Quality of life in hidradenitis suppurativa : Validation of the hsqol-24

Altres ajuts: reports grants, personal fees, non-financial support and other from Abbvie, Almirall, Amgen, Boehringer, Celgene, Janssen-Cilag, Leo Pharma, Lilly, MSD-Schering-Plough, Novartis, Pfizer and UCB, outside the submitted work. TGC reports personal fees from Lilly and Novartis, outside the submitted work. LP reports grants and personal fees from AbbVie, Almirall, Amgen, Boehringer Ingelheim, Celgene, Janssen, Leo-Pharma, Lilly, Novartis, Pfizer, Regeneron, Roche, Sanofi, and UCB, personal fees from Baxalta, Biogen, Fresenius-Kabi, JS Biocad, Mylan, Sandoz, Samsung-Bioepis, and Bristol Myers Squibb, outside the submitted work. The other authors have no conflicts of interest to declare.To date, there are no disease-specific instruments in Spanish to assess quality of life of patients with hidra-denitis suppurativa. A multicentre study was pre-viously carried out in Spain between 2016 and 2017 to develop the Hidradenitis Suppurativa Quality of Life-24 (HSQoL-24), a disease-specific questionnaire to assess quality of life in patients with hidradenitis suppurativa. The objectives of this study are to revali-date the HSQoL-24 in Spanish with a larger sample of patients, and to present the English version. In this multi centre study in Spain, patients with hidradenitis suppurativa completed the HSQoL-24, the Dermatology Life Quality Index and the Skindex-29. The Hurley staging system was used to assess the severity of the disease. Validation of the questionnaire was carried out in 130 patients, of whom 75 (57.7%) were women. This study demonstrates adequate values of reliability and validity of the HSQoL-24, confirming the previous test re-test validation and making this questionnaire one of wide clinical validity in terms of results perceiv-ed by patients

Drug Survival of Interleukin (IL)‑17 and IL‑23 Inhibitors for the Treatment of Psoriasis: A Retrospective Multi‑country, Multicentric Cohort Study

Background: Drug survival, defined as the length of time from initiation to discontinuation of a given therapy, allows comparisons between drugs, helps to predict patient's likelihood of remaining on a specific treatment, and achieving the best decision for each patient in daily clinical practice. Objective: The aim of this study was to provide data on drug survival of secukinumab, ixekizumab, brodalumab, guselkumab, tildrakizumab, and risankizumab in a large international cohort, and to identify clinical predictors that might have an impact on the drug survival of these drugs. Methods: This was a retrospective, multicentric, multi-country study that provides data of adult patients with moderate to severe psoriasis who started treatment with an interleukin (IL)-17 or IL-23 inhibitor between 1 February 2015 and 31 October 2021. Data were collected from 19 distinct hospital and non-hospital-based dermatology centers from Canada, Czech Republic, Italy, Greece, Portugal, Spain, and Switzerland. Kaplan-Meier estimator and proportional hazard Cox regression models were used for drug survival analysis. Results: A total of 4866 treatment courses (4178 patients)-overall time of exposure of 9500 patient-years-were included in this study, with 3164 corresponding to an IL-17 inhibitor (secukinumab, ixekizumab, brodalumab) and 1702 corresponding to an IL-23 inhibitor (guselkumab, risankizumab, tildrakizumab). IL-23 inhibitors had the highest drug survival rates during the entire study period. After 24 months of treatment, the cumulative probabilities of drug survival were 0.92 (95% confidence interval [CI] 0.89-0.95) for risankizumab, 0.90 (95% CI 0.88-0.92) for guselkumab, 0.80 (95% CI 0.76-0.84) for brodalumab, 0.79 (95% CI 0.76-0.82) for ixekizumab, and 0.75 (95% CI 0.73-0.77) for secukinumab. At 36 months, only guselkumab [0.88 (95% CI 0.85-0.91)], ixekizumab [0.73 (95% CI 0.70-0.76)], and secukinumab [0.67 (95% CI 0.65-0.70)] had more than 40 patients at risk of drug discontinuation. Only two drugs had more than 40 patients at risk of drug discontinuation at 48 months, with ixekizumab demonstrating to have a higher cumulative probability of drug survival [0.71 (95% CI 0.68-0.75)] when compared with secukinumab [0.63 (95% CI 0.60-0.66)]. Secondary failure was the main cause for drug discontinuation. According to the final multivariable model, patients receiving risankizumab, guselkumab, and ixekizumab were significantly less likely to discontinue treatment than those receiving secukinumab. Previous exposure to biologic agents, absent family history of psoriasis, higher baseline body mass index (BMI), and higher baseline Psoriasis Area and Severity Index (PASI) were identified as predictors of drug discontinuation. Conclusion: The cumulative probability of drug survival of both IL-17 and IL-23 inhibitors was higher than 75% at 24 months, with risankizumab and guselkumab demonstrating to have overall cumulative probabilities ≥ 90%. Biological agent chosen, prior exposure to biologic agents, higher baseline BMI and PASI values, and absence of family history of psoriasis were identified as predictors for drug discontinuation. Risankizumab, guselkumab, and ixekizumab were less likely to be discontinued than secukinumab

Tratamiento de los hemangiomas infantiles con propranolol: estudio prospectivo abierto con 25 pacientes. Evolución y manejo”

Estudi observacional prospectiu obert sobre l’eficàcia del propranolol oral en 25 nens amb hemangiomes infantils que associen algun tipus de morbiditat. S’analitzen també els efectes secundaris, l’evolució de les lesions i les variables que influeixen en les recaigudes al finalitzar la medicació. L’estudi conclou que el propranolol és un fàrmac efectiu i ben tolerat en el tractament dels hemangiomes infantils. La duració del tractament és la única variable que demostra influir de forma estadísticament significativa en l’aparició de recidives al suspendre la medicació.“Estudio observacional prospectivo abierto sobre la eficacia del propranolol oral en 25 niños con hemangiomas infantiles que asocian algún tipo de morbilidad. Se analizan también los efectos secundarios, la evolución de las lesiones y las variables que influyen en las recaídas al finalizar la medicación. El estudio señala que el propranolol es un fármaco efectivo y bien tolerado en el tratamiento de los hemangiomas infantiles. La duración del tratamiento es la única variable que demuestra influir de forma estadísticamente significativa en la aparición de recidivas al suspender la medicació

Dosis acumulada de metotrexato y fibrosis hepática en pacientes con psoriasis: cuantificación mediante elastografía transitoria

Context. La psoriasi és una malaltia inflamatòria crònica amb manifestació primàriament cutània, però també articular, i amb una gran repercussió sistèmica. El metotrexat (MTX) segueix sent un dels pilars del tractament de la psoriasi i l'artritis psoriàsica degut al seu bon balanç cost-efectivitat. L'ús crònic de MTX en pacients amb psoriasi s'ha associat a fibrosi hepàtica, però els efectes hepatotòxics reals a llarg termini continuen sent incerts. Els pacients amb psoriasi moderada-greu presenten una major prevalença i gravetat de la malaltia del fetge gras metabòlic (EHmet; anteriorment fetge gras no alcohòlic, HGNA). La síndrome metabòlica i el consum d'alcohol, entre altres factors de risc, poden contribuir al desenvolupament de fibrosi hepàtica. L'elastografia transitòria (ET) és un procediment ràpid i no invasiu que permet quantificar la fibrosi hepàtica. Actualment també disposem d'índexs de fibrosi, que permeten estimar el risc de fibrosi en pacients amb EHmet, tot i que la seva utilitat en pacients amb psoriasi encara disposa de poca evidència. Objectius. Determinar l'associació entre el tractament prolongat amb metotrexat (MTX) i altres factors de risc amb l'esteatosi hepàtica (avaluada mitjançant ecografia) i la fibrosi (quantificada mitjançant elastografia transitòria), en pacients amb psoriasi. Estudiar altres factors de risc associats a fibrosi hepàtica. Investigar la prevalença d'esteatosi i fibrosi hepàtica entre els pacients amb psoriasi moderada-greu. Avaluar la correlació entre alguns índexs de fibrosi i l'ET a la nostra cohort. Mètodes. Estudi observacional, no intervencionista, prospectiu i bicèntric per avaluar la fibrosi hepàtica mitjançant elastografia transitòria en pacients amb psoriasi tractats amb MTX. S'hi van incloure pacients consecutius amb psoriasi que rebien MTX. També es van incloure pacients amb psoriasi que mai no havien rebut MTX. Es van calcular les dosis acumulades de MTX i el temps de tractament amb MTX. Es van recollir les característiques basals i els paràmetres analítics. A tots els pacients se'ls va fer una elastografia transitòria per avaluar la fibrosi hepàtica. A més, es va realitzar ecografia hepàtica i el càlcul dels índexs de fibrosi (índexs FIB-4 i NAFLD). Es va avaluar la correlació de la dosi acumulada de MTX amb el valor de l'elastografia (kPa) i els paràmetres esmentats. Resultats. Es van incloure 170 pacients amb psoriasi (64 dones i 106 homes). Cinquanta-sis pacients tenien artritis psoriàsica concomitant. La mesura de la dosi acumulada de MTX va ser de 1325,4 ± 1961,5 mg (IC 95%: 0-19200mg) i la mitjana de la durada del tractament va ser de 27,3 ± 34 (IC 95%: 0 -240) mesos. El 38,46% (65/169) dels pacients presentaven fetge gras (definit per ecografia). Vint-i-sis pacients (15,3%) presentaven almenys fibrosi significativa (F3, LSM>7,5kPa) quan es va avaluar mitjançant elastografia transitòria. Un 16,4% dels pacients van presentr elevacions dels enzims hepàtics, que van ser transitoris i no es van relacionar al desenvolupament de fibrosi hepàtica. No hi va haver correlació entre la dosi total acumulada de MTX i la rigidesa hepàtica mesurada mitjançant elastografia transitòria en tota la cohort de pacients. La fibrosi hepàtica es va associar de forma independent amb la diabetis mellitus (OR 22,37; IC 95%: 24,54-27,09), l'obesitat (OR 4,02; IC 95%: 2,15-5,89 ) i l'edat (OR 8,95; IC 95%: 3,14-14,46). També es va observar correlació entre els índexs de fibrosi hepàtica (FIB-4 i NFS) i els resultats del Fibroscan (r=0,165; p=0,044 i r= 0,299; p=0,000, respectivament). Conclusions. En pacients amb psoriasi tractats amb MTX, la fibrosi hepàtica avançada és poc freqüent i no està directament relacionada amb la dosi acumulada de MTX. Altres factors de risc com la DM, l'obesitat i l'augment de l'edat tenen un paper central en el desenvolupament de fibrosi hepàtica en aquests pacients.Contexto. La psoriasis es una enfermedad inflamatoria crónica con manifestación primariamente cutánea, pero también articular, y con gran repercusión sistémica. El metotrexato (MTX) sigue siendo uno de los pilares del tratamiento de la psoriasis y la artritis psoriásica, debido a su buen balance coste-efectividad. El uso crónico de MTX en pacientes con psoriasis se ha asociado a fibrosis hepática, pero los efectos hepatotóxicos reales a largo plazo siguen siendo inciertos. Los pacientes con psoriasis moderada-grave presentan una mayor prevalencia y gravedad de la enfermedad del hígado graso metabólico (EHmet; anteriormente hígado graso no alcohólico, HGNA). El síndrome metabólico y el consumo de alcohol, entre otros factores de riesgo, pueden contribuir al desarrollo de fibrosis hepática. La elastografía transitoria (ET) es un procedimiento rápido y no invasivo que permite cuantificar la fibrosis hepática. Actualmente también disponemos de índices de fibrosis, que permiten estimar el riesgo de fibrosis en pacientes con EHmet, aunque su utilidad en pacientes con psoriasis todavía tiene poco evidencia. Objetivos. Determinar la asociación entre el tratamiento prolongado con metotrexato (MTX) y otros factores de riesgo con la esteatosis hepática (evaluada mediante ecografía) y la fibrosis (cuantificada mediante elastografía transitoria), en pacientes con psoriasis. Estudiar otros factores de riesgo asociados a fibrosis hepática. Investigar la prevalencia de esteatosis y fibrosis hepática entre los pacientes con psoriasis moderada-grave. Evaluar la correlación entre algunos índices de fibrosis y la ET en nuestra cohorte. Métodos. Estudio observacional, no intervencionista, prospectivo y bicéntrico para evaluar la fibrosis hepática con elastografía transitoria en pacientes con psoriasis tratados con MTX. Se incluyeron pacientes consecutivos con psoriasis que recibían MTX. También se incluyeron pacientes con psoriasis que nunca habían recibido MTX. Se calcularon las dosis acumuladas de MTX y el tiempo de tratamiento con MTX. Se recogieron las características basales y los parámetros analíticos. A todos los pacientes se les realizó una elastografía transitoria para evaluar la fibrosis hepática. Además, se realizó ecografía hepática y el cálculo de los índices de fibrosis (índices FIB-4 y NAFLD). Se evaluó la correlación de la dosis acumulada de MTX con el valor de la elastografía (kPa) y los parámetros mencionados. Resultados. Se incluyeron 170 pacientes con psoriasis (64 mujeres y 106 hombres). Cincuenta y seis pacientes tenían artritis psoriásica concomitante. La meida de la dosis acumulada de MTX fue de 1325,4 ± 1961,5 mg (IC 95%:0-19200mg) y la media de la duración del tratamiento fue de 27,3 ± 34 (IC 95%:0 -240) meses. El 38,46% (65/169) de los pacientes presentaban hígado graso (definido por ecografía). Veintiséis pacientes (15,3%) presentaban al menos fibrosis significativa (F3, LSM>7,5kPa) cuando se evaluó mediante elastografía transitoria. Un 16,4% de los pacientes presentaban alteraciones de las enzimas hepáticas, que eran transitorias y no estaban directamente asociadas al desarrollo de rigidez hepática. No hubo correlación entre la dosis total acumulada de MTX y la rigidez hepática medida mediante elastografía transitoria en toda la cohorte de pacientes. La fibrosis hepática se asoció de forma independiente con la diabetes mellitus (OR 22,37; IC 95%:24,54-27,09), la obesidad (OR 4,02;IC 95%:2,15-5,89) y la edad (OR 8,95; IC 95%:3,14-14,46). También se observó correlación entre los índices de fibrosis hepática (FIB-4 y NFS) y los resultados del Fibroscan (r=0,165; p=0,044 y r= 0,299; p=0,000, respectivamente) en nuestra serie de pacientes Conclusiones. En pacientes con psoriasis tratados con MTX, la fibrosis hepática avanzada es poco frecuente y no está directamente relacionada con la dosis acumulada de MTX. Otros factores de riesgo como la DM, la obesidad y el aumento de la edad desempeñan un papel central en el desarrollo de fibrosis hepática en estos pacientes.Background. Psoriasis is a chronic inflammatory disease with systemic implications. Its estimated prevalence in Spain is 1.17-1.43%. In the last 10 years there have been great advances in the topical and systemic treatment of this pathology. However, methotrexate (MTX) continues to be one of the mainstays in the treatment of psoriasis and psoriatic arthritis, due to its good costeffectiveness. Chronic use of MTX in patients with psoriasis has been associated with liver fibrosis, but the actual long-term hepatotoxic effects remain uncertain. Moreover, patients with moderate-severe psoriasis have a higher prevalence and severity of metabolic-associated fatty liver disease (MAFLD, non-alcoholic fatty liver disease, NAFLD). Metabolic syndrome and alcohol consumption, among other risk factors, may contribute to the development of liver fibrosis. Transient elastography (TE) (FibroScan, Echosens, Paris, France) is a rapid and non-invasive procedure that allows quantification of liver fibrosis. Fibrosis indices are also currently available, which make it possible to estimate the risk of fibrosis in patients with EHmet, although their convenience in patients with psoriasis still has little evidence. Objectives. To determine the association between prolonged treatment with methotrexate (MTX) and other risk factors with hepatic steatosis (assessed by ultrasound) and fibrosis (quantified by transient elastography) in patients with psoriasis. To study other risk factors associated with hepatic fibrosis. To investigate the prevalence of steatosis and hepatic fibrosis among patients with moderate-severe psoriasis. To evaluate the correlation between some scores of fibrosis and TE in our cohort. Methods. Observational, non-interventional, prospective, bicentric study to evaluate liver stiffness with transient elastography in patients with psoriasis treated with MTX. Consecutive patients with psoriasis receiving MTX, attending two university hospitals in Spain, were enrolled. Patients with psoriasis who had never received MTX were also included. Cumulative doses of MTX and time undergoing MTX were calculated. Baseline characteristics and analytical parameters were collected. All patients underwent transient elastography to evaluate liver fibrosis. Conventional liver ultrasound studies and calculation of fibrosis scores (FIB-4 and NAFLD scores) were also performed. The correlation of the cumulative dose of MTX with the elastography value (kPa) and the above-mentioned parameters was assessed. Results. One hundred and seventy patients with psoriasis were fully investigated (64 women and 106 men). Fifty-six patients had concomitant psoriatic arthritis. Median cumulative dose of MTX was 1325.4 ± 1961.5 mg (range: 0 - 19200 mg) and the median duration of treatment was 27.3 ± 34 (range: 0 - 240) months. Fatty liver (as defined by ultrasound findings) was present in 38.46% (65/169) of patients. Twenty-six patients (15.3%) had at least significant fibrosis (LSM > 7.5 kPa) when evaluated by transient elastography. Ony 16,4% of patients exhibited liver enzymes alterations, which were transient and not directly associated to liver stiffness development. There was no correlation between the total cumulative dose of MTX and liver stiffness measured by transient elastography in the whole cohort of patients. Liver fibrosis was independently associated with diabetes mellitus (OR 22.37; 95%CI 24.54,27.09), obesity (OR 4.02; 95%CI 2.15, 5.89) and age (OR 8.95; 95%CI 3.14, 14.46). Positive correlation was also observed between liver fibrosis scores (FIB-4 and NFS) and Fibroscan results (r= 0.165, p= 0.044 and r= 0.299, p= 0.000, respectively). Conclusion. In patients with psoriasis treated with MTX, advanced liver fibrosis is rare and it is not directly related to high cumulative doses of MTX. Other risk factors such as DM, obesity, and increasing age play a central role in the development of liver fibrosis in these patients. Limitations. Observational study, retrospective history chart review for some data.Universitat Autònoma de Barcelona. Programa de Doctorat en Medicin

Tratamiento de los hemangiomas infantiles con propranolol : estudio prospectivo abierto con 25 pacientes. Evolución y manejo"

Estudi observacional prospectiu obert sobre l'eficàcia del propranolol oral en 25 nens amb hemangiomes infantils que associen algun tipus de morbiditat. S'analitzen també els efectes secundaris, l'evolució de les lesions i les variables que influeixen en les recaigudes al finalitzar la medicació. L'estudi conclou que el propranolol és un fàrmac efectiu i ben tolerat en el tractament dels hemangiomes infantils. La duració del tractament és la única variable que demostra influir de forma estadísticament significativa en l'aparició de recidives al suspendre la medicació."Estudio observacional prospectivo abierto sobre la eficacia del propranolol oral en 25 niños con hemangiomas infantiles que asocian algún tipo de morbilidad. Se analizan también los efectos secundarios, la evolución de las lesiones y las variables que influyen en las recaídas al finalizar la medicación. El estudio señala que el propranolol es un fármaco efectivo y bien tolerado en el tratamiento de los hemangiomas infantiles. La duración del tratamiento es la única variable que demuestra influir de forma estadísticamente significativa en la aparición de recidivas al suspender la medicació

Tratamiento de los hemangiomas infantiles con propranolol : estudio prospectivo abierto con 25 pacientes. Evolución y manejo"

Estudi observacional prospectiu obert sobre l'eficàcia del propranolol oral en 25 nens amb hemangiomes infantils que associen algun tipus de morbiditat. S'analitzen també els efectes secundaris, l'evolució de les lesions i les variables que influeixen en les recaigudes al finalitzar la medicació. L'estudi conclou que el propranolol és un fàrmac efectiu i ben tolerat en el tractament dels hemangiomes infantils. La duració del tractament és la única variable que demostra influir de forma estadísticament significativa en l'aparició de recidives al suspendre la medicació."Estudio observacional prospectivo abierto sobre la eficacia del propranolol oral en 25 niños con hemangiomas infantiles que asocian algún tipo de morbilidad. Se analizan también los efectos secundarios, la evolución de las lesiones y las variables que influyen en las recaídas al finalizar la medicación. El estudio señala que el propranolol es un fármaco efectivo y bien tolerado en el tratamiento de los hemangiomas infantiles. La duración del tratamiento es la única variable que demuestra influir de forma estadísticamente significativa en la aparición de recidivas al suspender la medicació

The Essential Role of IL-17 as the Pathogenetic Link between Psoriasis and Metabolic-Associated Fatty Liver Disease

Interleukin 17 (IL-17) is an effector cytokine that plays a key role in the pathogenesis of both psoriasis and metabolic-associated fatty liver disease (MAFLD), a condition that is more prevalent and severe in patients with psoriasis. In liver inflammation, IL-17 is mainly produced by CD4+ T (TH17) and CD8+ T cells (Tc17), although numerous other cells (macrophages, natural killer cells, neutrophils and Tγδ cells) also contribute to the production of IL-17. In hepatocytes, IL-17 mediates systemic inflammation and the recruitment of inflammatory cells to the liver, and it is also implicated in the development of fibrosis and insulin resistance. IL-17 levels have been correlated with progression from MAFLD to steatohepatitis, cirrhosis, and even hepatocellular carcinoma. Clinical trials have shown that inhibiting IL-17A in patients with psoriasis could potentially contribute to the improvement of metabolic and liver parameters. A better understanding of the key factors involved in the pathogenesis of these chronic inflammatory processes could potentially lead to more efficient treatment for both psoriasis and MAFLD, and help to develop holistic strategies to improve the management of these patient

The Essential Role of IL-17 as the Pathogenetic Link between Psoriasis and Metabolic-Associated Fatty Liver Disease

Interleukin 17 (IL-17) is an effector cytokine that plays a key role in the pathogenesis of both psoriasis and metabolic-associated fatty liver disease (MAFLD), a condition that is more prevalent and severe in patients with psoriasis. In liver inflammation, IL-17 is mainly produced by CD4+ T (TH17) and CD8+ T cells (Tc17), although numerous other cells (macrophages, natural killer cells, neutrophils and Tγδ cells) also contribute to the production of IL-17. In hepatocytes, IL-17 mediates systemic inflammation and the recruitment of inflammatory cells to the liver, and it is also implicated in the development of fibrosis and insulin resistance. IL-17 levels have been correlated with progression from MAFLD to steatohepatitis, cirrhosis, and even hepatocellular carcinoma. Clinical trials have shown that inhibiting IL-17A in patients with psoriasis could potentially contribute to the improvement of metabolic and liver parameters. A better understanding of the key factors involved in the pathogenesis of these chronic inflammatory processes could potentially lead to more efficient treatment for both psoriasis and MAFLD, and help to develop holistic strategies to improve the management of these patients

The efficacy and tolerability of tetracyclines and clindamycin plus rifampicin for the treatment of hidradenitis suppurativa : Results of a prospective European cohort study

Background: Tetracyclines and clindamycin plus rifampicin combination therapy are both considered first-line therapy in current hidradenitis suppurativa guidelines. However, evidence for their efficacy is drawn from small studies, often without validated outcomes. Objective: To assess the 12-week efficacy of oral tetracyclines and a combination of clindamycin and rifampicin. Methods: A prospective, international cohort study performed between October 2018 and August 2019. Results: In total, 63.6% of the included 283 patients received oral tetracyclines, and 36.4% were treated with clindamycin and rifampicin. Both groups showed a significant decrease in International Hidradenitis Suppurativa Severity Score System from baseline (both P <.001). The Hidradenitis Suppurativa Clinical Response (HiSCR) was achieved in 40.1% and 48.2% of patients, respectively (P =.26). Patient characteristics or disease severity were not associated with the attainment of HiSCR or the minimal clinically important differences for the Dermatology Life Quality Index and pain. Limitations: Cohort study. Respectively, 23.9% and 19.4% of patients had to be excluded from the HiSCR analysis for the tetracycline and combination therapy group because of a low abscess and nodule count at baseline. Conclusion: This study shows significant efficacy of both tetracycline treatment and clindamycin and rifampicin combination therapy after 12 weeks in patients with hidradenitis suppurativa. No significant differences in efficacy were observed between the 2 treatments, regardless of disease severity

The efficacy and tolerability of tetracyclines and clindamycin plus rifampicin for the treatment of hidradenitis suppurativa; results of a prospective European cohort study.

Tetracyclines and clindamycin plus rifampicin combination therapy are both considered first-line therapy in current Hidradenitis Suppurativa (HS) guidelines. However, evidence for their efficacy is drawn from small studies, often without validated outcomes.info:eu-repo/semantics/publishe