Research Letter
Adalimumab for severe psoriasis in Chilean paediatric patients
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] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Daniela Armijo Fernandez, Fernando Valenzuela, Gustavo Saint-Pierre Contreras, Andrea Cortés González" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Daniela" "apellidos" => "Armijo Fernandez" "email" => array:1 [ 0 => "danielaarmijof@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Fernando" "apellidos" => "Valenzuela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Gustavo" "apellidos" => "Saint-Pierre Contreras" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Andrea" "apellidos" => "Cortés González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Dermatology, Hospital Clinico Universidad de Chile, Santiago, Chile" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital San José de la Mariquina, Valdivia, Chile" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Juvenile psoriasis is a chronic inflammatory skin disease affecting the 0.6–1.4% of paediatric patients.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> It is associated with several comorbidities including: psoriatic arthritis, psychiatric disorders, diabetes mellitus 1 and 2, hypertension, obesity, hyperlipidaemia and Crohn disease<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2–4</span></a>; therefore, it is essential to establish an early and adequate treatment. Systemic therapeutic options in children are limited because of the adverse events, and approved biologic therapies in severe psoriasis at the moment are few. Adalimumab has been approved by the European Medicines Agency (EMA) for the treatment of severe plaque psoriasis in patients from 4 years of age, and recently a randomized, double-blind clinical trial has shown its safety and superiority compared to methotrexate.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> In Chile, there's no economic reimbursement for biological therapies and patients must pay on their own the full treatment, so the access to these therapies is limited due to the costs. The aim of our research is to present our experience with the use of adalimumab in paediatric patients with severe psoriasis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Patients<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>18 years old with severe psoriasis and lack of response to topical and/or systemic-non-biological therapies were selected to receive adalimumab 0.8<span class="elsevierStyleHsp" style=""></span>mg/kg subcutaneously at week 0, then every other week since week 1. They were followed-up for at least 40 weeks. Monthly clinical evaluations were performed; Psoriasis Area and Severity Index (PASI) and Physician Global Assessment 6 point scale (PGA) were assessed at all visits.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Four patients were selected, three were female. The median age at diagnosis of psoriasis was 11 years old and the mean duration of the disease before the use of adalimumab was 4.2 years. Two had positive family history of psoriasis but none of them were first-degree relatives. All of them had severe plaque psoriasis. Patient 4, presented severe genital psoriasis and HLA B27+ psoriatic arthritis with involvement of sacroiliac joints that had failed to respond to methotrexate. Patient 2 was overweight. No other metabolic, joint or psychiatric comorbidities were identified. Baseline disease characteristics included: median PASI 21.3, median PGA scores 4, and median Body Surface Area (BSA) 29%. At week 16, three out of four achieved PASI 75, and the median PGA score was 2. At week 40 the median PASI was 1.7, all of them achieved PASI 75 and two achieved PASI 90. All patients achieved PGA score 1–0 (<a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>). Only mild adverse events were reported: upper respiratory tract infection (3 cases), lower respiratory tract infection (3 cases), and headache (1 case).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">We were unable to find any previous reports in Chilean paediatric patients with severe psoriasis treated with adalimumab. In our serie, the treatment with adalimumab 0.8<span class="elsevierStyleHsp" style=""></span>mg/kg in paediatric patients who had failed to previous non-biological therapies resulted in significant improvements in PASI 75 at week 16 that were maintained up to week 40.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Juvenile psoriasis has been associated with important comorbidities, and the estimated overall rate has been reported twice as high as in patients without psoriasis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Only one of the patients had psoriasis arthritis that had a good rate of response, improving joint symptoms and quality of life. Considering the comorbidities of juvenile psoriasis, the important detriment in quality of life and the recently published literature, adalimumab seems an effective and safety option for paediatric patients with severe psoriasis. However, as in our country there is no economic reimbursement for these therapies, the treatment of severe psoriasis that had failed to conventional management becomes challenging.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors’ contribution</span><p id="par0030" class="elsevierStylePara elsevierViewall">Daniela Armijo Fernandez: Approval of the final version of the manuscript; elaboration and writing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; critical review of the literature; critical review of the manuscript.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Fernando Valenzuela: Approval of the final version of the manuscript; conception and planning of the study; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cased; critical review of the manuscript.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Gustavo Saint-Pierre Contreras: Approval of the final version of the manuscript; elaboration and writing of the manuscript; collection, analysis, and interpretation of data; critical review of the literature.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Andrea Cortés González: Approval of the final version of the manuscript; collection, analysis, and interpretation of data; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cased; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Authors’ contribution" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-09-01" "fechaAceptado" => "2019-04-01" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Armijo D, Valenzuela F, Saint-Pierre G, Cortés A. Adalimumab for severe psoriasis in Chilean paediatric patients. An Bras Dermatol. 2020;95;105–6.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital Clinico Universidad de Chile, Santiago, Chile.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wk 16 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wk 40 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2264092.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Psoriasis area severity index, PASI.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wk 16 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Wk 40 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2264093.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Physician global assessment, PGA.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology and comorbidity of psoriasis in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Augustin" 1 => "G. Glaeske" 2 => "M.A. Radtke" 3 => "E. Christophers" 4 => "K. Reich" 5 => "I. Schäfer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2009.09593.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2010" "volumen" => "162" "paginaInicial" => "633" "paginaFinal" => "636" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19922529" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psychiatric comorbidities in children and adolescents with psoriasis: a population-based cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Todberg" 1 => "A. Egeberg" 2 => "P. Jensen" 3 => "G. Gislason" 4 => "L. Skov" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/bjd.15095" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2017" "volumen" => "177" "paginaInicial" => "551" "paginaFinal" => "553" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27681652" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psoriasis in children and adolescents: diagnosis, management and comorbidities" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I.M.G.J. Bronckers" 1 => "A.S. Paller" 2 => "M.J. van Geel" 3 => "P.C.M. van de Kerkhof" 4 => "M.M.B. Seyger" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Pediatr Drugs" "fecha" => "2015" "volumen" => "17" "paginaInicial" => "373" "paginaFinal" => "384" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Overweight childhood psoriasis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Boccardi" 1 => "S. Menni" 2 => "C. Vecchia" 3 => "M. La Nobile" 4 => "A. Decarli" 5 => "G. Volpi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2133.2009.09276.x" "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "2009" "volumen" => "161" "paginaInicial" => "484" "paginaFinal" => "486" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19519836" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy and safety of adalimumab every other week versus methotrexate once weekly in children and adolescents with severe chronic plaque psoriasis: a randomised, double-blind, phase 3 trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Papp" 1 => "D. Thaçi" 2 => "D. Marcoux" 3 => "L. Weibel" 4 => "S. Philipp" 5 => "P.D. Ghislain" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(17)31189-3" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2017" "volumen" => "390" "paginaInicial" => "40" "paginaFinal" => "49" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28478975" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009500000001/v3_202003240622/S0365059619301758/v3_202003240622/en/main.assets" "Apartado" => array:4 [ "identificador" => "82768" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Research Letter" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009500000001/v3_202003240622/S0365059619301758/v3_202003240622/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059619301758?idApp=UINPBA00008Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 16 | 9 | 25 |
| 2024 October | 110 | 68 | 178 |
| 2024 September | 133 | 81 | 214 |
| 2024 August | 150 | 106 | 256 |
| 2024 July | 137 | 115 | 252 |
| 2024 June | 93 | 60 | 153 |
| 2024 May | 88 | 57 | 145 |
| 2024 April | 116 | 81 | 197 |
| 2024 March | 96 | 68 | 164 |
| 2024 February | 98 | 73 | 171 |
| 2024 January | 93 | 43 | 136 |
| 2023 December | 70 | 72 | 142 |
| 2023 November | 99 | 66 | 165 |
| 2023 October | 59 | 63 | 122 |
| 2023 September | 77 | 53 | 130 |
| 2023 August | 43 | 34 | 77 |
| 2023 July | 71 | 40 | 111 |
| 2023 June | 66 | 41 | 107 |
| 2023 May | 48 | 21 | 69 |
| 2023 April | 28 | 15 | 43 |
| 2023 March | 52 | 41 | 93 |
| 2023 February | 38 | 28 | 66 |
| 2023 January | 39 | 34 | 73 |
| 2022 December | 30 | 21 | 51 |
| 2022 November | 46 | 46 | 92 |
| 2022 October | 43 | 52 | 95 |
| 2022 September | 39 | 45 | 84 |
| 2022 August | 31 | 37 | 68 |
| 2022 July | 35 | 41 | 76 |
| 2022 June | 35 | 51 | 86 |
| 2022 May | 31 | 49 | 80 |
| 2022 April | 40 | 45 | 85 |
| 2022 March | 36 | 61 | 97 |
| 2022 February | 29 | 31 | 60 |
| 2022 January | 40 | 80 | 120 |
| 2021 December | 38 | 52 | 90 |
| 2021 November | 34 | 60 | 94 |
| 2021 October | 47 | 66 | 113 |
| 2021 September | 30 | 41 | 71 |
| 2021 August | 40 | 51 | 91 |
| 2021 July | 29 | 33 | 62 |
| 2021 June | 42 | 48 | 90 |
| 2021 May | 50 | 66 | 116 |
| 2021 April | 177 | 237 | 414 |
| 2021 March | 53 | 60 | 113 |
| 2021 February | 17 | 12 | 29 |
| 2021 January | 20 | 16 | 36 |
| 2020 December | 17 | 22 | 39 |
| 2020 November | 12 | 10 | 22 |
| 2020 October | 10 | 12 | 22 |
| 2020 September | 12 | 10 | 22 |
| 2020 August | 9 | 8 | 17 |
| 2020 July | 11 | 11 | 22 |
| 2020 June | 10 | 10 | 20 |
| 2020 May | 12 | 11 | 23 |
| 2020 April | 1 | 1 | 2 |
| 2020 March | 7 | 4 | 11 |
| 2020 January | 0 | 5 | 5 |
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