Inmunogenicidad en terapia biológica. Implicaciones en Dermatología

It is now known that all biologic drugs, even those that are fully human, are immunogenic, that is, they have the ability to induce an immune response in the treated patient. Since the presence of antidrug antibodies may influence the levels and function of the drug in the body, this immune response can alter the efficacy of the biologic treatment and even its safety profile, depending on the mechanism of action (neutralizing or nonneutralizing) and/or an accelerated clearance of the drug. Immunogenicity is a dynamic factor that should be taken into account when prescribing biologic therapy in psoriasis, especially in the case of long-term treatment and when assessing secondary loss of response. An understanding of the immunogenicity of biologic therapies and how this can be managed is useful not only for optimizing the treatment strategy used with each drug, but also for designing predictive models of response and even for tailoring therapy on a case-by-case basis.     

Tratamiento de la psoriasis en placas con propiltiouracilo tópico

—Background: in recent years there are several reports that show the efficacy of both oral and topical antithyroid drugs (propylthiouracil and methimazole) in the treatment of plaque-type psoriasis.Objective: to determine the efficacy of topical propylthiouracil (5% cream) in comparison with calcipotriol ointment in the treatment of patients with plaque-type psoriasis.Materials and methods: a prospective, randomized comparison of calcipotriol ointment (14 patients) and propylthiouracil 5% cream (14 patients) was carried out.Results: there were no statistically differences between the PASI scores at 4 and 8 week from baseline in the group of patients treated with topical propylthiouracil. The differences in the PASI scores from baseline were statistically significantly in favour of calcipotriol.Conclusions: topical propylthiouracil is not an effective therapy in patients with plaque-type psoriasis.     

Indicadores de calidad en la atención dermatológica a pacientes con dermatitis atópica. Documento de consenso de la Academia Española de Dermatología y Venereología

No information is currently available on whether the available clinical practice guidelines on the management of atopic dermatitis are known or being applied in Spain. The aim of this study was to improve the care of patients with atopic dermatitis by developing a set of quality indicators based on existing clinical practice guidelines. Relevant clinical practice guidelines identified through a literature search were submitted to a panel of 11 specialists, who selected the highest quality guidelines using the AGREE (Appraisal of Guidelines for Research & Evaluation) II instrument. The panel then defined a subset of the recommendations supported by a high level of evidence and proposed a health care quality indicator for each one together with a standard for measuring degree of adherence. Consensus was achieved on 21 of the 150 proposed indicators using the modified Delphi method. The aim of implementing the indicators that achieved consensus in this study is to standardize the actions of health professionals providing care for patients with atopic dermatitis and ultimately to improve the quality of the care delivered.