Possibilités et obstacles à propos de l'utilisation d'un système Logo

L'introduction de micromondes au sein des écoles primaires, de machines et de langages nouveaux, nécessite une vigilance extrême quant à la construction du savoir chez les enfants et aux stratégies de formation à mettre en place. Une première phase de recherche réalisée en condition d'apprentissage permet d'objectiver les obstacles rencontrés et d'aboutir à des réflexions, des propositions techniques et pédagogiques sur l'utilisation de l'outil informatiqu

Drug Survival of IL-12/23, IL-17 and IL-23 Inhibitors for Psoriasis Treatment: A Retrospective Multi-Country, Multicentric Cohort Study

Background: Drug survival analysis of biologic agents in psoriasis is of extreme importance, as it allows not only the evaluation of objective clinical outcomes (such as effectiveness and safety) but also of factors that are associated with patients’ adherence to treatment. The aim of this study was to evaluate and compare the drug survival of the most recent biologic agents approved for the treatment of moderate-to-severe psoriasis—ustekinumab, secukinumab, ixekizumab, brodalumab, guselkumab, and risankizumab—and to identify clinical predictors that can influence the drug survival of these drugs. Methods: This retrospective multicentric cohort study from 16 dermatology centers in Portugal, Spain, Italy, Switzerland, Czech Republic, Canada, and the United States included patients that started IL-12/23, IL-17 (IL-17A and IL-17R) and IL-23 inhibitors for the treatment of psoriasis between January 1, 2012 and December 31, 2019. Survival analysis was performed using a Kaplan-Meier estimator, to obtain descriptive survival curves, and proportional hazard Cox regression models. Results: A total of 3312 treatment courses (total patients: 3145) were included in the study; 1118 (33.8%) with an IL-12/23 inhibitor (ustekinumab), 1678 (50.7%) with an IL-17 inhibitor [911 (27.5%) on secukinumab, 651 (19.7%) on ixekizumab, 116 (3.5%) on brodalumab], and 516 (15.5%) with an IL-23 inhibitor [398 (12.0%) on guselkumab, 118 (3.5%) on risankizumab]. At 18 months, the cumulative probability of survival was 96.4% for risankizumab, 91.1% for guselkumab, 86.3% for brodalumab, 86.1% for ustekinumab, 82.0% for ixekizumab, and 79.9% for secukinumab. Using ustekinumab as reference, drug survival of guselkumab was higher (HR 0.609; 95% CI 0.418–0.887) and that of secukinumab was lower (HR 1.490; 95% CI 1.257–1.766). In the final multivariable model, secukinumab, female sex, higher BMI, and prior exposure to biologic agents significantly increased the risk of drug discontinuation, whereas risankizumab was protective. Conclusion: In this multinational cohort with 8439 patient-years of follow-up, the cumulative probability of drug survival for all drugs was >79% at 18 months. Prescribed biologic, female sex, higher BMI, and previous exposure to biologic agents were predictors of drug discontinuation. Drug survival of guselkumab and risankizumab was higher than that of ustekinumab, and secukinumab was lower

Psoriasis paradoxal induit par anti-TNF – un challenge en clinique [Paradoxical psoriasis induced by anti-TNF - a clinical challenge]

Anti-TNFs have revolutionized the management of numerous chronic inflammatory diseases such as rheumatoid arthritis, inflammatory bowel disease, and psoriasis. Although anti-TNF drugs are highly effective, 2-5 % of treated patients develop psoriasis-like skin lesions called paradoxical psoriasis. Paradoxical psoriasis is specific to anti-TNFs and it is, despite clinically resembling classical psoriasis, immunologically distinct. As it frequently requires cessation of the anti-TNF therapy, paradoxical psoriasis is a critical drug side effect and a challenge in the management of patients with chronic inflammatory diseases. In this review, we discuss the clinical, histological and pathogenic distinctions between the two entities and the management of patients developing paradoxical psoriasis

Eczéma induit par les anti-IL-17 et le yin-yang Th2/Th17 [Anti-IL17 induced eczema and the yin-yang of Th2 and Th17]

Biologics targeting specific cytokines and pathways have revolutionized the management of patients with chronic inflammatory diseases. However, these treatments have their limitations and, surprisingly, can induce novel inflammatory diseases. Here, we present a case of a psoriasis patient developing anti-IL17 induced eczema, an intriguing side effect of IL-17 blockade. The coexistence of psoriasis and eczema in a single patient is uncommon given their distinct and opposing immune mechanisms. Psoriasis is mainly driven by Th17 cells, whereas atopic dermatitis is Th2-dominated. In this article, we propose the yin yang of Th2 and Th17 with IL-4 and IL17 as principal antipodal vectors that control each other. Thus, blocking one of these cytokines can tip the balance between Th2 and Th17 and lead to the induction of the opposing inflammatory pathway via lifting the controlling mediator