment with bimekizumab. At baseline and each dermatological examination (4, 16, and 36 weeks), clinical outcomes were measured by the following parameters: (1) PASI score; (2) site-specific (scalp, palmoplantar, genital, nail) Psoriasis Global Assessment (PGA). At each visit, the occurrence of any adverse events (AEs) was recorded, including serious AEs and AEs leading to bimekizumab discontinuation. Results: The mean PASI score was 16.6 ± 9.4 at baseline and significantly decreased to 4.3 ± 5.2 after 4 weeks (p < 0.001), and 1.1 ± 1.7 after 16 week (p < 0.001). This level of improvement was maintained after 36 weeks (p < 0.001). PASI ≤2 was recorded in 36 (36.7%) at week 4, 68% and 69.4% at week 16 and 36, respectively. By week 16, 86/98 (87.8%) patients reached PASI75, 71/98 (72.4%) obtained PASI90, and 52/98 (53.1%) PASI100. Binary logistic regression tests showed a significant association of PASI100 by week 4 with lower PASI at baseline. PASI 100 at 16 or 36 weeks was not associated with baseline PASI, obesity, age, gender, previously naïve state, and presence of psoriatic arthritis. Patients naïve to biologics at baseline had similar response to bimekizumab as non-naïve subjects. Conclusions: Bimekizumab is a suitable option for elder patients as it is effective, tolerated and has a convenient schedule

Contributo sulla diagnosi esofagogastroscopica nelle emorragie digestive alte in atto

L'analyse de 347 observations d'oesogastroscopies réalisées dans les hémorragies digestives hautes en phase active, permet aux auteurs de tirer les conclusions suivantes: 1° Dans les hémorragies oesogastriques, l'endoscopie est le moyen le plus sûr et le plus rapide pour porter un diagnostic de nature et de siège, mettant ainsi en évidence des lésions hémorragiques qui par leur siège superficiel ou par leur situation n'auraient pas été visualisées par un autre moyen. 2° Comparée à d'autres investigations diagnostiques, l'endoscopie a l'avantage de réaliser une vision directe du sang provenant de la lésion et permet la réalisation de biopsies dirigées. En cas de lésions multiples, seule l'endoscopie permet de dire celle qui saigne effectivement. 3° L'ensemble permet au thérapeute d'instituer immédiatement un traitement spécifique à la nature et à la localisation de la lésion hémorragique. Lorsque l'examen endoscopique est négatif, il permet d'orienter les recherches vers des lésions hémorragiques siégeant au-delà du territoire oesogastrique. Enfin, l'endoscopie permet d'établir si l'hémorragie a cessé ou persiste. 4° Effectuée avec compétence et patience, l'exploration oesogastrique ne présente ni inconvénients, ni danger. 5° Sur 347 examens pratiqués, le pourcentage de diagnostics exacts de tous les cas de lésions hémorragiques situées dans le territoire oesogastrique est de 92,30%

Caratterizzazione dei pazienti con questionario strutturato per la scelta della terapia renale sostitutiva. L’esperienza della provincia autonoma di Trento (PAT)

La Dialisi Peritoneale (DP) è una metodica ancora largamente sottoutilizzata in Italia. Nella Provincia Autonoma di Trento (PAT) dal 2008 si è attuato, con ottimi risultati, un programma per il potenziamento del suo utilizzo. Tra le innovazioni che hanno portato a questo esito vi è l’introduzione di un questionario strutturato nel colloquio informativo tra personale sanitario e paziente. Tale colloquio ha il duplice scopo di istruire adeguatamente il paziente riguardo le metodiche dialitiche e di far emergere eventuali criticità nell’esecuzione della DP. Il questionario mirava a descrivere il profilo personale e famigliare dei pazienti. Sono stati analizzati 174 questionari raccolti dall’1/04/2008 al 12/01/2015; sono state confrontate le risposte dei pazienti (84) che hanno optato per la DP con quelle dei pazienti (90) che hanno scelto l’emodialisi (ED). Dall’analisi dei questionari emerge che il paziente che opta per la DP ha un atteggiamento più positivo nei confronti di questa metodica, è più spesso lavoratore, abita più lontano dal Centro di ED, può contare più frequentemente sulla disponibilità di un famigliare ed è caratterizzato da un profilo psicologico più “triste” o “emotivo” rispetto al paziente che sceglie l’ED che risulta più “insicuro”. Non emergono invece come elementi che condizionano la scelta dialitica l’età, il tipo di nucleo familiare, il grado di autonomia e la nazionalità

Identikit of the patient who chooses the PD. Experience of the Autonomous Province of Trento,Caratterizzazione dei pazienti con questionario strutturato per la scelta della terapia renale sostitutiva. L{'}esperienza della provincia autonoma di Trento (PAT)

Peritoneal dialysis is a method still underused in Italy. In the Autonomous Province of Trento (PAT) since 2008 has been implemented, with excellent results, a program for the enhancement of the use of this therapy. The most important innovation was the introduction of a questionnaire proposed by nurses to patients in pre-dialysis colloquia. The questionnaire aimed to outline the patient personal and family profile in relation to the chosen dialysis methods. We analyzed 174 questionnaires collected from 1/04/2008 to 01/12/2015. Among these 84 patients had opted for the peritoneal dialysis (PD) and 90 had chosen the Hemodialysis (HD). The questionnaire comparison shown that the patient who opted for the PD have a more positive attitude towards this method. PD patient had more often a job, lived far away from the center of HD, had more frequently the support of a family and had a psychological profile more "sad" or "emotional" than the HD patient, who was more "insecure". On the other hand, factors like age, type of family, degree of autonomy and nationality do not affect the choice about dialysis

La fibroscopie oeso-gastro-duodénale en urgence pour hémorragie digestive haute A propos de 900 cas

900 observations permettent aux auteurs de démontrer l'intérêt de la fibroscopie en urgence pour hémorragie digestive haute. Dans 78 % des cas, le diagnostic exact a été porté directement par l'endoscopie. L'association radiologie-endoscopie a permis d'ob tenir le diagnostic dans 94,8 % des cas