ABSTRACT
BACKGROUND/PURPOSE: Biological therapy has demonstrated a very satisfactory anti-psoriatic effect; however, the loss of response with time has been reported. OBJECTIVE: To evaluate the efficacy of the narrow band ultraviolet-B phototherapy (NB-UVB) as a rescue in patients with moderate to severe psoriasis who have lost efficacy in their biological treatment. METHODS: A retrospective chart review study was conducted on patients with moderate to severe psoriasis receiving treatment with a biologic, with a good initial response that subsequently had lost efficacy. All the patients received combined treatment with NB-UVB. RESULTS: Seventeen patients were included, with a mean age of 44 years. The biologics were: 8 etanercept, 4 adalimumab, 3 ustekinumab, 1 efalizumab, and 1 infliximab. The mean NB-UVB sessions was 25 (7-48 sessions), with a mean accumulated dose of 31.12 J/cm(2) (5.2-94.6 J/cm(2) ). Sixteen patients had the following results: 44% PASI 90-100, 31.3% PASI 75-89, and 25% PASI 50-74 response. CONCLUSION: According to this study on clinical practice, it could be considered that the use of NB-UVB along with biological drugs that have lost efficacy in controlling moderate to severe psoriasis in adults could contribute to the recovery of the initial response.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Phototherapy , Psoriasis/therapy , Ultraviolet Rays , Adolescent , Adult , Aged , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Psoriasis/drug therapy , Retrospective Studies , Severity of Illness Index , Young AdultABSTRACT
B-lineage-committed cells are believed to arise in the liver of mouse embryos at 14 days after coitus (dpc). However, pre-B-specific gene transcripts and DJH gene rearrangements have been detected in earlier, midgestation embryos. We describe here a population of c-kit(+)AA4.1(+)CD19(+)Pax5(+) cells present in the aorta-gonad-mesonephros (AGM) area and in the livers of 11-dpc mouse embryos. In contrast to multipotent c-kit(+)AA4.1(+)CD19(-) hematopoietic stem cells (HSCs), these c-kit(+)AA4.1(+)CD19(+) progenitors differentiated only to B-lineage cells in vitro. We propose that mouse embryonic B lymphopoiesis starts earlier than previously thought, at 10 to 11 dpc, both in liver and extra-liver hematopoietic sites. The B-cell differentiation program is not delayed with respect to the emerging lymphohematopoiesis events in the midgestation mouse embryo (8-9 dpc).
