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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Serum cytokine levels in psoriasis patients according to drug survival stratified by 1 to 4 years and 5 to 6 years&#46; Data are shown as scattering distribution of individual values over bar charts representing median levels of each cytokine&#46; IL&#44; Interleukin&#59; TNF&#44; Tumor Necrosis Factor&#59; IFN&#44; Interferon&#59; HC&#44; Healthy Controls&#59; p-values for all groups that presented a significant difference are disclosed at the bottom of each graphic&#46; Non-significant p-values &#40;&#62; 0&#46;05&#41; are not represented&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Psoriasis is a chronic disease that affects between 1&#37; and 3&#37; of the global population&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> The revolution in the development of new biologic drugs and small molecules is supported by high-quality clinical trials&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> Those medications act through modulated blocking of cytokines involved in the pathogenesis of psoriasis&#44; reducing the occurrence of adverse events and achieving better results in comparison to classic immunosuppressants&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Since new medications are being constantly released in the market&#44; the necessity of additional data targeting the pharmacovigilance of immunosuppressors for the treatment of psoriasis is being constantly emphasized&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> The number of active registries for monitoring adverse events is still insufficient&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Psoriasis is a disease that affects the skin and other organs through systemic inflammation&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;13</span></a> The disease has also a significant impact on a patient&#39;s quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> In general&#44; pharmacovigilance data is scarce in developing countries&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> The Brazilian Unified Health System &#40;SUS&#41; is responsible for the provision of healthcare and pharmaceutical assistance to over 200 million people&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Therefore&#44; the Brazilian SUS constitutes a privileged scenario for pharmacovigilance&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> The national protocol regarding the sequence of medications used in psoriasis is not different from most international recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The authors aimed to evaluate drug survival in moderate to severe psoriasis&#46; The authors also aimed to evaluate whether serum cytokines can be used to predict psoriasis treatment failure and the occurrence of severe infection&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">From January 2016 to December 2017&#44; the authors consecutively included patients attending the Psoriasis Outpatient Clinic at the University Hospital of Bras&#237;lia&#44; University of Bras&#237;lia&#44; Brazil&#46; This main reference hospital serves an urban area with more than 3 million inhabitants in Bras&#237;lia Brazil&#46; This strategy warranted internal validation of frequencies&#46; Additional evaluations&#44; including predictors and risk effects&#44; were implemented according to a post hoc strategy&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Inclusion criteria</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors included patients with a diagnosis of moderate to severe psoriasis established through clinical assessment by two certified dermatologists&#46; Whenever necessary&#44; skin biopsies were performed&#46; The authors excluded patients with a concomitant diagnosis of psoriatic arthritis or other autoimmune diseases&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Baseline evaluation</span><p id="par0030" class="elsevierStylePara elsevierViewall">All patients were subjected to a baseline evaluation comprised of a standardized form seeking demographic information&#44; actual treatment information&#44; and previous treatment information&#46; Following the current literature and the international classification of diseases&#44; patients who had the most common pattern of plaque psoriasis&#44; associated or not with palmoplantar&#44; nail&#44; or scalp lesions were classified as having plaque psoriasis&#46; Patients classified as scalp psoriasis&#44; nail psoriasis&#44; palmoplantar pustular psoriasis&#44; guttate psoriasis&#44; and inverse psoriasis had lesions exclusively in these locations&#46; The medications used at the time of inclusion were considered basal medications&#46; The Psoriasis Area and Severity Index &#40;PASI&#41;&#44; Body Surface Area &#40;BSA&#41;&#44; Dermatology Life Quality Index &#40;DLQI&#41;&#44; and Nail Psoriasis Severity Index &#40;NAPSI&#41; were evaluated whenever possible&#46; Retrospective data regarding medication and disease history before inclusion presented important losses&#44; and this information was removed from the outcome evaluation&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Total blood was collected by cubital venipuncture&#46; Serum from each patient was isolated&#44; and Interleukin-2 &#40;IL-2&#41;&#44; Interleukin-4 &#40;IL-4&#41;&#44; Interleukin-6 &#40;IL-6&#41;&#44; Interleukin-10 &#40;IL-10&#41;&#44; Interleukin-17A &#40;IL-17A&#41;&#44; Interferon &#40;IFN&#41;-&#947; and Tumor Necrosis Factor &#40;TNF&#41;-&#945; were measured using the BD&#8482; Cytometric Bead Array &#40;CBA&#41; Human Th1&#47;Th2&#47;Th17 Cytokine Kit &#40;Becton Dickinson&#44; Franklin Lakes&#44; USA&#41; with a FACSVerse flow cytometer &#40;Becton Dickinson&#41;&#46; All analyses were performed in triplicate&#44; and the values were normalized and compared with those obtained from 47 healthy controls &#40;mean age&#160;&#61;&#160;42 years and 3 months&#44; 18 male and 29 female patients recruited at the same institution&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Follow-up visits</span><p id="par0040" class="elsevierStylePara elsevierViewall">Patients were followed up until December 2021 &#40;up to 6 years&#41; by a dermatologist through clinical consultation every 3 to 6 months&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Primary endpoint</span><p id="par0045" class="elsevierStylePara elsevierViewall">Drug survival was measured according to the time taken for basal medication interruption &#40;change or suspension&#41;&#46; The primary endpoint was considered the occurrence of drug interruption&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Secondary endpoints</span><p id="par0050" class="elsevierStylePara elsevierViewall">As secondary endpoints&#44; the authors considered the occurrences of treatment failure or severe infection&#46; Treatment failure was defined as the necessity of treatment modification due to poor disease control &#40;PASI&#44; BSA&#44; DLQI&#44; and NAPSI scores above 10&#41;&#46; Severe infection was defined as any infection that led to the suspension of clinical treatment for more than 1 month&#46; The incidence of additional outcomes&#44; such as adverse reactions&#44; was also evaluated&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Predictors</span><p id="par0055" class="elsevierStylePara elsevierViewall">Relevant clinical and laboratory baseline characteristics that were assessed as candidate predictors of drug survival included sex&#44; age&#44; smoking habits&#44; and alcohol abuse&#44; as well as pro-inflammatory &#40;IL-2&#44; IL-6&#44; IL-17A&#44; IFN-&#947; TNF-&#945;&#41; and anti-inflammatory &#40;IL-4&#44; IL-10&#41; cytokines&#46; At baseline&#44; patients that were on biologics only and who had never used other biologic drugs were classified as &#8220;naive&#8221;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Predictors were evaluated using log-rank tests&#46; Data censoring was set to occur when patients were lost to follow-up&#46; Numerical variables were not categorized in univariate analysis&#46; For adjusted analysis&#44; cytokine levels were categorized according to the median value of the global population or as positive&#47;negative if more than 30&#37; of the patients presented negative results&#46; The remaining numerical variables were only categorized to generate graphics&#46; PASI and BSA values were calculated only for patients with plaque psoriasis&#46; Missing data were not replaced and patients with missing data were excluded from specific analyses&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">For the primary outcome&#44; the authors used an adjusted multivariate model&#46; Predictors that met a low evidence threshold &#40;p&#160;&#8804;&#160;0&#46;100&#41; based on univariate analysis were included&#46; The authors calculated Hazard Ratios &#40;HRs&#41; using a Cox proportional hazards model&#46; All assumptions were carefully evaluated&#46; The authors used the survival and survminer packages in R Studio &#40;R Studio&#44; Vienna&#44; Austria&#41;&#46; For secondary outcomes&#44; the authors used a subgroup analysis strategy&#46; Graphical comparison of cytokine levels was performed using GraphPad Prism version 8&#46;0&#46;0 for Windows &#40;GraphPad Software&#44; San Diego&#41;&#46; Statistical significance was defined by a p-value &#60;0&#46;05 and an appropriate 95&#37; Confidence Interval &#40;95&#37; CI&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethics</span><p id="par0070" class="elsevierStylePara elsevierViewall">This study was approved by the Ethics Committee of the Faculty of Medicine of the University of Bras&#237;lia&#46; All patients were included after signing the informed consent form&#46;</p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors followed up 262 patients with psoriasis&#59; 133 &#40;50&#46;76&#37;&#41; were male&#44; and 129 &#40;49&#46;24&#37;&#41; were female&#46; Most patients presented with plaque psoriasis &#40;n&#160;&#61;&#160;222&#59; 84&#46;73&#37;&#41;&#46; The authors also included patients with scalp psoriasis &#40;n&#160;&#61;&#160;12&#59; 4&#46;58&#37;&#41;&#44; ungual psoriasis &#40;n&#160;&#61;&#160;5&#59; 1&#46;91&#37;&#41;&#44; palmoplantar pustulous psoriasis &#40;n&#160;&#61;&#160;8&#59; 3&#46;05&#37;&#41;&#44; guttate psoriasis &#40;n&#160;&#61;&#160;13&#59; 4&#46;96&#37;&#41; and inverse psoriasis &#40;n&#160;&#61;&#160;2&#59; 0&#46;76&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">In this study&#44; 71 &#40;27&#46;10&#37;&#41; patients were not using systemic immunosuppressants &#91;9 &#40;3&#46;44&#37;&#41; were without any treatment&#44; 5 &#40;1&#46;91&#37;&#41; underwent isolated phototherapy&#44; 50 &#40;19&#46;08&#37;&#41; used topical corticosteroids and 7 &#40;2&#46;67&#37;&#41; used acitretin&#93;&#59; 96 &#40;36&#46;64&#37;&#41; patients used classical immunosuppressors &#91;94 &#40;35&#46;88&#37;&#41; used methotrexate and 2 &#40;0&#46;76&#37;&#41; used systemic corticosteroids&#93;&#59; 75 patients &#40;28&#46;63&#37;&#41; used anti-TNF biologics &#91;22 &#40;8&#46;39&#37;&#41; used adalimumab&#44; 29 &#40;11&#46;07&#37;&#41; used etanercept and 24 &#40;9&#46;16&#37;&#41; used infliximab&#93;&#59; and 20 patients &#40;7&#46;63&#37;&#41; used anti-IL drugs &#91;9 &#40;3&#46;44&#37;&#41; used ustekinumab and 11 &#40;4&#46;19&#37;&#41; used secukinumab&#93;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The mean follow-up time was 4&#46;88 years &#40;range&#160;&#61;&#160;1&#8211;6 years&#41;&#46; Drug interruption before the end of the study follow-up was identified in 122 &#40;46&#46;56&#37;&#41; patients&#59; 88 &#40;33&#46;58&#37;&#41; patients had an isolated treatment failure identified&#44; and 18 &#40;6&#46;87&#37;&#41; patients had an isolated severe infection that led to treatment suspension&#46; Sixteen patients &#40;6&#46;11&#37;&#41; had interrupted treatment because of simultaneous severe infection and treatment failure&#46; In total&#44; 34 &#40;12&#46;97&#37;&#41; patients presented with severe infections &#40;25 patients had unidentified upper airway infections&#44; 8 patients had COVID-19 diagnosis and 1 patient had a severe gastrointestinal infection&#41;&#46; Additionally&#44; the data of only 5 patients were censored &#40;considered as a loss to follow-up&#41; because of other reported adverse events&#46; These events were only evaluated in a descriptive form because of the low number of events&#46; One patient developed hidradenitis suppurative while on acitretin therapy&#44; 2 patients presented with signs of neuropathy while using methotrexate&#44; 1 patient presented with dyspnoea while using methotrexate&#44; and 1 patient presented with signs of initial renal failure while using infliximab&#46;</p><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Cytokine profile</span><p id="par0090" class="elsevierStylePara elsevierViewall">The use of classic immunosuppressants&#44; mainly methotrexate&#44; was associated with important suppression of proinflammatory cytokines &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; For some mediators&#44; such as IL-17 and TNF-&#945;&#44; the suppressive effect of methotrexate was even greater than the effect observed in patients using anti-TNF or anti-IL biologics&#46; IL-6 baseline levels were significantly enhanced in patients with poorer survival rates &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Drug survival analysis</span><p id="par0095" class="elsevierStylePara elsevierViewall">Univariate analysis &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; showed that baseline PASI &#40;p&#160;&#61;&#160;0&#46;038&#41;&#44; DLQI &#40;p&#160;&#60;&#160;0&#46;001&#41;&#44; and NAPSI &#40;p&#160;&#60;&#160;0&#46;001&#41; values were significantly greater in patients who interrupted systemic treatment&#46; IL-6 was the only inflammatory marker that was significantly elevated in patients who had interruptions of their basal medication &#40;p&#160;&#61;&#160;0&#46;002&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In the multivariate model&#44; the authors observed that each point elevation in the DLQI score elevated the chance of treatment change by 1&#46;04 times with very narrow 95&#37; CIs &#40;HR&#160;&#61;&#160;1&#46;04&#59; 95&#37; CI 1&#46;01&#8210;1&#46;07&#59; p&#160;&#61;&#160;0&#46;012&#41;&#46; Additionally&#44; patients who had baseline IL-6 levels equal to or above the median value of the total population had an almost 2 times greater chance of interrupting systemic treatment than patients with lower levels of the proinflammatory marker &#40;HR&#160;&#61;&#160;1&#46;99&#59; 95&#37; CI 1&#46;29&#8210;3&#46;08&#59; p&#160;&#61;&#160;0&#46;002&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Detailed information related to the subgroup analysis can be found in Supplementary File 1&#44; &#40;Tables A and B&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">Psoriasis is a complex inflammatory disease&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> It is didactic to consider that the beginning of the inflammatory cascade is jointly caused by stimuli of environmental factors associated with genetic susceptibility&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a> These stimuli activate antigen-presenting cells&#44; macrophages and dendritic cells to produce coordinating cytokines &#40;TNF&#44; IL-23&#44; IFN&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Subsequently&#44; the activation of the Th1 and Th17 pathways results in the activation of final cytokines&#44; such as IL-17&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Finally&#44; inflamed keratinocytes also express inflammatory mediators&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The utility of measuring cytokines in the blood of patients with skin conditions is under debate&#46; Although most studies highlight the autocrine and paracrine effects of those mediators in psoriasis&#44; virtually all involved cytokines have an endocrine-like effect&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;24</span></a> Cataldi et al&#46; found that plasma Th17 pathway mediators were significantly higher in a population of 70 psoriasis patients than in a control group&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">In the present study&#44; IL-6 elevation was the most consistent proinflammatory marker for treatment interruption&#46; Although IL-6 is a proinflammatory mediator&#44; the use of tocilizumab&#44; a recombinant humanized anti-IL-6 biologic&#44; in psoriasis led to unpredictable results&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#44;27</span></a> Studies that evaluated the inflammatory environment of the skin failed to include IL-6 expression in the main pathogenic pathway of psoriasis&#46; Nakajima et al&#46;&#44; in 2010&#44; found that IL-6 was not crucial for the development of T-cell-independent psoriasis-like dermatitis in a murine model&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> The same result was found for IL-17&#44; one of the main modern targets for psoriasis treatment&#44; showing that the human inflammatory profile can be unpredictable&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Interestingly&#44; in line with the present findings&#44; previous data that evaluated smaller populations reinforce the role of circulating IL-6 for the prediction of treatment response in psoriasis&#46; Zalewska et al&#46; found that plasma IL-6 levels were consistently elevated in 106 untreated psoriasis patients and that elevated levels of these mediators were related to poor treatment response&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> In addition&#44; several studies have related the levels of circulating IL-6 to the systemic inflammation profile of psoriasis patients&#44; including the occurrence of psoriatic arthritis and dyslipidemia&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30&#8211;37</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">It is possible that IL-6 is not very important for triggering the inflammatory cascade of psoriasis in the skin environment&#44; but its suppressive effect on regulatory T-cells may explain why this mediator is a more important marker for treatment response&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> Additionally&#44; previous studies have shown that IL-6 is one of the inflammatory mediators with the most important systemic effects&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Joint modulation of IL-6 and other cytokines&#44; as achieved by Janus kinase inhibitors&#44; may be an interesting strategy for refractory cases&#44; as demonstrated by phase 2 clinical trials&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Classic medications&#44; mainly methotrexate&#44; were associated with lower levels of TNF and IL-17 &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46; Considering that methotrexate is clinically less effective than biologics&#44; the authors hypothesize that an intense suppression of the two main mediators for psoriasis is not directly correlated to treatment responses&#46; On the other hand&#44; patients responding to methotrexate may present with milder cases of psoriasis and&#44; consequently&#44; have lower levels of TNF and IL-17&#46; Unfortunately&#44; in the present study&#44; the authors did not measure inflammatory cytokines at different time points&#46; Long-term serial evaluation of those markers can offer better clues related to the pathogenesis of psoriasis&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Additionally&#44; in the present study&#44; poor scores of traditional clinical markers&#44; including PASI&#44; DLQI&#44; and NAPSI&#44; were significantly related to reduced drug survival&#46; This result was expected since these parameters are internationally recognized predictors of drug switching&#46; Quality of life &#40;DLQI&#41; had the greatest influence on drug survival among the evaluated clinical scores&#46; The main limitation of any cohort study is the presence of confounders that cannot be treated by randomization&#46; However&#44; the IL-6 results were consistent in the laboratory analysis&#44; the univariate analysis&#44; and the multivariate model&#46; This result also represents a reproduction of previous studies in smaller populations&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> Furthermore&#44; the authors only aimed to measure baseline cytokine levels as long-term markers for psoriasis severity&#46; Multiple measurements at different time points may help to elucidate the role of serum markers in the evolution of psoriasis and its treatment&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusion</span><p id="par0140" class="elsevierStylePara elsevierViewall">The present study showed that reduced quality of life and elevated serum IL-6 levels were predictors of poor drug survival in patients with moderate to severe psoriasis&#46; The authors can also conclude that although IL-6 is not the most important mediator of the inflammatory pathway in the skin environment&#44; it is an interesting candidate biomarker for predicting psoriasis systemic treatment response&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Financial support</span><p id="par0145" class="elsevierStylePara elsevierViewall">The research was funded by <span class="elsevierStyleGrantSponsor" id="gs0005">Funda&#231;&#227;o de Apoio &#224; Pesquisa do Distrito Federal &#40;FAP-DF&#41;</span> Grant numbers&#58; <span class="elsevierStyleGrantNumber" refid="gs0005">FINATEC 7044</span> and <span class="elsevierStyleGrantNumber" refid="gs0005">7155</span>&#59; and by <span class="elsevierStyleGrantSponsor" id="gs0010">La Roche Posay Foundation</span>&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Authors&#39; contributions</span><p id="par0150" class="elsevierStylePara elsevierViewall">Nat&#225;lia Ribeiro de Magalh&#227;es Alves&#58; Investigation&#44; writing &#8210; original draft&#44; writing &#8210; review &#38; editing&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Patr&#237;cia Shu Kurizky&#58; Investigation&#44; writing &#8210; original draft&#44; writing &#8210; review &#38; editing&#44; project administration&#44; supervision&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Licia Maria Henrique da Mota&#58; Investigation&#44; writing &#8210; review &#38; editing&#44; supervision&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Cleandro Pires de Albuquerque&#58; Investigation&#44; writing &#8210; review &#38; editing&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Juliana Tomaz Esper&#58; Investigation&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Aridne Souza Costa Campos&#58; Investigation&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Vitoria Pereira Reis&#58; Investigation&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Henrique Metzker Ferro&#58; Investigation&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Natalia Gil-Jaramillo&#58; Investigation&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Joaquim Pedro Brito-de-Sousa&#58; Investigation&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Luana Cabral Leao Leal&#58; Investigation&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Ot&#225;vio de Toledo N&#243;brega&#58; Investigation&#44; writing &#8210; review &#38; editing&#44; supervision&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Carla Nunes de Ara&#250;jo&#58; Investigation&#44; writing &#8210; original draft&#44; supervision&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Agenor de Castro Moreira dos Santos J&#250;nior&#58; Investigation&#44; writing &#8210; original draft&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Gladys Aires Martins&#58; Investigation&#44; supervision&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Olindo Assis Martins Filho&#58; Investigation&#44; writing &#8210; original draft&#44; writing &#8210; review &#38; editing&#44; supervision&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Ciro Martins Gomes&#58; Investigation&#44; writing &#8210; review &#38; editing&#44; project administration&#44; funding acquisition&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of interest</span><p id="par0235" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2022-11-17"
    "fechaAceptado" => "2023-03-11"
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        0 => array:4 [
          "clase" => "keyword"
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          "identificador" => "xpalclavsec1765103"
          "palabras" => array:5 [
            0 => "Allergy and immunology"
            1 => "Autoimmune disease"
            2 => "Biomarkers"
            3 => "Immunosuppression therapy"
            4 => "Psoriasis"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Real-world&#44; primary data on the treatment of psoriasis are scarce&#44; especially concerning the role of soluble biomarkers as outcome predictors&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The authors evaluated the utility of Th1&#47;Th17 serum cytokines along with clinical characteristics as predictors of drug survival in the treatment of psoriasis&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The authors consecutively included participants with moderate to severe psoriasis who were followed up for 6 years&#46; Baseline interferon-&#945;&#44; tumor necrosis factor-&#945;&#44; and interleukin &#40;IL&#41;-2&#44; IL-4&#44; IL-6&#44; IL-10&#44; and IL-17A were measured using a cytometric bead array&#59; clinical data were assessed&#46; The authors calculated hazard ratios &#40;HRs&#41; for drug survival using a Cox proportional hazards model&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The authors included 262 patients&#44; most of whom used systemic immunosuppressants or biologics&#46; In the multivariate model&#44; poor quality of life measured by the Dermatology Life Quality Index &#40;HR&#160;&#61;&#160;1&#46;04&#59; 95&#37; CI 1&#46;01&#8210;1&#46;07&#59; p&#160;&#61;&#160;0&#46;012&#41; and elevated baseline IL-6 &#40;HR&#160;&#61;&#160;1&#46;99&#59; 95&#37; CI 1&#46;29&#8210;3&#46;08&#59; p&#160;&#61;&#160;0&#46;002&#41; were associated with treatment interruption&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Study limitations</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The main limitation of any cohort study is the presence of confounders that could not be detected in clinical evaluation&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Poor quality of life and elevated baseline serum IL-6 level predicted treatment interruption in patients with moderate to severe psoriasis&#46; Although IL-6 is not the most important mediator of the inflammatory pathway in the skin environment&#44; it is an interesting biomarker candidate for predicting psoriasis treatment response&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Study conducted at the Servi&#231;o de Dermatologia&#44; Hospital Universit&#225;rio de Bras&#237;lia&#44; Bras&#237;lia&#44; DF&#44; Brazil&#59; Instituto Ren&#233; Rachou&#44; Funda&#231;&#227;o Oswaldo Cruz&#44; Fiocruz Minas&#44; Belo Horizonte&#44; MG&#44; Brazil&#46;</p>"
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            "apendice" => "<p id="par0250" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0100"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Serum cytokine levels in psoriasis patients according to the type of basal immunosuppressive therapy at the time of inclusion&#46; Data are shown as a scattering distribution of individual values over bar charts representing the median levels of each cytokine&#46; IL&#44; Interleukin&#59; TNF&#44; Tumor Necrosis Factor&#59; IFN&#44; Interferon&#59; HC&#44; Healthy Controls&#59; No&#44; Psoriasis patients using no systemic immunosuppressors&#59; Classic&#44; Psoriasis patients using classic immunosuppressors&#59; &#945;-TNF&#44; Psoriasis patients using anti-tumor necrosis factor agents&#59; &#945;-IL&#44; Psoriasis patients using anti IL agents&#59; p-values for all groups that presented a significant difference are disclosed at the bottom of each graphic&#46; Non-significant p-values &#40;&#62; 0&#46;05&#41; are not represented&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Serum cytokine levels in psoriasis patients according to drug survival stratified by 1 to 4 years and 5 to 6 years&#46; Data are shown as scattering distribution of individual values over bar charts representing median levels of each cytokine&#46; IL&#44; Interleukin&#59; TNF&#44; Tumor Necrosis Factor&#59; IFN&#44; Interferon&#59; HC&#44; Healthy Controls&#59; p-values for all groups that presented a significant difference are disclosed at the bottom of each graphic&#46; Non-significant p-values &#40;&#62; 0&#46;05&#41; are not represented&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Survival curve showing the joint effect of the two main predictors of drug interruption Interleukin &#40;IL&#41;-6 levels and Dermatology Life Quality Index &#40;DLQI&#41;&#46; It can be seen that patients experiencing higher DLQI and IL-6 levels had an almost 75&#37; chance of systemic treatment change in the follow-up period&#46; mIL6&#44; Median IL-6 scores of the present population &#40;0&#160;&#61;&#160;below the median value&#59; 1&#160;&#61;&#160;above the median value&#41;&#46; mDLQI&#44; DLQI score of the present population&#59; 0&#160;&#61;&#160;below 5&#59; 1&#160;&#61;&#160;above or equal 5&#46;</p>"
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">BSA&#44; Body Surface Area&#59; PASI&#44; Psoriasis Area and Severity Index&#59; DLQI&#44; Dermatology Life Quality Index&#46;</p>"
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                  \t\t\t\t" scope="col">p-value &#40;log-rank test&#41;</th><th class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&#44; n &#40;&#37;&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;51&#46;64&#37;&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 &#40;50&#46;00&#37;&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">133 &#40;50&#46;76&#37;&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;888&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;760&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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"><span class="elsevierStyleHsp" style=""></span>Female&#44; n &#40;&#37;&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;48&#46;36&#37;&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 &#40;50&#46;00&#37;&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">129 &#40;49&#46;23&#37;&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\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">Age&#58; mean &#40;SD&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&#46;17 &#40;14&#46;75&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#46;79 &#40;14&#46;58&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&#46;64 &#40;14&#46;81&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;012&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;99 &#40;0&#46;98&#8210;1&#46;01&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;302&nbsp;\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">Smoking habit n &#40;&#37;&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;22&#46;13&#37;&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;13&#46;57&#37;&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 &#40;17&#46;56&#37;&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;104&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;063&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;29 &#40;0&#46;80&#8210;2&#46;08&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;294&nbsp;\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">Alcohol abuse&#44; n &#40;&#37;&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#40;19&#46;67&#37;&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;26&#46;43&#37;&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;23&#46;28&#37;&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;239&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;270&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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">IL2 levels&#58; median &#40;IQR&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;19 &#40;2&#46;36&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;00 &#40;1&#46;46&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;081&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;03 &#40;0&#46;68&#8210;1&#46;56&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;890<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\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">IL4 levels&#58; median &#40;IQR&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;53 &#40;1&#46;67&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;12 &#40;1&#46;55&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;255&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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">IL6 levels&#58; median &#40;IQR&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;69 &#40;3&#46;83&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;40 &#40;3&#46;27&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;002&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;99 &#40;1&#46;29&#8210;3&#46;08&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;002<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\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">IL10 levels&#58; median &#40;IQR&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;11 &#40;1&#46;08&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;97 &#40;0&#46;90&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;312&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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">IL17A levels median &#40;IQR&#41;&nbsp;\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="left" valign="\n
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                  \t\t\t\t">3&#46;13 &#40;6&#46;65&#41;&nbsp;\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="left" valign="\n
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                  \t\t\t\t">1&#46;44 &#40;7&#46;54&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;344&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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">IFN levels&#58; median &#40;IQR&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;30 &#40;1&#46;73&#41;&nbsp;\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="left" valign="\n
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                  \t\t\t\t">0&#46;20 &#40;1&#46;55&#41;&nbsp;\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="left" valign="\n
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                  \t\t\t\t">&nbsp;\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="left" valign="\n
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                  \t\t\t\t">0&#46;478&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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">TNF levels&#58; median &#40;IQR&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;10 &#40;1&#46;74&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;04 &#40;0&#46;74&#41;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;335&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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="left" valign="\n
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                  \t\t\t\t">&#8210;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\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">Associated medications&#44; n &#40;&#37;&#41;&nbsp;\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="left" valign="\n
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                  \t\t\t\t">5 &#40;4&#46;09&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;7&#46;86&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&#46;00 &#40;6&#46;11&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;313&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8210;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8210;&nbsp;\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">Previous therapeutic failures&#58; median &#40;IQR&#41;&nbsp;\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="left" valign="\n
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                  \t\t\t\t">1&#46;00 &#40;1&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;00 &#40;1&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;00 &#40;1&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;964&nbsp;\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="left" valign="\n
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                  \t\t\t\t">&#8210;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#8210;&nbsp;\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="left" valign="\n
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                  \t\t\t\t">&#8210;&nbsp;\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">Bioexclusive&#44; n &#40;&#37;&#41;&nbsp;\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="left" valign="\n
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                  \t\t\t\t">32 &#40;26&#46;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">36 &#40;25&#46;71&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">68 &#40;25&#46;95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;760&nbsp;\t\t\t\t\t\t\n
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                  \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"><span class="elsevierStyleBold">Psoriasis Classification</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Plaques&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">109 &#40;89&#46;34&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">113 &#40;80&#46;71&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">222 &#40;84&#46;73&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;462&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;810&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8210;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Scalp n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;3&#46;28&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;5&#46;71&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;4&#46;58&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Basal BSA mean &#40;SD&#41;&nbsp;\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="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8210;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Basal PASI mean &#40;SD&#41;&nbsp;\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="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;99 &#40;0&#46;96&#8210;1&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#46;739&nbsp;\t\t\t\t\t\t\n
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                  \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">Basal DLQI mean &#40;SD&#41;&nbsp;\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="left" valign="\n
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                  \t\t\t\t">7&#46;57 &#40;7&#46;79&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;42 &#40;6&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8210;&nbsp;\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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;04 &#40;1&#46;01&#8210;1&#46;07&#41;&nbsp;\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="left" valign="\n
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                  \t\t\t\t">0&#46;012&nbsp;\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">Basal NAPSI mean &#40;SD&#41;&nbsp;\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="left" valign="\n
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                  \t\t\t\t">3&#46;79 &#40;7&#46;76&#41;&nbsp;\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="left" valign="\n
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                  \t\t\t\t">1&#46;08 &#40;3&#46;50&#41;&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Tofacitinib attenuates pathologic immune pathways in patients with psoriasis&#58; a randomized phase 2 study"
                      "autores" => array:1 [
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                          "autores" => array:6 [
                            0 => "J&#46; Krueger"
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                            3 => "J&#46; Fuentes-Duculan"
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                            5 => "C&#46;Q&#46; Wang"
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                      "doi" => "10.1016/j.jaci.2015.12.1318"
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                        "tituloSerie" => "J Allergy Clin Immunol&#46;"
                        "fecha" => "2016"
                        "volumen" => "137"
                        "paginaInicial" => "1079"
                        "paginaFinal" => "1090"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27059729"
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