Estudio retrospectivo observacional de una serie de casos de penfigoide ampolloso (2000-2020) : análisis de las características clínicas, histopatológicas e inmunológicas de 257 pacientes

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 16-11-2022El penfigoide ampolloso (PA) es una enfermedad autoinmune producida por la presencia de autoanticuerpos dirigidos frente a BP180 y BP230. A pesar de ser la enfermedad ampollosa autoinmune más frecuente en población adulta y de presentar una prevalencia, globalmente, baja, su incidencia se está incrementando en las últimas décadas y, en nuestro medio, son escasos los trabajos cuyo objetivo sea dar explicación a este fenómeno. Una de las causas atribuibles a dicho incremento, sería la exposición a determinados fármacos, como los inhibidores de la dipeptidilpeptidasa 4 (DPP4i), los cuales parecen determinar un subtipo de PA diferente del no desencadenado por fármacos. El PA se ha relacionado con comorbilidades neurológicas y oncológicas, así como a una mortalidad elevada respecto a la población general; sin embargo, la literatura al respecto es heterogénea y dispersa. Además, la fisiopatogenia exacta está aún por definir y los criterios diagnósticos clínicos “clásicos” han demostrado tener una sensibilidad menor a la establecida en el momento de su publicación, lo cual genera una necesidad de investigación y caracterización de esta enfermedad, especialmente, en nuestro medio...Bullous pemphigoid (BP) is an autoimmune disease caused by the presence of autoantibodies against BP180 and BP230. Despite being the most frequent autoimmune blistering disease in adults and presenting a globally low prevalence, its incidence has been increasing in recent decades and few studies aimed to explain this phenomenon, at least, in our population. One of the attributable cases to this increase would be the exposure to certain drugs, such as dipeptidyl peptidase 4 inhibitors (DPP4i), which seem to determine a BP subtype different from “classic” BP. This disease has been related to neurological comorbidities, malignancy and to a higher mortality in comparison to the general population; however, published literature is heterogeneous and scattered. Furthermore, the exact pathophysiology is yet to be defined and the “classical” clinical diagnostic criteria have been shown to have a lower sensitivity than that established at the time of publication. The need for research and characterization of this disease is clearcut, especially in our milieu...Fac. de MedicinaTRUEunpu

The risk of hepatic adverse events of systemic medications for psoriasis: a prospective cohort study using the BIOBADADERM registry

Background Limited information is available regarding the risk of incident liver disease in patients with psoriasis receiving systemic therapies. Objectives To describe the liver safety findings of conventional and modern systemic therapies for moderate-to-severe psoriasis, and to compare the relative incidence rates of hepatic adverse events (AEs) for each drug. Methods All the patients on the BIOBADADERM registry were included. Crude and adjusted incidence rate ratios (cIRR and aIRR, respectively) of hepatic AEs, using anti-TNF drugs as reference, were determined. Outcomes of interest were hypertransaminasemia, nonalcoholic fatty liver disease (NADFLD) and a group of other, less represented, hepatic AEs. Results Our study included 3,171 patients exposed to systemic drugs (6279 treatment cycles). Incident hypertransaminasemia was the most frequent hepatic AE (incidence rate of 21 per 1000 patients-years [CI 95% 18–23]), followed by NAFLD (8 cases per 1000 patients-years [95% CI 6–10]). Methotrexate (aIRR 3.06 [2.31–4.4]; p = 0.000) and cyclosporine (aIRR 2.37 [1.05–5.35]; p = .0378) were associated with an increased risk for hypertransaminasemia when compared to anti-TNF-α agents. No differences were observed between different groups of biologics. Conventional therapies were not associated with new incident NAFLD. Conclusions Comparative information of the incidence of hepatic AEs could facilitate drug selection in moderate-to-severe psoriasis