Targeted therapy for immune mediated skin diseases. What should a dermatologist know?

Abstract Background Molecularly targeted therapies, such as monoclonal antibodies (mAbs) and Janus Kinase inhibitors (JAKis), have emerged as essential tools in the treatment of dermatological diseases. These therapies modulate the immune system through specific signaling pathways, providing effective alternatives to traditional systemic immunosuppressive agents. This review aims to provide an updated summary of targeted immune therapies for inflammatory skin diseases, considering their pathophysiology, efficacy, dosage, and safety profiles. Methods The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search was conducted on PubMed over the past 10 years, focusing on randomized clinical trials, case reports, and case series related to targeted immune therapies in dermatology. Eligibility criteria were applied, and data were extracted from each study, including citation data, study design, and results. Results We identified 1360 non-duplicate articles with the initial search strategy. Title and abstract review excluded 1150, while a full-text review excluded an additional 50 articles. The review included 143 studies published between 2012 and 2022, highlighting 39 drugs currently under investigation or in use for managing inflammatory skin diseases. Study limitations The heterogeneity of summarized information limits this review. Some recommendations originated from data from clinical trials, while others relied on retrospective analyses and small case series. Recommendations will likely be updated as new results emerge. Conclusion Targeted therapies have revolutionized the treatment of chronic skin diseases, offering new options for patients unresponsive to standard treatments. Paradoxical reactions are rarely observed. Further studies are needed to fully understand the mechanisms and nature of these therapies. Overall, targeted immune therapies in dermatology represent a promising development, significantly improving the quality of life for patients with chronic inflammatory skin diseases.

Research progress of gut microbiome in the treatment of psoriasis / 重庆医学

Psoriasis is a chronic,recurrent,systemic inflammatory skin disease that is immune-media-ted.The balance and communication between the intestinal microbiota and its metabolites and the host play an important role in maintaining the body's normal functions,such as immune homeostasis and vitamin synthe-sis.Recent studies have found that compared with the healthy individuals,the psoriasis patients have experi-enced significant changes in the abundance and diversity of intestinal microbiota,including an imbalance in in-testinal microbiota,reduced production of short-chain fatty acids(SCFAs),and abnormal Firmicutes/Bacte-roidetes(F/B)ratio.The gut microbiota also changed after systematic medication treatment,biologic agents treatment and small molecule chemotherapy,indicating that the gut microbiota could be a potential biomarker for assessing treatment efficacy.The relationship between psoriasis and gut microbiota is not fully under-stood,and further research is needed.

Research Progress on Paradoxical Extraintestinal Manifestations of Biologics in the Treatment of Inflammatory Bowel Disease / 昆明医科大学学报

Inflammatory Bowel Diseases(IBD)is a class of genetically related diseases caused by multiple genes and environmental factors that accelerate the disturbance of the immune-gut-microbiome axis.Lesions often involve multiple organs and systems.Biological agents are an important means of treating IBD and its extraintestinal manifestations.Current studies suggest that biologics can bring benefits to patients,but paradoxical skin lesions,joint lesions,and ocular lesions appear during the treatment.Diseases,pulmonary lesions and other manifestations or lesions are easily ignored in clinical practice,thereby delaying the patient's condition and affecting the patient's quality of life.Therefore,by summarizing the clinical characteristics and diagnosis and treatment experience of contradictory extraintestinal manifestations in the current application of biological agents,this review aims to improve the understanding of clinicians,identify this clinical manifestation early,and avoid delaying the patient's condition.

Analysis of clinical characteristics of 33 cases of tuberculosis complicated by tumor necrosis factor-α inhibi-tor in autoimmune diseases / 实用医学杂志

Objective To investigate the clinical characteristics,treatment and prognosis of tuberculosis in patients with autoimmune diseases after tumor necrosis factor-αinhibitors.Methods Clinical data of 33 patients with TB after biologics(tumor necrosis factor-α inhibitors)treated in Guangzhou Chest Hospital from January 2019 to March 2023 were collected,including 25 males and 8 females,with a median age of 32 years.The clinical symptoms,laboratory results,imaging and tracheoscopic features,pathological features,treatment and outcome were analyzed retrospectively.Results The common clinical manifestations were cough(26/33),sputum(23/33)and fever(17/33).The most common cases were pulmonary tuberculosis(32/33),bronchial tuberculosis(15/33),mediastinum and hilar lymph node tuberculosis(11/33).Bilateral lung spread of tuberculosis(21/33),intrapulmonary spread of tuberculosis(bronchus,mediastinal hilar lymph nodes,pleura)(19/33),extrapulmonary tuberculosis(18/33),pulmonary tuberculosis with intrapulmonary or extrapulmonary tuberculosis(26/33).Blood CD4+T lymphocyte test was normal(23/33),and blood IGRA test was positive(27/33).Pulmonary imaging miliary nodules(8/33).The histopathology of the lymph nodes showed atypical granulomatous nodules.The duration of anti-tuberculosis treatment is 8-32 months.1 case of death.Conclusion Patients with autoimmune diseases complicated with tuberculosis after the application of tumor necrosis fact-α inhibitor are more likely to have double lung lesions,which are easy to spread to lung tissues and multiple organs of the body,and have decreased immune function.Most of them need to extend the treatment course,and the prognosis is generally good after comprehensive treatment.

Progress and prospect of inhaled biological agents in asthma / 中国临床药理学与治疗学

More than 300 million people worldwide suffer from asthma, and the incidence is increasing year by year. As one of the most common chronic diseases, asthma is an immune-mediated inflammatory disease with complex triggering mechanisms and strong heterogeneity. With the in-depth study of physiological and pathological mechanisms, therapeutic small molecule and hormone drugs have been introduced to control and treat most patients, but about 5% - 10% of patients still suffer from various subtypes of difficult to control and treat asthma, that is, severe asthma. In the past decade, with the rapid development of bio-pharmaceutical research, protein and antibody have become the key drugs for the treatment of severe asthma with high efficacy, high specificity and high safety. However, biological drugs are usually administered by injection, they cannot be noninvasive and directly delivered into the lung to quickly absorb and take effect. Therefore, there is an urgent need for the introduction of inhaled biologics with quick effectiveness, convenience, economy and safety in clinical. The review summarizes the existing small molecule, hormone and biological therapy drugs, and summarizes the development of inhalable biological agents of asthma, and analyzes the future prospects of the inhalable biological drugs, which is designed to deepen the perception of the direction of the inhalable biological drugs research, and update the information of the field, in order to provide reference for the development of more inhalable biologics.

Immunologic characteristics and management and prospects of targeted biological therapy in adults with severe asthma / 中国临床药理学与治疗学

Severe asthma stands as a formidable contributor to both mortality and morbidity of patients suffering asthma, casting substantial social and economic shadows on communities. As our understanding of asthma's pathophysiology deepens, a beacon of hope emerges in the form of biological targeted therapies, offering a promising avenue for the management of this challenging condition. These therapies, by precisely inhibiting or modulating pivotal molecules in the inflammatory cascade, offer potential benefits in symptom alleviation, lung function enhancement, and risk reduction of acute exacerbations. They signify a paradigm shift in severe asthma treatment. Within the confines of this article, we embark on a systematic exploration of the immunological underpinnings that define severe asthma. By delving into the intricacies of the immune system's role in exacerbating this condition, we aim to offer a comprehensive assessment of both the current landscape and the future prospects of biological therapies. Our objective is to provide a scientifically robust and valuable reference that can guide the individualized treatment of patients grappling with severe asthma.

mIgM-mediated splenic marginal zone B cells targeting of folic acid for immunological evasion

Folic acid is a fully oxidized synthetic folate with high bioavailability and stability which has been extensively prescribed to prevent congenital disabilities. Here we revealed the immunosuppressive effect of folic acid by targeting splenic marginal zone B (MZB) cells. Folic acid demonstrates avid binding with the Fc domain of immunoglobulin M (IgM), targeting IgM positive MZB cells in vivo to destabilize IgM-B cell receptor (BCR) complex and block immune responses. The induced anergy of MZB cells by folic acid provides an immunological escaping window for antigens. Covalent conjugation of folic acid with therapeutic proteins and antibodies induces immunological evasion to mitigate the production of anti-drug antibodies, which is a major obstacle to the long-term treatment of biologics by reducing curative effects and/or causing adverse reactions. Folic acid acts as a safe and effective immunosuppressant via IgM-mediated MZB cells targeting to boost the clinical outcomes of biologics by inhibiting the production of anti-drug antibodies, and also holds the potential to treat other indications that adverse immune responses need to be transiently shut off.

Development on Cancer Therapeutic Drugs Approved by FDA in 2023 / 肿瘤防治研究

Since the beginning of the 21st century, the field of cancer drug development has undergone significant changes. Kinase inhibitors are the product category with the highest number of approved drugs and indications. However, despite checkpoint inhibitors being only introduced to the market since 2011, they have become the second most approved product categories. In the year of 2023, the FDA’s Center for Drug Evaluation and Research (CDER) has approved 13 new cancer therapeutic drugs. In the past five years, a slight increase in drug approvals targeting biomarker-defined populations as well as emerging approvals that are agnostic to tumor anatomy has been recorded. Currently, new treatment approaches and technologies, such as the development of Artificial Intelligence (AI), have increasingly profound progress on cancer drug development.

Taxa de infecção (tuberculose) em pacientes particulares brasileiros com DII: acompanhamento de 15 anos / Rate of infection (tuberculosis) in brazilians ibd private patients: follow-up 15 years

ABSTRACT Background: Latent tuberculosis (LTB) is a condition where the patient is infected with Mycobacterium tuberculosis but does not develop active TB. There's a possibility of tuberculosis (TB) activation following the introduction of anti-TNFs. Objective: To assess the risk of biological therapy inducing LTB during inflammatory bowel diseases (IBD) treatment over 15 years in a high-risk area in Brazil. Methods: A retrospective study of an IBD patients' database was carried out in a private reference clinic in Brazil. All patients underwent TST testing and chest X-ray prior to treatment, and once a year after starting it. Patients were classified according to the Montreal stratification and risk factors were considered for developing TB. Results: Among the analyzed factors, age and gender were risk factors for LTB. DC (B2 and P) and UC (E2) patients showed a higher number of LTB cases with statistical significance, what was also observed for adalimumab and infliximab users, compared to other medications, and time of exposure to them favored it significantly. Other factors such as enclosed working environment have been reported as risk. Conclusion: The risk of biological therapy causing LTB is real, so patients with IBD should be continually monitored. This study reveals that the longer the exposure to anti-TNFs, the greater the risk.

RESUMO Contexto: A tuberculose latente (TBL) é uma condição em que o paciente está infectado com Mycobacterium tuberculosis, mas não desenvolve tuberculose (TB) ativa. Existe a possibilidade de ativação da TB após a introdução de anti-TNFs. Objetivo: Avaliar o risco da terapia biológica induzindo TBL durante o tratamento de doenças inflamatórias intestinais (DII) ao longo de 15 anos em uma área de alto risco no Brasil. Métodos: Foi realizado um estudo retrospectivo de um banco de dados de pacientes com DII em uma clínica privada de referência no Brasil. Todos os pacientes foram submetidos a teste de TST e radiografia de tórax antes do tratamento e uma vez por ano após seu início. Os pacientes foram classificados de acordo com a estratificação de Montreal e foram considerados fatores de risco para o desenvolvimento de TB. Resultados: Entre os fatores analisados, a idade e o sexo foram fatores de risco para TBL. Os pacientes com doença de Crohn' (B2 e P) e colite ulcerativa (E2) apresentaram maior número de casos de TBL com significância estatística, o que também foi observado para usuários de adalimumab e infliximab, em comparação com outros medicamentos, e o tempo de exposição a eles favoreceu significativamente. Outros fatores, como ambiente de trabalho fechado, foram relatados como riscos. Conclusão: O risco da terapia biológica causar TBL é real, por isso os pacientes com DII devem ser monitorados continuamente. Este estudo revela que quanto maior a exposição aos anti-TNFs, maior o risco.

Esofagitis eosinofílica: más allá del tratamiento con inhibidores de bomba de protones (uso de biológicos) / Eosinophilic esophagitis: beyond proton pump inhibitor therapy (Biologic therapies)

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease of the esophagus characterized by symptoms of esophageal dysfunction such as dysphagia, food impaction, and chest pain in adults. It is associated with atopic di- seases such as allergic rhinitis, atopic dermatitis, and asthma. Diagnosis requires symptoms of esophageal dysfunction, eosinophilic inflammation in esophageal biopsies with at least 15 eosinophils per high power field, and exclusion of other causes of local or systemic eosinophilia. EoE is more common in men and has an increasing prevalence, varying globally. The pathophysiology involves TH2-mediated eosinophilic inflammation driven by food antigens, esophageal barrier dysfunction and tissue remodeling. Various therapeutic options aim for clinical and histological remission, including dietary and pharmacological treatments. Dietary therapy, topical corticosteroids and proton pump inhibitors are first-line treatments. Topical corticosteroids achieve high histological remission. Development of new therapies is ongoing. Dupilumab, an antibody against IL-4Rα, shows efficacy in achieving histological and symptomatic remission in patients unresponsive to proton pump inhibitors. Other targeted therapies with clinical trials for EoE include mepolizumab, reslizumab, cendakimab, lirentelimab, and etrasimod with variable clinical and histological results. A subgroup of patients with EoE unresponsive or with bad adherence to first line therapies or patients with multiple comorbid atopic diseases may benefit from biological therapies. This review aims to describe new therapeutic options, detailing their mechanisms, efficacy, and safety profiles.

La esofagitis eosinofílica (EEo) es una enfermedad crónica, inmunomediada del esófago, caracterizada por síntomas de disfunción esofágica como disfagia, impactación y dolor torácico en adultos. Se asocia a otras enfermedades atópicas como rinitis alérgica, dermatitis atópica y asma. El diagnóstico requiere síntomas de disfunción esofágica, inflamación eosinofílica en biopsias de esófago con al menos 15 eosinófilos por campo de aumento mayor, y exclusión de otras causas de eosinofilia local o sistémica. La EEo es más común en hombres y tiene una prevalencia en aumento. La fisiopatología incluye inflamación eosinofílica mediada por una respuesta TH2 gatillada por antígenos alimenticios, además disfunción de barrera esofágica y remodelación de tejido. Varias opciones terapéuticas tienen como objetivo la remisión clínica e histológica, incluyendo terapias dietéticas y tratamientos farmacológicos. La terapia dietética, inhibidores de bomba de protones o corticosteroides tópicos sin terapias de primera línea. Los corticosteroides tópicos alcanzan altas tasas de remisión histológica. El desarrollo de nuevas terapias se está llevando a cabo. Dupilumab, un anticuerpo contra IL-4Rα, muestra eficacia en alcanzar remisión histológica y sintomática en pacientes no responde- dores a inhibidores de bomba de protones. Otras terapias con estudios clínicos para EEo incluyen el mepolizumab, reslizumab, cendakimab, lirentelimab y etrasimod, con resultados variables. Un subgrupo de pacientes con EEo no respondedores o con mala adherencia a terapias de primera línea o con comorbilidades atópicas graves se podrían beneficiar de terapias biológicas como dupilumab. Esta revisión tiene como objetivo describir nuevas opciones tera- péuticas, detallando su mecanismo de acción, eficacia y perfil de seguridad.

The efficacy of anti–TNF-? agents in the treatment of juvenile idiopathic arthritis-associated uveitis in a pediatric cohort

Purpose: Biologic therapy has shown promising control in children with often intractable juvenile idiopathic arthritis (JIA)?associated uveitis (JIA?U). Methods: This is a retrospective cohort study of 35 eyes of 35 children who received biologics for JIA?U. Pretreatment and posttreatment data (at 3, 6, 9, 12, 18, 24, and >24 months) were analyzed to determine functional success (stable/improved visual acuity), quiescence success (?0.5 cells in the anterior chamber), complete steroid success (termination of systemic, periocular therapy and decreased topical drops to ?2/day) or systemic steroid success (termination of systemic steroids only), and complete success (all of the above). Results: This study included 35 eyes up to 12 months and 21 eyes beyond 24 months. Steroid?sparing, functional, and quiescence success showed a rate of success of 52.43%, 77%, and 91%, respectively, at 12 months and 66.67%, 85.7%, and 76.2%, respectively, beyond 24 months. Complete success was 34.29% at 12 months, peaking at 18 months (65.62%) and reached 57.14% beyond 24 months. In their final follow?up, the best corrected visual acuity (BCVA) remained the same in 45.71%, improved in 37.14%, and worsened in 17.14% children. Conclusion: Biologic therapy is effective in JIA?U, especially in termination of systemic steroids, stabilization of vision, and maintaining quiescence

Clinical profile and management with immunosuppressants and biologics in Behcet’s uveitis: A cohort of 25 patients from a tertiary eye care center in South India

Purpose: To report the clinical profile of Behcet’s disease and its management with immunosuppressants and biologics in a cohort of 25 patients from a tertiary eye care center in South India. Methods: This was a retrospective, observational study. Records of 45 eyes of 25 patients between January 2016 and December 2021 were retrieved from the hospital database. Complete ophthalmic evaluation and systemic examination by the rheumatologist with appropriate investigations had been done. Results were analyzed using Statistical Package for the Social Sciences (SPSS) software. Results: Males (19, 76%) were found to be more affected than females (6, 24%). Mean age of presentation was 27.68 ± 11.08 years. Twenty patients had bilateral involvement (80%), and unilateral involvement was seen in five patients (20%). Seven eyes of four patients (16%) had isolated anterior uveitis, out of which one patient had unilateral and three patients had bilateral involvement. Twenty?six eyes of 16 patients (64%) had posterior uveitis, out of which six patients had unilateral and 10 had bilateral involvement. Twelve eyes of seven patients (28%) had panuveitis, out of which two patients had unilateral and five had bilateral involvement. Hypopyon was seen in five eyes (11.1%) and posterior synechiae in seven eyes (15.55%). Posterior segment findings included vitritis (24.44%), vasculitis (17.78%), retinitis (17.78%), disc hyperemia (11.11%), and disc pallor (8.89%). Steroids alone were given in five patients (20%) and intravenous methylprednisolone (IVMP) was given in four patients (16%). Immunosuppressive agents along with steroids were given in 20 patients (80%), of which azathioprine alone was given in seven patients (28%), cyclosporin alone was given in two patients (8%), mycophenolate mofetil alone was given in three patients (12%), combination of azathioprine and cyclosporin was given in six patients (24%), and combination of methotrexate and mycophenolate mofetil was given in one patient (4%). Biologics were given in 10 patients (40%) – adalimumab in seven patients (28%) and infliximab in three patients (12%). Conclusion: Behcet’s disease is an uncommon uveitis in India. Addition of immunosuppressants and biologics to conventional steroid therapy gives better visual outcomes.

Advances in systemic juvenile idiopathic arthritis associated-lung disease / 中华实用儿科临床杂志

Systemic juvenile idiopathic arthritis(sJIA) is one of the most serious critical illnesses in childhood, characterized by high fever, recurrent rash, and arthritis, etc.Children with sJIA associated-lung disease(sJIA-LD) are more severely ill and have a worse prognosis, the correlation between the mechanism and age, disease activity, anti-rheumatic drug therapy, applications of biologics, infection and other factors is worth exploring.This article reviews the research progress on the mechanism, risk factors, treatment methods and prognosis of sJIA-LD, so as to provide a theoretical basis for improving the diagnosis and treatment of sJIA and improving the prognosis.

New advances in the pathogenesis and drug research of psoriasis / 药学学报

Psoriasis is a chronic, recurrent, and inflammatory skin disease induced by multiple factors. Its typical clinical manifestation is scaly erythema or plaques, which can cause various complications such as metabolic syndrome, cardiovascular disease, and inflammatory arthritis, seriously affecting the quality of life of patients. A deep understanding of the pathogenesis of psoriasis is helpful to discover new therapeutic targets and develop effective new therapeutic drugs, thus having important clinical significance. This manuscript reviews the new advances in the pathogenesis and drug research of psoriasis in recent years.

The perspectives of biologics in the treatment of chronic rhinosinusitis with nasal polyps / 临床耳鼻咽喉头颈外科杂志

Chronic rhinosinusitis with nasal polyps （CRSwNP） remains the most difficult-to-treat subtype in the world. Biologics have shown positive results, especially in reducing nasal polyp size and improving patient-reported outcomes. The development of biologics has the potential to fulfill the unmet medical needs of treatment.

Clinical treatment options oriented to the endotype of chronic rhinosinusitis / 临床耳鼻咽喉头颈外科杂志

Chronic rhinosinusitis（CRS） is an inflammatory disease involving the mucosa of the nasal and paranasal sinuses for more than 12 weeks and can be classified as CRS with nasal polyp（CRSwNP） and CRS without nasal polyp（CRSsNP） depending on the phenotype. Clinical treatments reveal significant differences in disease prognosis and improvement in quality of life in patients with the same clinical phenotype. Inflammatory cells infiltration and inflammatory mediators are important factors driving CRS endotypes. In particular, CRS with predominantly eosinophilic infiltration and type 2 CRS present severe clinical symptoms, comorbidities, and high recurrence rates. CRS endotype-oriented treatment methods may better contribute to improving patient prognosis and quality of life. This article summarizes the current progress of CRS endotype research and reviews the endotype-oriented treatment options.

Recomendaciones en el manejo y tratamiento del asma en la Argentina (REMA). Consenso Delphi modificado RAND/UCLA de la Asociación Argentina de Alergia e Inmunología Clínica y Asociación Argentina de Medicina Respiratoria / Recommendations for the Management and Treatment of Asthma in Argentina (RE.M.A). A RAND/UCLA modified Delphi Consensus Argentinian Association of Allergy and Clinical Immunology and Argentinian Association of Respiratory Medicine

El asma es una enfermedad crónica de la vía aérea prevalente en nuestro país, con frecuente mal control. Algunos especialistas de la Asociación de Alergia e Inmunología Clínica y la Asociación Argentina de Medicina Respiratoria han realizado recomendaciones sobre el manejo y tratamiento del asma mediante la metodología de consenso RAND/UCLA Delphi modificada sobre la base de la evidencia científica (GRADE). Este documento provee recomendaciones basadas en la opinión de especialistas y fundamentada en evidencia científica seleccionada en cuanto a la importancia de mejorar la adherencia al tratamiento y seguimiento a través de diferentes estrategias. Así mismo, provee recomendaciones actualizadas en aspectos críticos del tratamiento del asma leve al grave. Se recomienda, para mejorar la adherencia, el uso de planes personalizados de manejo (1 °C), uso de herramientas a través de teléfonos móviles (1B) y educación (1 °C). Con respecto a la inmunoterapia sublingual solo debe ser indicada a pacientes con asociación con rinitis alérgica, asociada a ácaros y síntomas de asma a pesar del tratamiento adecuado con FEV1 > 70 % (1B). Se recomienda fuertemente en el asma leve (escalón 2 GINA) el uso de broncodilatadores de acción rápida asociados a corticoides inhalados a demanda (1A). En asma grave, se recomienda el uso de la triple terapia inhalada con anticolinérgicos de acción prolongada, beta 2 de acción prolongada y corticoides inhaladas (1B). El uso de biológicos en asma grave está fuertemente indicado en fenotipo T2 con dupilumab (1A), T2 alérgico con omalizumab (1A) y en el T2 eosinofílico con benralizumab, o mepolizumab, con sus características distintivas (1A).

Asthma is a common chronic airway disease in our country, although with high poor control. Some specialists of the Asociación de Alergia e Inmunología Clínica and Asociación Argentina de Medicina Respiratoria have made recommendations for management and treatment of asthma, using a RAND/UCLA modified Delphi consensus methodology, based on GRADE evidence. This document provides recommendations based on specialist opinions about different strategies to improve adherence. Besides, it provides recommendations about critical issues of mild to severe asthma treatment. It´s recommended to improve adherence, personalized control-based management plan (1 °C), mobile devices (1B) and education (1 °C). Sublingual immunotherapy must be prescribed only in patients with allergic rhinitis, mite associated, and persistent symptoms although appropriate treatment with FEV1 > 70 % (1B). Use of fast action bronchodilators associated with inhaled corticosteroids prn in mild asthma (GINA stage 2) has strong recommendation (1A). Use of triple inhaled therapy (long acting anticholinergics, long acting beta 2 agonists and inhaled corticosteroids) is recommended in severe asthma (1B). Biologics has strong recommendations severe asthma: in phenotype T2 with dupilumab (1A), in phenotype allergic T2 with omalizumab (1A) and phenotype eosinophilic T2 with benralizumab or mepolizumab with distinctive characteristic (1A).

Tuberculose latente em pacientes psoriásicos tratados com imunobiológicos do estado da Paraíba / Latent tuberculosis in psoriatic patients treated with immunobiologics from the state of Paraíba / Tuberculosis latente en pacientes psoriásicos tratados con inmunobiológicos del estado de Paraíba

Objetivo: Investigar a prevalência e os riscos para tuberculose (TB) em pacientes com psoríase em uso de imunobiológicos tratados em centro de referência na Paraíba. Métodos: Trata-se de um estudo transversal, com psoriásicos registrados no Centro de Referência de Psoríase de um Hospital Universitário em parceria com o Centro Especializado de Dispensação de Medicamentos Excepcionais, com idade ≥ 18 anos, tratados com imunobiológicos de setembro/2021 a agosto/2022. Resultados: A amostra de 185 pacientes, foram 94 (50.8%) mulheres, com média de idade de 51,8 ± 16,0 anos,147 (79.4%) eram da capital da Paraíba. A forma de psoríase mais prevalente foi do tipo Vulgar em placas, com 181 (45.9%) pacientes. Todos os pacientes estavam usando imunobiológicos, sendo o inibidor do fator de necrose tumoral o mais utilizado. Observou-se Teste de Mantoux reativo em 12 (6.5%) pacientes e fortemente reativo em 5 (2.7%), e alteração na radiografia de tórax em 6 pacientes. Os 17 pacientes com TB- latente foram tratados com isoniazida por 9 meses, e nenhum desenvolveu a TB-doença. Conclusão: Este estudo foi imperioso para conhecer o perfil epidemiológico dos pacientes com psoríase em uso de imunobiológicos e que estão expostos a um risco maior em desenvolver a TB-doença.

Objective: To investigate the prevalence and risks of tuberculosis (TB) in patients with psoriasis using immunobiologics treated at a referral center in Paraíba. Methods: This is a cross-sectional study with psoriatic individuals registered at the Psoriasis Reference Center at the University Hospita in partnership with the Specialized Center for the Dispensation of Exceptional Medicines, aged ≥ 18 years, treated with immunobiologics from September/2021 to August/2022. Results: The sample of 185 patients who met the criteria were 94 (50.8%) women, with a mean age of 51.8 ± 16.0 years,147 (79.4%) were from the capital of Paraíba. The most prevalent form of psoriasis was the vulgar plaque type, with 181 (45.9%) patients. All patients were using immunobiologicals, and the tumor necrosis factor inhibitor was the most widely used. Reactive Mantoux test was observed in 12 (6.5%) patients and strongly reactive in 5 (2.7%), and chest X-ray changes were observed in 6 patients. The 17 patients with latent TB were treated with isoniazid for 9 months, and none developed TB-disease. Conclusion: This study was imperative to know the epidemiological profile of patients with psoriasis using immunobiologics and who are exposed to a higher risk of developing TB-disease.

Objetivo: Investigar la prevalencia y los riesgos de tuberculosis (TB) en pacientes con psoriasis utilizando inmunobiológicos tratados en un centro de referencia en Paraíba. Métodos: Estudio transversal con individuos psoriásicos registrados en el Centro de Referencia de Psoriasis del Hospital en asociación con el Centro Especializado para la Dispensación de Medicamentos Excepcionales, con edad ≥ 18 años, tratados con productos inmunobiológicos desde septiembre/2021 hasta agosto/2022. Resultados: La muestra de 185 pacientes que cumplieron con los criterios fueron 94 (50,8%) mujeres, con edad promedio de 51,8 ± 16,0 años, 147 (79,4%) eran de la capital de Paraíba. La forma más prevalente de psoriasis fue el tipo de placa vulgar, con 181 (45,9%) pacientes. Todos los pacientes usaban productos inmunobiológicos, y el inhibidor del factor de necrosis tumoral fue el más utilizado. Se observó teste de Mantoux reactiva en 12 (6,5%) pacientes y fuertemente reactiva en 5 (2,7%), y se observaron cambios en la radiografía de tórax en 6 pacientes. Los 17 pacientes con TB latente fueron tratados con isoniazida durante 9 meses, y ninguno desarrolló enfermedad de TB. Conclusión: Este estudio fue imprescindible para conocer el perfil epidemiológico de los pacientes con psoriasis que utilizan productos inmunológicos y que están expuestos a un mayor riesgo de desarrollar la enfermedad de TB.

Estado actual y retos futuros en el tratamiento de las enfermedades reumáticas / Current status and future challenges in the treatment of rheumatic diseases

Las nuevas estrategias, que incluyen el diagnóstico y el tratamiento tempranos, el enfoque de tratamiento dirigido a un objetivo, la remisión como ese objetivo principal del tratamiento, la participación de los pacientes en las decisiones terapéuticas, junto con el desarrollo de nuevos tratamientos efectivos, han cambiado las expectativas de los reumatólogos y de los pacientes con enfermedades reumáticas. Todavía existen, sin embargo, importantes desafíos tales como la seguridad a largo plazo de los tratamientos actuales y poder escoger tratamientos más individualizados y eficaces, de forma tal de elegir el mejor tratamiento para cada paciente. El futuro, como en el resto de la medicina, probablemente sea la prevención del desarrollo de enfermedades reumáticas. Discutiremos estos temas en esta revisión. (AU)

New strategies, including early diagnosis and treatment, targeted therapy, remission as the main objective of treatment, patient involvement in therapeutic decision-making, and the development of new effective therapies, have changed the expectations of rheumatologists and patients with rheumatic diseases.There are still serious challenges, such as the long-term safety of current treatments and the ability to make more individualized and effective treatments to choose the best treatment for each patient. The future, as that of the whole of medical science, will probably lie in preventing the development of rheumatic diseases. We will discuss these issues in this review. (AU)

Pattern of use of biologics in psoriasis among Indian dermatologists – a cross sectional survey

Background and Aims: Biologics are a relatively new class of highly effective drugs in the management of psoriasis. They act on specific immune processes, achieve rapid and sustained clearance and do not cause target organ damage unlike conventional systemic therapy. It appears that their use in our country is not as widespread as in developed nations despite these benefits ; their prohibitive cost may be a major factor for the limited usage. This survey aimed to find out the extent of use and factors hindering usage of biologics for the management of psoriasis by Indian dermatologists. Methods: It was a cross?sectional questionnaire based study. The questionnaire was designed after a focussed group discussion, followed by validation. The survey was sent in the form of a link to Indian dermatologists. The responses were recorded in excel-sheet and the data was analyzed by SPSS ver 25. Results: Of the 310 participants who took part, 287 completed the survey. Two hundred (70%) were users of biologics, while 87 (30%) had never used them. Cost was the major factor which prevented biologic use. Majority of the respondents used biologics in less than 2 cases per month. Secukinumab was the most common biologic used followed by etanercept. The factors which determined choice of biologics were convenience, cost, previous experience, co-morbid conditions and recommendations by an expert. Limitations: A small sample size was the limitation of the study. Dermatologists who do not use biologics may be under?represented in the study. Conclusions: Biologics are not used optimally by Indian dermatologists for management of psoriasis. The cost, fear of adverse effects, lack of awareness and inadequate felt need are major factors which prevent their regular use