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O objetivo do presente estudo foi avaliar a efic&#225;cia e a seguran&#231;a do secuquinumabe e os fatores que afetaram sua efic&#225;cia em pacientes com psor&#237;ase em placas acompanhados em uma cl&#237;nica dermatol&#243;gica na Turquia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materiais e m&#233;todos</span><p id="par0015" class="elsevierStylePara elsevierViewall">Neste estudo observacional e retrospectivo de seguimento&#44; foram inclu&#237;dos pacientes com psor&#237;ase em placas&#44; moderada a grave&#44; com idade igual ou superior a 18 anos&#44; submetidos a pelo menos 16 semanas de tratamento com secuquinumabe em uma cl&#237;nica dermatol&#243;gica&#44; entre junho de 2018 e junho de 2023&#46; Antes do tratamento com secuquinumabe&#44; todas as infec&#231;&#245;es&#44; incluindo infec&#231;&#227;o pelos v&#237;rus da hepatite B e C e <span class="elsevierStyleItalic">status</span> de tuberculose &#40;Tb&#41;&#44; foram avaliadas por meio de hist&#243;ria&#44; exame f&#237;sico&#44; hemograma completo&#44; prote&#237;na C reativa&#44; transaminases&#44; exame de urina completo&#44; radiografia de t&#243;rax&#44; exame de prova tubercul&#237;nica &#40;PPD&#44; do ingl&#234;s <span class="elsevierStyleItalic">purified protein derivative</span>&#41; e&#47;ou testes QuantiFERON&#8208;TB e marcadores de v&#237;rus da hepatite B e C&#46; Secuquinumabe &#40;300<span class="elsevierStyleHsp" style=""></span>mg&#44; via SC&#41; foi administrado como dose de ataque inicial nas semanas 0&#44; 1&#44; 2&#44; 3 e 4&#44; e depois uma vez a cada quatro semanas&#46; Inje&#231;&#245;es de secuquinumabe foram administradas durante as consultas&#46; O estudo foi aprovado pelo Comit&#234; de &#201;tica local &#40;Decis&#227;o n&#176; 25&#47;2023&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Foram registradas caracter&#237;sticas sociodemogr&#225;ficas&#44; tratamentos sist&#234;micos e biol&#243;gicos anteriores&#44; ocorr&#234;ncia concomitante de artrite psori&#225;sica e envolvimento ungueal&#44; uso de isoniazida e estado de profilaxia para hepatite B dos pacientes&#46; Os escores do &#237;ndice de gravidade da &#225;rea de psor&#237;ase &#40;PASI&#44; do ingl&#234;s <span class="elsevierStyleItalic">Psoriasis Area Severity Index</span>&#41; foram comparados antes do secuquinumabe e nas semanas 16&#44; 28&#44; 52&#44; 76&#44; 100&#44; 148 e 196&#46; A efic&#225;cia do secuquinumabe foi expressa como a porcentagem de pacientes que atingiram PASI&#8208;75&#44; PASI&#8208;90 e PASI&#8208;100&#46; Al&#233;m disso&#44; os pacientes que alcan&#231;aram PASI absoluto &#8804; 1&#44; &#8804; 3 e &#8804; 5 com secuquinumabe foram determinados como porcentagem&#46; Foram registrados efeitos adversos&#44; dura&#231;&#227;o do uso de secuquinumabe e motivos para a descontinua&#231;&#227;o do secuquinumabe&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">An&#225;lise estat&#237;stica</span><p id="par0025" class="elsevierStylePara elsevierViewall">Foi realizada a an&#225;lise descritiva de todas as vari&#225;veis inclu&#237;das no estudo&#46; As vari&#225;veis quantitativas foram expressas como m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desvio padr&#227;o &#40;DP&#41;&#44; ou como mediana e intervalo&#46; As vari&#225;veis qualitativas foram expressas em valor absoluto &#40;n&#41; e porcentagem&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">As an&#225;lises de Qui&#8208;Quadrado de Pearson e teste T de amostras independentes foram utilizadas na an&#225;lise das tabelas cruzadas&#46; O <span class="elsevierStyleItalic">software</span> IBM SPSS Statistics 21&#46;0 &#40;IBM Corp&#46;&#44; Armonk&#44; NY&#41; foi utilizado para a an&#225;lise&#46; O valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foi aceito como crit&#233;rio para signific&#226;ncia estat&#237;stica&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Resultados</span><p id="par0035" class="elsevierStylePara elsevierViewall">Um total de 101 pacientes&#44; 66 &#40;65&#37;&#41; homens e 35 &#40;35&#37;&#41; mulheres&#44; foram inclu&#237;dos no estudo&#46; A m&#233;dia de idade dos pacientes foi de 50&#44;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;60 anos&#46; A m&#233;dia do &#237;ndice de massa corporal &#40;IMC&#41; dos pacientes foi de 28&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;74&#46; Setenta e quatro &#40;73&#37;&#41; dos pacientes apresentavam sobrepeso ou obesidade &#40;IMC &#8805; 25&#41;&#46; Quando os tratamentos anteriores foram avaliados&#44; 95 &#40;95&#37;&#41; pacientes haviam sido tratados com terapia sist&#234;mica convencional e 53 &#40;53&#37;&#41; pacientes eram virgens de tratamento biol&#243;gico&#46; Vinte e um &#40;21&#37;&#41; pacientes apresentavam artrite psori&#225;sica&#44; e 38 &#40;38&#37;&#41; pacientes apresentavam envolvimento ungueal &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; Trinta e sete &#40;37&#37;&#41; pacientes apresentavam pelo menos uma comorbidade&#46; As comorbidades mais comuns foram hipertens&#227;o arterial &#40;HT&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41;&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> &#40;DM&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&#44; doen&#231;as da tireoide &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&#44; doen&#231;a arterial coronariana &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; asma &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; doen&#231;a de Parkinson &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; hemangioma &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; enxaqueca &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; insufici&#234;ncia card&#237;aca &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; esclerose m&#250;ltipla &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; doen&#231;a de Buerger &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; artrite reumatoide &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; doen&#231;a de Beh&#231;et &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; vitiligo &#40;1&#41;&#44; insufici&#234;ncia renal cr&#244;nica &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; e policitemia vera &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">O PASI m&#233;dio dos pacientes foi de 12&#44;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;47 antes do tratamento com secuquinumabe&#46; Depois de 16&#44; 28 e 52 semanas&#44; o PASI m&#233;dio foi 2&#44;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;73&#59; 2&#44;08<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;99&#59; e 1&#44;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;43&#44; respectivamente&#46; Esses valores foram significantemente menores em pacientes virgens de tratamento biol&#243;gico em compara&#231;&#227;o com pacientes n&#227;o virgens em 16&#44; 28 e 52 semanas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#59; e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#44; respectivamente&#59; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Na semana 16&#44; 72&#37; dos pacientes tinham PASI&#8208;75&#44; 50&#37; tinham PASI&#8208;90 e 30&#37; tinham PASI&#8208;100&#46; As respostas PASI&#8208;75 e &#8208;90 foram maiores em pacientes virgens de tratamento nas semanas 16 e 28 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#44; respectivamente&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; A porcentagem de todos os pacientes com PASI &#8804; 1&#44; &#8804; 3 e &#8804; 5 foi de 50&#37;&#44; 77&#37; e 92&#37;&#44; respectivamente&#44; na semana 16 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; No grupo virgem de tratamento&#44; essas porcentagens foram 62&#44;2&#37;&#44; 90&#44;5&#37;&#44; 98&#44;1&#37; e 60&#37;&#44; 88&#44;8&#37;&#44; 97&#44;7&#37; nas semanas 16 e 28&#44; respectivamente&#46; No grupo n&#227;o virgem de tratamento&#44; essas porcentagens foram 37&#44;5&#37;&#44; 62&#44;5&#37;&#44; 85&#44;4&#37; e 38&#44;1&#37;&#44; 61&#44;9&#37;&#44; 80&#44;9&#37; nas semanas 16 e 28&#44; respectivamente&#46; Elas foram maiores no grupo virgem do que no grupo n&#227;o virgem de tratamento &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;07&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#44; respectivamente&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">No presente estudo&#44; 56 &#40;56&#37;&#41; dos pacientes eram tabagistas&#46; Em geral&#44; as taxas de resposta ao secuquinumabe foram baixas em pacientes tabagistas em todas as semanas&#46; Na semana 52&#44; as respostas PASI&#8208;75 &#40;58&#44;33&#37; em fumantes&#44; 83&#44;87&#37; em n&#227;o fumantes&#41;&#44; PASI&#8208;90 &#40;44&#44;44&#37; em fumantes&#44; 74&#44;19&#37; em n&#227;o fumantes&#41; e PASI&#8208;100 &#40;19&#44;44&#37; em fumantes&#44; 54&#44;84&#37; em n&#227;o fumantes&#41; foram significantemente menores em pacientes tabagistas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#44; respectivamente&#41;&#46; Al&#233;m disso&#44; a porcentagem de pacientes com PASI absoluto &#8804; 1 na semana 16 &#40;39&#44;29&#37; em fumantes&#44; 64&#44;44&#37; em n&#227;o fumantes&#41; e com PASI absoluto &#8804; 3 na semana 52 &#40;66&#44;67&#37; em fumantes&#44; 90&#44;32&#37; em n&#227;o fumantes&#41; foi significantemente menor em fumantes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#44; respectivamente&#41;&#46; No presente estudo&#44; a dura&#231;&#227;o m&#233;dia do tratamento com secuquinumabe foi de 19&#44;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;49 meses em fumantes e de 20&#44;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;23 meses em n&#227;o fumantes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;77&#41;&#46; O tratamento com secuquinumabe foi interrompido por algum motivo em 48&#44;21&#37; dos fumantes e 33&#44;33&#37; dos n&#227;o fumantes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;19&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Doze &#40;12&#37;&#41; dos pacientes consumiam &#225;lcool e n&#227;o houve rela&#231;&#227;o entre o consumo de &#225;lcool e as taxas de resposta ao tratamento &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Nos pacientes com IMC &#8805; 25&#44; presen&#231;a de artrite&#44; envolvimento ungueal e pelo menos uma comorbidade&#44; as respostas ao tratamento foram geralmente baixas em todas as semanas em compara&#231;&#227;o com aqueles sem essas condi&#231;&#245;es&#44; mas n&#227;o houve diferen&#231;a significante &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A dura&#231;&#227;o m&#233;dia do tratamento com secuquinumabe foi de 19&#44;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;76 meses&#46; No momento em que o estudo foi realizado&#44; 87 pacientes atingiram o m&#234;s 7&#44; 67 atingiram o m&#234;s 13&#44; 30 atingiram o m&#234;s 25&#44; 22 atingiram o m&#234;s 31&#44; 13 atingiram o m&#234;s 37&#44; nove atingiram o m&#234;s 43 e dois atingiram o m&#234;s 49&#46; O secuquinumabe foi descontinuado em um algum momento durante o tratamento em 40 &#40;40&#37;&#41; pacientes&#46; Vinte e um &#40;21&#37;&#41; desses pacientes n&#227;o quiseram usar o secuquinumabe ou abandonaram o seguimento&#46; Inefic&#225;cia prim&#225;ria foi observada em seis pacientes &#40;6&#37;&#41;&#44; inefic&#225;cia secund&#225;ria em nove &#40;9&#37;&#41;&#44; e eventos adversos em dois &#40;2&#37;&#41; pacientes&#46; Os efeitos adversos foram neutropenia em um paciente e diarreia em outro&#46; Al&#233;m disso&#44; um paciente desenvolveu c&#226;ncer da mama subsequentemente e o secuquinumabe foi descontinuado&#46; Um paciente apresentou piora da artrite psori&#225;sica&#44; embora sua pele apresentasse boas condi&#231;&#245;es&#44; e o secuquinumabe foi descontinuado&#46; O secuquinumabe foi descontinuado em 14 &#40;26&#44;4&#37;&#41; dos pacientes virgens de tratamento e em 28 &#40;58&#44;3&#37;&#41; dos pacientes n&#227;o virgens de tratamento em algum momento durante o tratamento &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; As raz&#245;es para a descontinua&#231;&#227;o do secuquinumabe em pacientes virgens de tratamento foram o n&#227;o seguimento &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#59; 53&#44;8&#37;&#41;&#44; inefic&#225;cia secund&#225;ria &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#59; 30&#44;7&#37;&#41; e eventos adversos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#59; 15&#44;3&#37;&#41;&#59; em pacientes n&#227;o virgens de tratamento&#44; os motivos foram o n&#227;o seguimento &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#59; 51&#44;8&#37;&#41;&#44; inefic&#225;cia prim&#225;ria &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#59; 22&#44;2&#37;&#41;&#44; inefic&#225;cia secund&#225;ria &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#59; 18&#44;5&#37;&#41; e outras raz&#245;es &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#59; 7&#44;4&#37;&#41;&#44; respectivamente &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;26&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">O evento adverso mais comum foi infec&#231;&#227;o mucocut&#226;nea por <span class="elsevierStyleItalic">Candida</span> &#40;8&#37;&#41;&#46; Al&#233;m disso&#44; foram observadas infec&#231;&#227;o leve do trato respirat&#243;rio superior em tr&#234;s pacientes&#44; infec&#231;&#227;o do trato urin&#225;rio em um paciente&#44; neutropenia em um paciente e diarreia em um paciente&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">No presente estudo&#44; 20 &#40;20&#37;&#41; dos pacientes apresentavam infec&#231;&#227;o inativa pelo v&#237;rus da hepatite B &#40;HBV&#59; anticorpo central da hepatite B &#40;HbcAb&#41;&#43;&#44; ant&#237;geno de superf&#237;cie do v&#237;rus da hepatite B &#40;HBsAg&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>&#44; DNA do HBV&#8722;&#41;&#46; Nenhum paciente apresentou anticorpos HBsAg&#43; e antiv&#237;rus da hepatite C &#40;anticorpos anti&#8208;HCV&#43;&#41;&#46; Todos os pacientes com infec&#231;&#227;o inativa pelo VHB receberam profilaxia para reativa&#231;&#227;o por consultor de gastroenterologia&#46; Nenhuma reativa&#231;&#227;o de hepatite B ou C foi observada no per&#237;odo de seguimento&#46; No presente estudo&#44; o teste tubercul&#237;nico &#40;PPD&#41; foi &#8805; 5<span class="elsevierStyleHsp" style=""></span>mm em 21 &#40;48&#37;&#41; dos 57 pacientes avaliados com teste PPD&#44; e o teste QuantiFERON&#8208;TB foi positivo em 19 &#40;23&#37;&#41; dos 83 pacientes avaliados com testes QuantiFERON&#8208;TB&#46; Quarenta e oito &#40;48&#37;&#41; pacientes receberam profilaxia com isoniazida por um consultor de doen&#231;as pulmonares&#46; Nenhum caso de Tb ativa ou reativa&#231;&#227;o foi observado durante o per&#237;odo de seguimento&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Discuss&#227;o</span><p id="par0070" class="elsevierStylePara elsevierViewall">A efic&#225;cia e a seguran&#231;a do secuquinumabe na psor&#237;ase foram demonstradas em ensaios cl&#237;nicos&#46; As taxas de resposta de PASI&#8208;75&#44; &#8208;90&#44; &#8208;100 na semana 12 com 300<span class="elsevierStyleHsp" style=""></span>mg de secuquinumabe foram 81&#44;6&#37;&#44; 59&#44;2&#37;&#44; 28&#44;6&#37;&#44; 77&#44;1&#37;&#44; 54&#44;2&#37;&#44; 24&#44;1&#37;&#44; 86&#44;7&#37;&#44; 55&#37; e 26&#44;7&#37;&#44; respectivamente&#44; em ensaios cl&#237;nicos randomizados de fase 3&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">4&#8211;6</span></a> No presente estudo&#44; as taxas de resposta PASI&#8208;75&#44; &#8208;90&#44; &#8208;100 foram de 72&#37;&#44; 50&#37;&#44; 30&#37;&#44; respectivamente&#44; na semana 16 e foram mais baixas do que em estudos cl&#237;nicos&#46; No presente estudo&#44; em 16 e 28 semanas&#44; as taxas de resposta PASI&#8208;75&#44; &#8208;90&#44; &#8208;100 foram maiores em pacientes virgens de tratamento em compara&#231;&#227;o com pacientes n&#227;o virgens de tratamento &#40;53&#37; dos pacientes eram virgens de tratamentos biol&#243;gicos&#41;&#46; Nos ensaios cl&#237;nicos randomizados de fase 3&#44; 71&#44;4&#37;&#44; 88&#44;4&#37; e 75&#37; dos pacientes eram virgens de tratamentos biol&#243;gicos&#44; respectivamente&#46; Portanto&#44; as taxas de resposta PASI&#8208;75&#44; &#8208;90&#44; &#8208;100 no presente estudo podem ter sido inferiores &#224;s dos estudos cl&#237;nicos&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">4&#8211;6</span></a>Em um conjunto de dados da pr&#225;tica cl&#237;nica de 121 pacientes&#44; as taxas de resposta PASI&#8208;75&#44; &#8208;90&#44; &#8208;100 &#40;84&#44;3&#37;&#44; 68&#44;6&#37;&#44; 18&#44;2&#37; <span class="elsevierStyleItalic">vs</span>&#46; 89&#44;3&#37;&#44; 73&#44;6&#37;&#44; 9&#44;1&#37; <span class="elsevierStyleItalic">vs</span>&#46; 86&#44;1&#37;&#44; 64&#44;6&#37;&#44; 7&#44;6&#37;&#41; nas semanas 16&#44; 24 e 52 foram superiores &#224;s do presente estudo&#46; No entanto&#44; naquele estudo&#44; o n&#250;mero de pacientes virgens de tratamento biol&#243;gico foi bem maior &#40;80&#37;&#41; do que no presente&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> Aus&#234;ncia de tratamento biol&#243;gico anterior &#233; um dos fatores mais importantes que afetam as taxas de resposta ao secuquinumabe em pacientes com psor&#237;ase&#46; Assim como em ensaios cl&#237;nicos&#44; foi demonstrado que a aus&#234;ncia de experi&#234;ncia biol&#243;gica anterior est&#225; associada a resposta elevada ao secuquinumabe em muitos casos da pr&#225;tica cl&#237;nica&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">7&#8211;12</span></a>No presente estudo&#44; o PASI absoluto dos pacientes tamb&#233;m foi avaliado no tratamento com secuquinumabe&#46; A porcentagem de pacientes com PASI &#8804; 1&#44; PASI &#8804; 3&#44; PASI &#8804; 5 foi de 50&#37;&#44; 77&#37; e 92&#37;&#44; respectivamente&#44; na semana 16&#46; Essas taxas foram maiores em pacientes virgens de tratamento do que em pacientes n&#227;o virgens&#46; Segundo dados da pr&#225;tica cl&#237;nica de 136 pacientes na Espanha com psor&#237;ase tratados com secuquinumabe&#44; a porcentagem de pacientes com PASI &#8804; 1&#44; &#8804; 2&#44; &#8804; 3&#44; &#8804; 5 foi de 47&#37;&#44; 64&#37;&#44; 75&#37; e 86&#37;&#44; respectivamente na semana 16&#46; Essas taxas s&#227;o mais baixas do que as encontradas no presente estudo&#46; Da mesma maneira&#44; taxas de resposta mais altas foram relatadas em pacientes virgens de tratamento naquele estudo&#44; e apenas 27&#44;9&#37; dos pacientes eram virgens de tratamentos biol&#243;gicos&#44; explicando as taxas de resposta mais baixas em compara&#231;&#227;o com o presente estudo&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a> Em outro estudo&#44; o PASI absoluto baixo com secuquinumabe foi associado ao fato de os pacientes serem virgens de tratamento biol&#243;gicos&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Fatores ambientais extr&#237;nsecos&#44; como ingest&#227;o de &#225;lcool&#44; tabagismo&#44; estresse&#44; dist&#250;rbios do sono&#44; vida sedent&#225;ria e dieta&#44; afetam a apresenta&#231;&#227;o cl&#237;nica&#44; a gravidade&#44; o curso e as taxas de resposta ao tratamento da psor&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a> Em um estudo&#44; descobriu&#8208;se que a obesidade reduz a possibilidade de tratamento com produtos biol&#243;gicos&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> Al&#233;m disso&#44; foi demonstrado que IMC mais elevado est&#225; associado &#224; resposta baixa ao secuquinumabe&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">8&#44;10</span></a> Em outro estudo&#44; a obesidade foi relatada como importante fator preditivo para taxas de resposta PASI&#8208;75 com secuquinumabe na semana 16&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> No presente estudo&#44; as taxas de resposta PASI&#8208;75&#44; &#8208;90&#44; &#8208;100 em todas as semanas foram baixas em pacientes obesos ou com sobrepeso &#40;IMC &#8805; 25&#41;&#44; mas n&#227;o houve diferen&#231;a estatisticamente significante&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Os mediadores pr&#243;&#8208;inflamat&#243;rios circulantes na psor&#237;ase causam resposta inflamat&#243;ria generalizada e comorbidades&#44; como doen&#231;as cardiovasculares&#44; hipertens&#227;o&#44; DM&#44; HT e s&#237;ndrome metab&#243;lica &#40;SM&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a> Al&#233;m disso&#44; muitas doen&#231;as como obesidade&#44; artrite psori&#225;sica&#44; doen&#231;as inflamat&#243;rias intestinais&#44; doen&#231;as renais cr&#244;nicas&#44; doen&#231;as autoimunes da tireoide&#44; transtornos de humor e asma podem acompanhar a psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">16&#44;17</span></a> Neste estudo&#44; 37 &#40;37&#37;&#41; dos pacientes tinham pelo menos uma comorbidade&#59; as mais comuns foram HT &#40;19 pacientes&#41;&#44; DM &#40;13 pacientes&#41;&#44; doen&#231;as da tireoide &#40;11 pacientes&#41;&#44; doen&#231;a arterial coronariana &#40;quatro pacientes&#41;&#44; e asma &#40;quatro pacientes&#41;&#44; respectivamente&#46; As comorbidades tamb&#233;m causam dificuldades no tratamento da psor&#237;ase&#46; Um estudo demonstrou que comorbidades como SM&#44; HT e DM est&#227;o associadas &#224; baixa resposta ao secuquinumabe&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a> No presente estudo&#44; as taxas de resposta do secuquinumabe foram geralmente baixas em pacientes com comorbidades&#44; mas n&#227;o houve diferen&#231;a estatisticamente significante&#46; Al&#233;m disso&#44; 52&#44;35&#37; dos pacientes com comorbidades e 35&#44;6&#37; dos pacientes sem comorbidades descontinuaram o uso de secuquinumabe durante o per&#237;odo do tratamento&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Cinquenta e seis &#40;56&#37;&#41; dos pacientes eram tabagistas no presente estudo&#46; As taxas de resposta do secuquinumabe foram geralmente baixas em pacientes tabagistas em todas as semanas&#46; A porcentagem de pacientes com PASI &#8804; 1 na semana 16 e PASI &#8804; 3 na semana 52 foi significantemente menor em fumantes&#46; Al&#233;m disso&#44; as taxas de resposta PASI&#8208;75&#44; &#8208;90&#44; &#8208;100 na semana 52 foram significantemente mais baixas nos fumantes&#46; H&#225; resultados conflitantes associados &#224;s taxas de resposta ao secuquinumabe e ao tabagismo na literatura&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">7&#44;18</span></a> Em um estudo de coorte que avaliou um total de 2&#46;384 pacientes recebendo terapia biol&#243;gica&#44; incluindo adalimumabe&#44; etanercepte&#44; infliximabe&#44; ustequinumabe e secuquinumabe&#44; foi relatado que o tabagismo reduz as taxas de resposta ao tratamento com todos os agentes&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> N presente estudo&#44; 12 &#40;12&#37;&#41; dos pacientes consumiam &#225;lcool e n&#227;o houve rela&#231;&#227;o entre a ingest&#227;o de &#225;lcool e as taxas de resposta ao secuquinumabe&#46; Esses dados foram compat&#237;veis com a literatura&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">7&#44;14</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Uma metan&#225;lise de 43 estudos relatou que as taxas de eventos adversos foram consistentes com estudos cl&#237;nicos e n&#227;o foi observado nenhum novo sinal de seguran&#231;a associado ao secuquinumabe&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a> O evento adverso mais comum na pr&#225;tica cl&#237;nica com secuquinumabe foi infec&#231;&#227;o por <span class="elsevierStyleItalic">Candida</span>&#46; Eventos adversos como nasofaringite&#44; pneumonia&#44; foliculite&#44; cefaleia&#44; diarreia&#44; tireoidite subaguda&#44; neutropenia&#44; trombocitopenia e transaminases elevadas tamb&#233;m foram relatados&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">7&#8211;10</span></a> O evento adverso mais comum nos pacientes do presente estudo foi candid&#237;ase oral &#40;8&#37;&#41;&#46; Al&#233;m disso&#44; foi observada infec&#231;&#227;o leve do trato respirat&#243;rio superior em tr&#234;s pacientes e infec&#231;&#227;o do trato urin&#225;rio em um paciente&#46; Nenhum desses pacientes necessitou de descontinua&#231;&#227;o do secuquinumabe&#46; No entanto&#44; o secuquinumabe foi descontinuado em decorr&#234;ncia de neutropenia em um paciente e diarreia em outro&#46; N&#227;o foi detectada doen&#231;a inflamat&#243;ria intestinal &#40;DII&#41; no per&#237;odo de controle e seguimento do paciente com diarreia pelo consultor da gastroenterologia&#46; Em dados reais de 108 pacientes com psor&#237;ase tratados com secuquinumabe&#44; foi observada diarreia em tr&#234;s pacientes durante o per&#237;odo de seguimento&#44; mas nenhum apresentou DII&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> Al&#233;m disso&#44; uma metan&#225;lise de 21 estudos cl&#237;nicos incluindo 7&#46;355 pacientes mostrou que o secuquinumabe n&#227;o aumentou o risco de DII&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a> Na an&#225;lise de ensaios cl&#237;nicos e dados de vigil&#226;ncia p&#243;s&#8208;comercializa&#231;&#227;o de at&#233; cinco anos&#44; foi demonstrado um baixo risco de neoplasia maligna com o secuquinumabe&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a> No presente estudo&#44; c&#226;ncer de mama foi detectado em uma paciente durante o tratamento com secuquinumabe&#46; A hist&#243;ria familiar da paciente era positiva para c&#226;ncer de mama e o tratamento com secuquinumabe foi descontinuado&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Vinte &#40;20&#37;&#41; pacientes apresentaram infec&#231;&#227;o inativa pelo VHB no presente estudo&#46; Todos receberam profilaxia para reativa&#231;&#227;o por gastroenterologista&#46; Nenhum caso de reativa&#231;&#227;o de hepatite B ou C foi observado no per&#237;odo de seguimento&#46; Da mesma maneira&#44; foi relatado que o secuquinumabe &#233; seguro em pacientes com hist&#243;rico de infec&#231;&#227;o por hepatite B e C em dados da pr&#225;tica cl&#237;nica&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">9&#44;23&#44;24</span></a> O secuquinumabe foi relatado como seguro em pacientes com Tb em ensaios cl&#237;nicos e tamb&#233;m em estudos de pr&#225;tica cl&#237;nica&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">9&#44;23&#44;25</span></a> No presente estudo&#44; 48 &#40;48&#37;&#41; pacientes receberam profilaxia com isoniazida por pneumologista&#46; Nenhum caso de reativa&#231;&#227;o de Tb foi observado nos pacientes durante o per&#237;odo de seguimento&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Em uma metan&#225;lise de 43 estudos&#44; a sobrevida do secuquinumabe foi relatada como 90&#37; aos tr&#234;s e seis meses e 80&#37; aos 12 meses&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a> No momento em que o presente estudo estava sendo conduzido&#44; 87&#37; dos pacientes atingiram sete meses&#44; 67&#37; atingiram 13 meses&#44; 30&#37; 25 meses&#44; 22&#37; 31 meses&#44; 13&#37; 37 meses&#44; 9&#37; 43 meses&#44; e 2&#37; 49 meses&#46; Em 40 &#40;40&#37;&#41; pacientes&#44; o secuquinumabe foi descontinuado durante o tratamento&#46; Desses&#44; 21 interromperam o seguimento&#44; seis foram descontinuados por inefic&#225;cia prim&#225;ria&#44; nove por inefic&#225;cia secund&#225;ria&#44; dois por eventos adversos &#40;um por neutropenia&#44; outro por diarreia&#41;&#44; um por c&#226;ncer de mama que apareceu mais tarde e um por agravamento de artrite &#40;mas a pele estava em boas condi&#231;&#245;es&#41;&#46; Parte do per&#237;odo de seguimento dos pacientes coincidiu com a pandemia de COVID&#8208;19 &#40;2020&#8208;2022&#41;&#59; portanto&#44; a taxa de pacientes que abandonaram o seguimento pode ter sido maior do que em outros estudos&#46; A propor&#231;&#227;o de pacientes que descontinuaram o secuquinumabe devido &#224; inefic&#225;cia foi semelhante aos dados da pr&#225;tica cl&#237;nica&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a> Entretanto&#44; em alguns estudos&#44; esse n&#250;mero foi inferior ao do presente estudo&#44; e isso pode ser decorrente da alta taxa de pacientes virgens de tratamentos biol&#243;gicos nesses estudos&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">7&#44;11</span></a> Em um estudo&#44; a descontinua&#231;&#227;o do secuquinumabe por inefic&#225;cia foi maior do que no presente estudo&#46; A taxa de pacientes virgens de tratamentos biol&#243;gicos &#233; muito baixa naquele estudo&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a> A experi&#234;ncia com tratamentos biol&#243;gicos anteriores &#233; fator muito importante para a continua&#231;&#227;o do tratamento com secuquinumabe&#46; No presente estudo&#44; a descontinua&#231;&#227;o do medicamento por inefic&#225;cia foi mais comum em pacientes n&#227;o virgens de tratamento do que em pacientes virgens de tratamento&#46; Al&#233;m disso&#44; embora o secuquinumabe n&#227;o tenha sido descontinuado em nenhum dos pacientes virgens de tratamento por inefic&#225;cia prim&#225;ria&#44; ele foi descontinuado em 22&#44;2&#37; dos pacientes n&#227;o virgens de tratamento&#46;</p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Limita&#231;&#245;es</span><p id="par0105" class="elsevierStylePara elsevierViewall">O presente estudo tem algumas limita&#231;&#245;es&#46; Este &#233; um estudo retrospectivo unic&#234;ntrico com relativamente poucos pacientes e que inclui apenas a popula&#231;&#227;o turca&#46; No entanto&#44; inclui a experi&#234;ncia de cinco anos na pr&#225;tica cl&#237;nica com secuquinumabe na psor&#237;ase&#46; Apesar dessas limita&#231;&#245;es&#44; os autores acreditam que os resultados do presente estudo s&#227;o valiosos&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conclus&#227;o</span><p id="par0110" class="elsevierStylePara elsevierViewall">Secuquinumabe &#233; op&#231;&#227;o de tratamento eficaz em pacientes com psor&#237;ase em placas em uso prolongado&#46; Nenhuma experi&#234;ncia com tratamentos biol&#243;gicos e aus&#234;ncia de tabagismo podem aumentar a efic&#225;cia e a sobrevida do medicamento&#46; &#201; tamb&#233;m uma op&#231;&#227;o de tratamento segura para casos de reativa&#231;&#227;o de hepatite e Tb latente&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Suporte financeiro</span><p id="par0115" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Contribui&#231;&#227;o dos autores</span><p id="par0120" class="elsevierStylePara elsevierViewall">Ersoy Acer&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Hilal Kaya Erdo&#287;an&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Esra A&#287;ao&#287;lu&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Hatice Ba&#351;t&#252;rk&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Muzaffer Bilgin&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Zeynep Nurhan Sara&#231;o&#287;lu&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflito de interesses</span><p id="par0150" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Efic&#225;cia e seguran&#231;a do secuquinumabe em pacientes com psor&#237;ase foram demonstradas em ensaios cl&#237;nicos randomizados e controlados&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar a efic&#225;cia e seguran&#231;a do secuquinumabe em pacientes com psor&#237;ase em placas acompanhados em uma cl&#237;nica dermatol&#243;gica&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dados de 101 pacientes com psor&#237;ase em placas submetidos a pelo menos 16 semanas de tratamento com secuquinumabe entre junho de 2018 e junho de 2023 foram analisados retrospectivamente&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Cinquenta e tr&#234;s &#40;53&#37;&#41; dos pacientes n&#227;o haviam recebido tratamento biol&#243;gico&#46; As taxas de resposta PASI&#8208;75&#44; &#8208;90 e &#8208;100 foram de 72&#37;&#44; 50&#37; e 30&#37;&#44; respectivamente&#44; na semana 16 em todos os pacientes&#46; As respostas PASI&#8208;75 e &#8208;90 foram maiores em pacientes virgens de tratamento nas semanas 16 e 28 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#44; respectivamente&#41;&#46; A porcentagem de todos os pacientes com PASI &#8804; 1&#44; &#8804; 3&#44; &#8804; 5 foi de 50&#37;&#44; 77&#37; e 92&#37;&#44; respectivamente&#44; na semana 16&#46; Elas foram maiores no grupo virgem do que no grupo n&#227;o virgem de tratamento nas semanas 16 e 28 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;07&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#44; respectivamente&#41;&#46; Na semana 52&#44; as respostas PASI&#8208;75&#44; &#8208;90 e &#8208;100 foram significantemente menores em pacientes tabagistas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#44; respectivamente&#41;&#46; A dura&#231;&#227;o m&#233;dia do tratamento com secuquinumabe foi de 19&#44;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;76 meses&#46; O secuquinumabe foi descontinuado em 14 &#40;26&#44;4&#37;&#41; dos pacientes virgens de tratamento e em 28 &#40;58&#44;3&#37;&#41; dos pacientes n&#227;o virgens de tratamento em um &#250;nico momento do tratamento &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; O evento adverso mais comuns nos pacientes foi infec&#231;&#227;o mucocut&#226;nea por <span class="elsevierStyleItalic">Candida</span> &#40;8&#37;&#41;&#46; Nenhum caso de reativa&#231;&#227;o de hepatite B ou C e nenhum caso de tuberculose ativa ou reativa&#231;&#227;o foi observado em nenhum dos pacientes durante o per&#237;odo de seguimento&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Este &#233; um estudo retrospectivo de centro &#250;nico e tem relativamente poucos pacientes&#44; incluindo apenas a popula&#231;&#227;o turca&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O secuquinumabe parece ser eficaz na psor&#237;ase em placas&#44; particularmente em pacientes n&#227;o submetidos anteriormente a tratamento com biol&#243;gicos e n&#227;o fumantes&#46; Al&#233;m disso&#44; &#233; seguro em pacientes com hepatite inativa e tuberculose&#46;</p></span>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">101 &#40;100&#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  " align="left" valign="\n
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                  \t\t\t\t">35 &#40;35&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Masculino&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 ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Idade &#40;anos&#41;&#44; m&#233;dia</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DP</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">50&#44;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;60 &#40;20&#8208;77&#41;&nbsp;\t\t\t\t\t\t\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</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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Etilismo&#44; n &#40;&#37;&#41;</span>&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">12 &#40;12&#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 ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Dura&#231;&#227;o m&#233;dia da doen&#231;a &#40;anos&#41;&#44; m&#233;dia</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DP</span>&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">19&#44;85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;81 &#40;1&#8208;56&#41;&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
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                  \t\t\t\t"><span class="elsevierStyleItalic">IMC&#44; m&#233;dia</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DP</span>&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">28&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;74&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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sobrepeso ou obeso &#40;IMC &#8805; 25&#41;&#44; n &#40;&#37;&#41;</span>&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">74 &#40;73&#37;&#41;&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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Artrite psori&#225;sica&#44; n &#40;&#37;&#41;</span>&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</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
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">38 &#40;&#37;38&#41;&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
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                  \t\t\t\t"><span class="elsevierStyleItalic">PASI basal&#44; m&#233;dia</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DP</span>&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\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">43 &#40;43&#37;&#41;&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\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">40 &#40;40&#37;&#41;&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>UVB&#8208;NB&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">33 &#40;33&#37;&#41;&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="elsevierStyleItalic">Terapia biol&#243;gica anterior&#44; n &#40;&#37;&#41;</span>&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">53 &#40;52&#37;&#41;&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Adalimumabe&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;33&#37;&#41;&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infliximabe&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;13&#37;&#41;&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Etanercepte&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#37;&#41;&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>Certolizumabe&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;3&#37;&#41;&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>Ustequinumabe&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">14 &#40;14&#37;&#41;&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="elsevierStyleItalic">Teste PPD positivo&#44; n &#40;&#37;&#41;</span>&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">21 &#40;37&#37;&#41; &#40;Total 57 pacientes&#41;&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="elsevierStyleItalic">Teste QuantiFERON TB positivo&#44; n &#40;&#37;&#41;</span>&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;23&#37;&#41; &#40;Total 83 pacientes&#41;&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="elsevierStyleItalic">Profilaxia com isoniazida</span>&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 &#40;48&#37;&#41;&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="elsevierStyleItalic">Profilaxia antiviral para hepatite B</span>&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">20 &#40;20&#37;&#41;&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="elsevierStyleItalic">Pelo menos uma comorbidade</span>&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;37&#37;&#41;&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="elsevierStyleItalic">Dura&#231;&#227;o m&#233;dia do uso de secuquinumabe &#40;meses&#41;</span>&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&#44;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;76 &#40;4&#8208;52&#41;&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="elsevierStyleItalic">Causa da descontinua&#231;&#227;o do secuquinumabe&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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"><span class="elsevierStyleHsp" style=""></span>Inefic&#225;cia prim&#225;ria&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;6&#37;&#41;&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>Inefic&#225;cia secund&#225;ria&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;9&#37;&#41;&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>Efeitos adversos e outros&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;4&#37;&#41;&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>N&#227;o seguimento&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;21&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">101 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">53 &#40;100&#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  " align="left" valign="\n
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                  \t\t\t\t">48 &#40;100&#37;&#41;&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
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">101&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">53&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">48&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PASI&#8208;75&#44; n &#40;&#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">73 &#40;72&#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">47 &#40;88&#44;6&#41;&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\ttop\n
                  \t\t\t\t">26 &#40;54&#44;1&#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
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                  \t\t\t\t"><span class="elsevierStyleBold">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&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="elsevierStyleHsp" style=""></span>PASI&#8208;90&#44; n &#40;&#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">51 &#40;50&#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">35 &#40;66&#44;04&#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"><span class="elsevierStyleItalic">N&#250;mero de pacientes na semana 28</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">N&#250;mero de pacientes na semana 52</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">N&#250;mero de pacientes na semana 76</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">N&#250;mero de pacientes na semana 100</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">N&#250;mero de pacientes na semana 124</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">N&#250;mero de pacientes na semana 148</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;00&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">N&#250;mero de pacientes na semana 172</span>&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Resultados das respostas PASI dos grupos de pacientes de acordo com as semanas</p>"
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                          "etal" => false
                          "autores" => array:3 [
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                    0 => array:2 [
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                        "volumen" => "140"
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                        "link" => array:1 [
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                        "volumen" => "75"
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                        "paginaFinal" => "338"
                        "link" => array:1 [
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Eficácia e segurança do secuquinumabe na psoríase: experiência de cinco anos na prática clínica
Ersoy Acera,
Corresponding author
ersoyacer@hotmail.com

Autor para correspondência.
, Hilal Kaya Erdoğana, Esra Ağaoğlua, Hatice Baştürka, Muzaffer Bilginb, Zeynep Nurhan Saraçoğlua
a Departamento de Dermatologia e Venereologia, Eskisehir Osmangazi University, Eskisehir, Turquia
b Departamento de Bioestatística, Eskisehir Osmangazi University, Eskisehir, Turquia
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Assim&#44; os antagonistas da IL&#8208;17 ganharam destaque no tratamento da doen&#231;a&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">1&#44;2</span></a> O secuquinumabe &#233; um anticorpo monoclonal totalmente humano contra IL&#8208;17A&#44; &#233; o primeiro agente contra IL&#8208;17A e foi aprovado em 2015 para o tratamento da psor&#237;ase moderada a grave&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A efic&#225;cia e a seguran&#231;a do secuquinumabe em pacientes com psor&#237;ase foram demonstradas em ensaios cl&#237;nicos randomizados e controlados&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">4&#8211;6</span></a> No entanto&#44; pode haver diferen&#231;as significantes entre os resultados dos ensaios cl&#237;nicos e aqueles obtidos de diferentes popula&#231;&#245;es na pr&#225;tica di&#225;ria&#46; O objetivo do presente estudo foi avaliar a efic&#225;cia e a seguran&#231;a do secuquinumabe e os fatores que afetaram sua efic&#225;cia em pacientes com psor&#237;ase em placas acompanhados em uma cl&#237;nica dermatol&#243;gica na Turquia&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materiais e m&#233;todos</span><p id="par0015" class="elsevierStylePara elsevierViewall">Neste estudo observacional e retrospectivo de seguimento&#44; foram inclu&#237;dos pacientes com psor&#237;ase em placas&#44; moderada a grave&#44; com idade igual ou superior a 18 anos&#44; submetidos a pelo menos 16 semanas de tratamento com secuquinumabe em uma cl&#237;nica dermatol&#243;gica&#44; entre junho de 2018 e junho de 2023&#46; Antes do tratamento com secuquinumabe&#44; todas as infec&#231;&#245;es&#44; incluindo infec&#231;&#227;o pelos v&#237;rus da hepatite B e C e <span class="elsevierStyleItalic">status</span> de tuberculose &#40;Tb&#41;&#44; foram avaliadas por meio de hist&#243;ria&#44; exame f&#237;sico&#44; hemograma completo&#44; prote&#237;na C reativa&#44; transaminases&#44; exame de urina completo&#44; radiografia de t&#243;rax&#44; exame de prova tubercul&#237;nica &#40;PPD&#44; do ingl&#234;s <span class="elsevierStyleItalic">purified protein derivative</span>&#41; e&#47;ou testes QuantiFERON&#8208;TB e marcadores de v&#237;rus da hepatite B e C&#46; Secuquinumabe &#40;300<span class="elsevierStyleHsp" style=""></span>mg&#44; via SC&#41; foi administrado como dose de ataque inicial nas semanas 0&#44; 1&#44; 2&#44; 3 e 4&#44; e depois uma vez a cada quatro semanas&#46; Inje&#231;&#245;es de secuquinumabe foram administradas durante as consultas&#46; O estudo foi aprovado pelo Comit&#234; de &#201;tica local &#40;Decis&#227;o n&#176; 25&#47;2023&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Foram registradas caracter&#237;sticas sociodemogr&#225;ficas&#44; tratamentos sist&#234;micos e biol&#243;gicos anteriores&#44; ocorr&#234;ncia concomitante de artrite psori&#225;sica e envolvimento ungueal&#44; uso de isoniazida e estado de profilaxia para hepatite B dos pacientes&#46; Os escores do &#237;ndice de gravidade da &#225;rea de psor&#237;ase &#40;PASI&#44; do ingl&#234;s <span class="elsevierStyleItalic">Psoriasis Area Severity Index</span>&#41; foram comparados antes do secuquinumabe e nas semanas 16&#44; 28&#44; 52&#44; 76&#44; 100&#44; 148 e 196&#46; A efic&#225;cia do secuquinumabe foi expressa como a porcentagem de pacientes que atingiram PASI&#8208;75&#44; PASI&#8208;90 e PASI&#8208;100&#46; Al&#233;m disso&#44; os pacientes que alcan&#231;aram PASI absoluto &#8804; 1&#44; &#8804; 3 e &#8804; 5 com secuquinumabe foram determinados como porcentagem&#46; Foram registrados efeitos adversos&#44; dura&#231;&#227;o do uso de secuquinumabe e motivos para a descontinua&#231;&#227;o do secuquinumabe&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">An&#225;lise estat&#237;stica</span><p id="par0025" class="elsevierStylePara elsevierViewall">Foi realizada a an&#225;lise descritiva de todas as vari&#225;veis inclu&#237;das no estudo&#46; As vari&#225;veis quantitativas foram expressas como m&#233;dia<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desvio padr&#227;o &#40;DP&#41;&#44; ou como mediana e intervalo&#46; As vari&#225;veis qualitativas foram expressas em valor absoluto &#40;n&#41; e porcentagem&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">As an&#225;lises de Qui&#8208;Quadrado de Pearson e teste T de amostras independentes foram utilizadas na an&#225;lise das tabelas cruzadas&#46; O <span class="elsevierStyleItalic">software</span> IBM SPSS Statistics 21&#46;0 &#40;IBM Corp&#46;&#44; Armonk&#44; NY&#41; foi utilizado para a an&#225;lise&#46; O valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 foi aceito como crit&#233;rio para signific&#226;ncia estat&#237;stica&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Resultados</span><p id="par0035" class="elsevierStylePara elsevierViewall">Um total de 101 pacientes&#44; 66 &#40;65&#37;&#41; homens e 35 &#40;35&#37;&#41; mulheres&#44; foram inclu&#237;dos no estudo&#46; A m&#233;dia de idade dos pacientes foi de 50&#44;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;60 anos&#46; A m&#233;dia do &#237;ndice de massa corporal &#40;IMC&#41; dos pacientes foi de 28&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;74&#46; Setenta e quatro &#40;73&#37;&#41; dos pacientes apresentavam sobrepeso ou obesidade &#40;IMC &#8805; 25&#41;&#46; Quando os tratamentos anteriores foram avaliados&#44; 95 &#40;95&#37;&#41; pacientes haviam sido tratados com terapia sist&#234;mica convencional e 53 &#40;53&#37;&#41; pacientes eram virgens de tratamento biol&#243;gico&#46; Vinte e um &#40;21&#37;&#41; pacientes apresentavam artrite psori&#225;sica&#44; e 38 &#40;38&#37;&#41; pacientes apresentavam envolvimento ungueal &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; Trinta e sete &#40;37&#37;&#41; pacientes apresentavam pelo menos uma comorbidade&#46; As comorbidades mais comuns foram hipertens&#227;o arterial &#40;HT&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41;&#44; diabetes <span class="elsevierStyleItalic">mellitus</span> &#40;DM&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&#44; doen&#231;as da tireoide &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&#44; doen&#231;a arterial coronariana &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; asma &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#44; doen&#231;a de Parkinson &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; hemangioma &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; enxaqueca &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; insufici&#234;ncia card&#237;aca &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; esclerose m&#250;ltipla &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; doen&#231;a de Buerger &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; artrite reumatoide &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; doen&#231;a de Beh&#231;et &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#44; vitiligo &#40;1&#41;&#44; insufici&#234;ncia renal cr&#244;nica &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41; e policitemia vera &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">O PASI m&#233;dio dos pacientes foi de 12&#44;41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;47 antes do tratamento com secuquinumabe&#46; Depois de 16&#44; 28 e 52 semanas&#44; o PASI m&#233;dio foi 2&#44;11<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;73&#59; 2&#44;08<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;99&#59; e 1&#44;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;43&#44; respectivamente&#46; Esses valores foram significantemente menores em pacientes virgens de tratamento biol&#243;gico em compara&#231;&#227;o com pacientes n&#227;o virgens em 16&#44; 28 e 52 semanas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#59; e p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#44; respectivamente&#59; <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Na semana 16&#44; 72&#37; dos pacientes tinham PASI&#8208;75&#44; 50&#37; tinham PASI&#8208;90 e 30&#37; tinham PASI&#8208;100&#46; As respostas PASI&#8208;75 e &#8208;90 foram maiores em pacientes virgens de tratamento nas semanas 16 e 28 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#44; respectivamente&#59; <a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46; A porcentagem de todos os pacientes com PASI &#8804; 1&#44; &#8804; 3 e &#8804; 5 foi de 50&#37;&#44; 77&#37; e 92&#37;&#44; respectivamente&#44; na semana 16 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; No grupo virgem de tratamento&#44; essas porcentagens foram 62&#44;2&#37;&#44; 90&#44;5&#37;&#44; 98&#44;1&#37; e 60&#37;&#44; 88&#44;8&#37;&#44; 97&#44;7&#37; nas semanas 16 e 28&#44; respectivamente&#46; No grupo n&#227;o virgem de tratamento&#44; essas porcentagens foram 37&#44;5&#37;&#44; 62&#44;5&#37;&#44; 85&#44;4&#37; e 38&#44;1&#37;&#44; 61&#44;9&#37;&#44; 80&#44;9&#37; nas semanas 16 e 28&#44; respectivamente&#46; Elas foram maiores no grupo virgem do que no grupo n&#227;o virgem de tratamento &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;07&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#44; respectivamente&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">No presente estudo&#44; 56 &#40;56&#37;&#41; dos pacientes eram tabagistas&#46; Em geral&#44; as taxas de resposta ao secuquinumabe foram baixas em pacientes tabagistas em todas as semanas&#46; Na semana 52&#44; as respostas PASI&#8208;75 &#40;58&#44;33&#37; em fumantes&#44; 83&#44;87&#37; em n&#227;o fumantes&#41;&#44; PASI&#8208;90 &#40;44&#44;44&#37; em fumantes&#44; 74&#44;19&#37; em n&#227;o fumantes&#41; e PASI&#8208;100 &#40;19&#44;44&#37; em fumantes&#44; 54&#44;84&#37; em n&#227;o fumantes&#41; foram significantemente menores em pacientes tabagistas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#44; respectivamente&#41;&#46; Al&#233;m disso&#44; a porcentagem de pacientes com PASI absoluto &#8804; 1 na semana 16 &#40;39&#44;29&#37; em fumantes&#44; 64&#44;44&#37; em n&#227;o fumantes&#41; e com PASI absoluto &#8804; 3 na semana 52 &#40;66&#44;67&#37; em fumantes&#44; 90&#44;32&#37; em n&#227;o fumantes&#41; foi significantemente menor em fumantes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#44; respectivamente&#41;&#46; No presente estudo&#44; a dura&#231;&#227;o m&#233;dia do tratamento com secuquinumabe foi de 19&#44;46<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;49 meses em fumantes e de 20&#44;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;23 meses em n&#227;o fumantes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;77&#41;&#46; O tratamento com secuquinumabe foi interrompido por algum motivo em 48&#44;21&#37; dos fumantes e 33&#44;33&#37; dos n&#227;o fumantes &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;19&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Doze &#40;12&#37;&#41; dos pacientes consumiam &#225;lcool e n&#227;o houve rela&#231;&#227;o entre o consumo de &#225;lcool e as taxas de resposta ao tratamento &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Nos pacientes com IMC &#8805; 25&#44; presen&#231;a de artrite&#44; envolvimento ungueal e pelo menos uma comorbidade&#44; as respostas ao tratamento foram geralmente baixas em todas as semanas em compara&#231;&#227;o com aqueles sem essas condi&#231;&#245;es&#44; mas n&#227;o houve diferen&#231;a significante &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">A dura&#231;&#227;o m&#233;dia do tratamento com secuquinumabe foi de 19&#44;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;76 meses&#46; No momento em que o estudo foi realizado&#44; 87 pacientes atingiram o m&#234;s 7&#44; 67 atingiram o m&#234;s 13&#44; 30 atingiram o m&#234;s 25&#44; 22 atingiram o m&#234;s 31&#44; 13 atingiram o m&#234;s 37&#44; nove atingiram o m&#234;s 43 e dois atingiram o m&#234;s 49&#46; O secuquinumabe foi descontinuado em um algum momento durante o tratamento em 40 &#40;40&#37;&#41; pacientes&#46; Vinte e um &#40;21&#37;&#41; desses pacientes n&#227;o quiseram usar o secuquinumabe ou abandonaram o seguimento&#46; Inefic&#225;cia prim&#225;ria foi observada em seis pacientes &#40;6&#37;&#41;&#44; inefic&#225;cia secund&#225;ria em nove &#40;9&#37;&#41;&#44; e eventos adversos em dois &#40;2&#37;&#41; pacientes&#46; Os efeitos adversos foram neutropenia em um paciente e diarreia em outro&#46; Al&#233;m disso&#44; um paciente desenvolveu c&#226;ncer da mama subsequentemente e o secuquinumabe foi descontinuado&#46; Um paciente apresentou piora da artrite psori&#225;sica&#44; embora sua pele apresentasse boas condi&#231;&#245;es&#44; e o secuquinumabe foi descontinuado&#46; O secuquinumabe foi descontinuado em 14 &#40;26&#44;4&#37;&#41; dos pacientes virgens de tratamento e em 28 &#40;58&#44;3&#37;&#41; dos pacientes n&#227;o virgens de tratamento em algum momento durante o tratamento &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; As raz&#245;es para a descontinua&#231;&#227;o do secuquinumabe em pacientes virgens de tratamento foram o n&#227;o seguimento &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#59; 53&#44;8&#37;&#41;&#44; inefic&#225;cia secund&#225;ria &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#59; 30&#44;7&#37;&#41; e eventos adversos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#59; 15&#44;3&#37;&#41;&#59; em pacientes n&#227;o virgens de tratamento&#44; os motivos foram o n&#227;o seguimento &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#59; 51&#44;8&#37;&#41;&#44; inefic&#225;cia prim&#225;ria &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#59; 22&#44;2&#37;&#41;&#44; inefic&#225;cia secund&#225;ria &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#59; 18&#44;5&#37;&#41; e outras raz&#245;es &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#59; 7&#44;4&#37;&#41;&#44; respectivamente &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;26&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">O evento adverso mais comum foi infec&#231;&#227;o mucocut&#226;nea por <span class="elsevierStyleItalic">Candida</span> &#40;8&#37;&#41;&#46; Al&#233;m disso&#44; foram observadas infec&#231;&#227;o leve do trato respirat&#243;rio superior em tr&#234;s pacientes&#44; infec&#231;&#227;o do trato urin&#225;rio em um paciente&#44; neutropenia em um paciente e diarreia em um paciente&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">No presente estudo&#44; 20 &#40;20&#37;&#41; dos pacientes apresentavam infec&#231;&#227;o inativa pelo v&#237;rus da hepatite B &#40;HBV&#59; anticorpo central da hepatite B &#40;HbcAb&#41;&#43;&#44; ant&#237;geno de superf&#237;cie do v&#237;rus da hepatite B &#40;HBsAg&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>&#44; DNA do HBV&#8722;&#41;&#46; Nenhum paciente apresentou anticorpos HBsAg&#43; e antiv&#237;rus da hepatite C &#40;anticorpos anti&#8208;HCV&#43;&#41;&#46; Todos os pacientes com infec&#231;&#227;o inativa pelo VHB receberam profilaxia para reativa&#231;&#227;o por consultor de gastroenterologia&#46; Nenhuma reativa&#231;&#227;o de hepatite B ou C foi observada no per&#237;odo de seguimento&#46; No presente estudo&#44; o teste tubercul&#237;nico &#40;PPD&#41; foi &#8805; 5<span class="elsevierStyleHsp" style=""></span>mm em 21 &#40;48&#37;&#41; dos 57 pacientes avaliados com teste PPD&#44; e o teste QuantiFERON&#8208;TB foi positivo em 19 &#40;23&#37;&#41; dos 83 pacientes avaliados com testes QuantiFERON&#8208;TB&#46; Quarenta e oito &#40;48&#37;&#41; pacientes receberam profilaxia com isoniazida por um consultor de doen&#231;as pulmonares&#46; Nenhum caso de Tb ativa ou reativa&#231;&#227;o foi observado durante o per&#237;odo de seguimento&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Discuss&#227;o</span><p id="par0070" class="elsevierStylePara elsevierViewall">A efic&#225;cia e a seguran&#231;a do secuquinumabe na psor&#237;ase foram demonstradas em ensaios cl&#237;nicos&#46; As taxas de resposta de PASI&#8208;75&#44; &#8208;90&#44; &#8208;100 na semana 12 com 300<span class="elsevierStyleHsp" style=""></span>mg de secuquinumabe foram 81&#44;6&#37;&#44; 59&#44;2&#37;&#44; 28&#44;6&#37;&#44; 77&#44;1&#37;&#44; 54&#44;2&#37;&#44; 24&#44;1&#37;&#44; 86&#44;7&#37;&#44; 55&#37; e 26&#44;7&#37;&#44; respectivamente&#44; em ensaios cl&#237;nicos randomizados de fase 3&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">4&#8211;6</span></a> No presente estudo&#44; as taxas de resposta PASI&#8208;75&#44; &#8208;90&#44; &#8208;100 foram de 72&#37;&#44; 50&#37;&#44; 30&#37;&#44; respectivamente&#44; na semana 16 e foram mais baixas do que em estudos cl&#237;nicos&#46; No presente estudo&#44; em 16 e 28 semanas&#44; as taxas de resposta PASI&#8208;75&#44; &#8208;90&#44; &#8208;100 foram maiores em pacientes virgens de tratamento em compara&#231;&#227;o com pacientes n&#227;o virgens de tratamento &#40;53&#37; dos pacientes eram virgens de tratamentos biol&#243;gicos&#41;&#46; Nos ensaios cl&#237;nicos randomizados de fase 3&#44; 71&#44;4&#37;&#44; 88&#44;4&#37; e 75&#37; dos pacientes eram virgens de tratamentos biol&#243;gicos&#44; respectivamente&#46; Portanto&#44; as taxas de resposta PASI&#8208;75&#44; &#8208;90&#44; &#8208;100 no presente estudo podem ter sido inferiores &#224;s dos estudos cl&#237;nicos&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">4&#8211;6</span></a>Em um conjunto de dados da pr&#225;tica cl&#237;nica de 121 pacientes&#44; as taxas de resposta PASI&#8208;75&#44; &#8208;90&#44; &#8208;100 &#40;84&#44;3&#37;&#44; 68&#44;6&#37;&#44; 18&#44;2&#37; <span class="elsevierStyleItalic">vs</span>&#46; 89&#44;3&#37;&#44; 73&#44;6&#37;&#44; 9&#44;1&#37; <span class="elsevierStyleItalic">vs</span>&#46; 86&#44;1&#37;&#44; 64&#44;6&#37;&#44; 7&#44;6&#37;&#41; nas semanas 16&#44; 24 e 52 foram superiores &#224;s do presente estudo&#46; No entanto&#44; naquele estudo&#44; o n&#250;mero de pacientes virgens de tratamento biol&#243;gico foi bem maior &#40;80&#37;&#41; do que no presente&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> Aus&#234;ncia de tratamento biol&#243;gico anterior &#233; um dos fatores mais importantes que afetam as taxas de resposta ao secuquinumabe em pacientes com psor&#237;ase&#46; Assim como em ensaios cl&#237;nicos&#44; foi demonstrado que a aus&#234;ncia de experi&#234;ncia biol&#243;gica anterior est&#225; associada a resposta elevada ao secuquinumabe em muitos casos da pr&#225;tica cl&#237;nica&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">7&#8211;12</span></a>No presente estudo&#44; o PASI absoluto dos pacientes tamb&#233;m foi avaliado no tratamento com secuquinumabe&#46; A porcentagem de pacientes com PASI &#8804; 1&#44; PASI &#8804; 3&#44; PASI &#8804; 5 foi de 50&#37;&#44; 77&#37; e 92&#37;&#44; respectivamente&#44; na semana 16&#46; Essas taxas foram maiores em pacientes virgens de tratamento do que em pacientes n&#227;o virgens&#46; Segundo dados da pr&#225;tica cl&#237;nica de 136 pacientes na Espanha com psor&#237;ase tratados com secuquinumabe&#44; a porcentagem de pacientes com PASI &#8804; 1&#44; &#8804; 2&#44; &#8804; 3&#44; &#8804; 5 foi de 47&#37;&#44; 64&#37;&#44; 75&#37; e 86&#37;&#44; respectivamente na semana 16&#46; Essas taxas s&#227;o mais baixas do que as encontradas no presente estudo&#46; Da mesma maneira&#44; taxas de resposta mais altas foram relatadas em pacientes virgens de tratamento naquele estudo&#44; e apenas 27&#44;9&#37; dos pacientes eram virgens de tratamentos biol&#243;gicos&#44; explicando as taxas de resposta mais baixas em compara&#231;&#227;o com o presente estudo&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a> Em outro estudo&#44; o PASI absoluto baixo com secuquinumabe foi associado ao fato de os pacientes serem virgens de tratamento biol&#243;gicos&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">11</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Fatores ambientais extr&#237;nsecos&#44; como ingest&#227;o de &#225;lcool&#44; tabagismo&#44; estresse&#44; dist&#250;rbios do sono&#44; vida sedent&#225;ria e dieta&#44; afetam a apresenta&#231;&#227;o cl&#237;nica&#44; a gravidade&#44; o curso e as taxas de resposta ao tratamento da psor&#237;ase&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">13</span></a> Em um estudo&#44; descobriu&#8208;se que a obesidade reduz a possibilidade de tratamento com produtos biol&#243;gicos&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> Al&#233;m disso&#44; foi demonstrado que IMC mais elevado est&#225; associado &#224; resposta baixa ao secuquinumabe&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">8&#44;10</span></a> Em outro estudo&#44; a obesidade foi relatada como importante fator preditivo para taxas de resposta PASI&#8208;75 com secuquinumabe na semana 16&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">7</span></a> No presente estudo&#44; as taxas de resposta PASI&#8208;75&#44; &#8208;90&#44; &#8208;100 em todas as semanas foram baixas em pacientes obesos ou com sobrepeso &#40;IMC &#8805; 25&#41;&#44; mas n&#227;o houve diferen&#231;a estatisticamente significante&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Os mediadores pr&#243;&#8208;inflamat&#243;rios circulantes na psor&#237;ase causam resposta inflamat&#243;ria generalizada e comorbidades&#44; como doen&#231;as cardiovasculares&#44; hipertens&#227;o&#44; DM&#44; HT e s&#237;ndrome metab&#243;lica &#40;SM&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">15</span></a> Al&#233;m disso&#44; muitas doen&#231;as como obesidade&#44; artrite psori&#225;sica&#44; doen&#231;as inflamat&#243;rias intestinais&#44; doen&#231;as renais cr&#244;nicas&#44; doen&#231;as autoimunes da tireoide&#44; transtornos de humor e asma podem acompanhar a psor&#237;ase&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">16&#44;17</span></a> Neste estudo&#44; 37 &#40;37&#37;&#41; dos pacientes tinham pelo menos uma comorbidade&#59; as mais comuns foram HT &#40;19 pacientes&#41;&#44; DM &#40;13 pacientes&#41;&#44; doen&#231;as da tireoide &#40;11 pacientes&#41;&#44; doen&#231;a arterial coronariana &#40;quatro pacientes&#41;&#44; e asma &#40;quatro pacientes&#41;&#44; respectivamente&#46; As comorbidades tamb&#233;m causam dificuldades no tratamento da psor&#237;ase&#46; Um estudo demonstrou que comorbidades como SM&#44; HT e DM est&#227;o associadas &#224; baixa resposta ao secuquinumabe&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">18</span></a> No presente estudo&#44; as taxas de resposta do secuquinumabe foram geralmente baixas em pacientes com comorbidades&#44; mas n&#227;o houve diferen&#231;a estatisticamente significante&#46; Al&#233;m disso&#44; 52&#44;35&#37; dos pacientes com comorbidades e 35&#44;6&#37; dos pacientes sem comorbidades descontinuaram o uso de secuquinumabe durante o per&#237;odo do tratamento&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Cinquenta e seis &#40;56&#37;&#41; dos pacientes eram tabagistas no presente estudo&#46; As taxas de resposta do secuquinumabe foram geralmente baixas em pacientes tabagistas em todas as semanas&#46; A porcentagem de pacientes com PASI &#8804; 1 na semana 16 e PASI &#8804; 3 na semana 52 foi significantemente menor em fumantes&#46; Al&#233;m disso&#44; as taxas de resposta PASI&#8208;75&#44; &#8208;90&#44; &#8208;100 na semana 52 foram significantemente mais baixas nos fumantes&#46; H&#225; resultados conflitantes associados &#224;s taxas de resposta ao secuquinumabe e ao tabagismo na literatura&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">7&#44;18</span></a> Em um estudo de coorte que avaliou um total de 2&#46;384 pacientes recebendo terapia biol&#243;gica&#44; incluindo adalimumabe&#44; etanercepte&#44; infliximabe&#44; ustequinumabe e secuquinumabe&#44; foi relatado que o tabagismo reduz as taxas de resposta ao tratamento com todos os agentes&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">14</span></a> N presente estudo&#44; 12 &#40;12&#37;&#41; dos pacientes consumiam &#225;lcool e n&#227;o houve rela&#231;&#227;o entre a ingest&#227;o de &#225;lcool e as taxas de resposta ao secuquinumabe&#46; Esses dados foram compat&#237;veis com a literatura&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">7&#44;14</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Uma metan&#225;lise de 43 estudos relatou que as taxas de eventos adversos foram consistentes com estudos cl&#237;nicos e n&#227;o foi observado nenhum novo sinal de seguran&#231;a associado ao secuquinumabe&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a> O evento adverso mais comum na pr&#225;tica cl&#237;nica com secuquinumabe foi infec&#231;&#227;o por <span class="elsevierStyleItalic">Candida</span>&#46; Eventos adversos como nasofaringite&#44; pneumonia&#44; foliculite&#44; cefaleia&#44; diarreia&#44; tireoidite subaguda&#44; neutropenia&#44; trombocitopenia e transaminases elevadas tamb&#233;m foram relatados&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">7&#8211;10</span></a> O evento adverso mais comum nos pacientes do presente estudo foi candid&#237;ase oral &#40;8&#37;&#41;&#46; Al&#233;m disso&#44; foi observada infec&#231;&#227;o leve do trato respirat&#243;rio superior em tr&#234;s pacientes e infec&#231;&#227;o do trato urin&#225;rio em um paciente&#46; Nenhum desses pacientes necessitou de descontinua&#231;&#227;o do secuquinumabe&#46; No entanto&#44; o secuquinumabe foi descontinuado em decorr&#234;ncia de neutropenia em um paciente e diarreia em outro&#46; N&#227;o foi detectada doen&#231;a inflamat&#243;ria intestinal &#40;DII&#41; no per&#237;odo de controle e seguimento do paciente com diarreia pelo consultor da gastroenterologia&#46; Em dados reais de 108 pacientes com psor&#237;ase tratados com secuquinumabe&#44; foi observada diarreia em tr&#234;s pacientes durante o per&#237;odo de seguimento&#44; mas nenhum apresentou DII&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">20</span></a> Al&#233;m disso&#44; uma metan&#225;lise de 21 estudos cl&#237;nicos incluindo 7&#46;355 pacientes mostrou que o secuquinumabe n&#227;o aumentou o risco de DII&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">21</span></a> Na an&#225;lise de ensaios cl&#237;nicos e dados de vigil&#226;ncia p&#243;s&#8208;comercializa&#231;&#227;o de at&#233; cinco anos&#44; foi demonstrado um baixo risco de neoplasia maligna com o secuquinumabe&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">22</span></a> No presente estudo&#44; c&#226;ncer de mama foi detectado em uma paciente durante o tratamento com secuquinumabe&#46; A hist&#243;ria familiar da paciente era positiva para c&#226;ncer de mama e o tratamento com secuquinumabe foi descontinuado&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Vinte &#40;20&#37;&#41; pacientes apresentaram infec&#231;&#227;o inativa pelo VHB no presente estudo&#46; Todos receberam profilaxia para reativa&#231;&#227;o por gastroenterologista&#46; Nenhum caso de reativa&#231;&#227;o de hepatite B ou C foi observado no per&#237;odo de seguimento&#46; Da mesma maneira&#44; foi relatado que o secuquinumabe &#233; seguro em pacientes com hist&#243;rico de infec&#231;&#227;o por hepatite B e C em dados da pr&#225;tica cl&#237;nica&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">9&#44;23&#44;24</span></a> O secuquinumabe foi relatado como seguro em pacientes com Tb em ensaios cl&#237;nicos e tamb&#233;m em estudos de pr&#225;tica cl&#237;nica&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">9&#44;23&#44;25</span></a> No presente estudo&#44; 48 &#40;48&#37;&#41; pacientes receberam profilaxia com isoniazida por pneumologista&#46; Nenhum caso de reativa&#231;&#227;o de Tb foi observado nos pacientes durante o per&#237;odo de seguimento&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Em uma metan&#225;lise de 43 estudos&#44; a sobrevida do secuquinumabe foi relatada como 90&#37; aos tr&#234;s e seis meses e 80&#37; aos 12 meses&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">19</span></a> No momento em que o presente estudo estava sendo conduzido&#44; 87&#37; dos pacientes atingiram sete meses&#44; 67&#37; atingiram 13 meses&#44; 30&#37; 25 meses&#44; 22&#37; 31 meses&#44; 13&#37; 37 meses&#44; 9&#37; 43 meses&#44; e 2&#37; 49 meses&#46; Em 40 &#40;40&#37;&#41; pacientes&#44; o secuquinumabe foi descontinuado durante o tratamento&#46; Desses&#44; 21 interromperam o seguimento&#44; seis foram descontinuados por inefic&#225;cia prim&#225;ria&#44; nove por inefic&#225;cia secund&#225;ria&#44; dois por eventos adversos &#40;um por neutropenia&#44; outro por diarreia&#41;&#44; um por c&#226;ncer de mama que apareceu mais tarde e um por agravamento de artrite &#40;mas a pele estava em boas condi&#231;&#245;es&#41;&#46; Parte do per&#237;odo de seguimento dos pacientes coincidiu com a pandemia de COVID&#8208;19 &#40;2020&#8208;2022&#41;&#59; portanto&#44; a taxa de pacientes que abandonaram o seguimento pode ter sido maior do que em outros estudos&#46; A propor&#231;&#227;o de pacientes que descontinuaram o secuquinumabe devido &#224; inefic&#225;cia foi semelhante aos dados da pr&#225;tica cl&#237;nica&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">8</span></a> Entretanto&#44; em alguns estudos&#44; esse n&#250;mero foi inferior ao do presente estudo&#44; e isso pode ser decorrente da alta taxa de pacientes virgens de tratamentos biol&#243;gicos nesses estudos&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">7&#44;11</span></a> Em um estudo&#44; a descontinua&#231;&#227;o do secuquinumabe por inefic&#225;cia foi maior do que no presente estudo&#46; A taxa de pacientes virgens de tratamentos biol&#243;gicos &#233; muito baixa naquele estudo&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">10</span></a> A experi&#234;ncia com tratamentos biol&#243;gicos anteriores &#233; fator muito importante para a continua&#231;&#227;o do tratamento com secuquinumabe&#46; No presente estudo&#44; a descontinua&#231;&#227;o do medicamento por inefic&#225;cia foi mais comum em pacientes n&#227;o virgens de tratamento do que em pacientes virgens de tratamento&#46; Al&#233;m disso&#44; embora o secuquinumabe n&#227;o tenha sido descontinuado em nenhum dos pacientes virgens de tratamento por inefic&#225;cia prim&#225;ria&#44; ele foi descontinuado em 22&#44;2&#37; dos pacientes n&#227;o virgens de tratamento&#46;</p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Limita&#231;&#245;es</span><p id="par0105" class="elsevierStylePara elsevierViewall">O presente estudo tem algumas limita&#231;&#245;es&#46; Este &#233; um estudo retrospectivo unic&#234;ntrico com relativamente poucos pacientes e que inclui apenas a popula&#231;&#227;o turca&#46; No entanto&#44; inclui a experi&#234;ncia de cinco anos na pr&#225;tica cl&#237;nica com secuquinumabe na psor&#237;ase&#46; Apesar dessas limita&#231;&#245;es&#44; os autores acreditam que os resultados do presente estudo s&#227;o valiosos&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Conclus&#227;o</span><p id="par0110" class="elsevierStylePara elsevierViewall">Secuquinumabe &#233; op&#231;&#227;o de tratamento eficaz em pacientes com psor&#237;ase em placas em uso prolongado&#46; Nenhuma experi&#234;ncia com tratamentos biol&#243;gicos e aus&#234;ncia de tabagismo podem aumentar a efic&#225;cia e a sobrevida do medicamento&#46; &#201; tamb&#233;m uma op&#231;&#227;o de tratamento segura para casos de reativa&#231;&#227;o de hepatite e Tb latente&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Suporte financeiro</span><p id="par0115" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Contribui&#231;&#227;o dos autores</span><p id="par0120" class="elsevierStylePara elsevierViewall">Ersoy Acer&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; an&#225;lise estat&#237;stica&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Hilal Kaya Erdo&#287;an&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Esra A&#287;ao&#287;lu&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Hatice Ba&#351;t&#252;rk&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Muzaffer Bilgin&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Zeynep Nurhan Sara&#231;o&#287;lu&#58; Concep&#231;&#227;o e planejamento do estudo&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflito de interesses</span><p id="par0150" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Fundamentos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Efic&#225;cia e seguran&#231;a do secuquinumabe em pacientes com psor&#237;ase foram demonstradas em ensaios cl&#237;nicos randomizados e controlados&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Avaliar a efic&#225;cia e seguran&#231;a do secuquinumabe em pacientes com psor&#237;ase em placas acompanhados em uma cl&#237;nica dermatol&#243;gica&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Dados de 101 pacientes com psor&#237;ase em placas submetidos a pelo menos 16 semanas de tratamento com secuquinumabe entre junho de 2018 e junho de 2023 foram analisados retrospectivamente&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Cinquenta e tr&#234;s &#40;53&#37;&#41; dos pacientes n&#227;o haviam recebido tratamento biol&#243;gico&#46; As taxas de resposta PASI&#8208;75&#44; &#8208;90 e &#8208;100 foram de 72&#37;&#44; 50&#37; e 30&#37;&#44; respectivamente&#44; na semana 16 em todos os pacientes&#46; As respostas PASI&#8208;75 e &#8208;90 foram maiores em pacientes virgens de tratamento nas semanas 16 e 28 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#44; respectivamente&#41;&#46; A porcentagem de todos os pacientes com PASI &#8804; 1&#44; &#8804; 3&#44; &#8804; 5 foi de 50&#37;&#44; 77&#37; e 92&#37;&#44; respectivamente&#44; na semana 16&#46; Elas foram maiores no grupo virgem do que no grupo n&#227;o virgem de tratamento nas semanas 16 e 28 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;02&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;07&#44; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#44; respectivamente&#41;&#46; Na semana 52&#44; as respostas PASI&#8208;75&#44; &#8208;90 e &#8208;100 foram significantemente menores em pacientes tabagistas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;04&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#44; respectivamente&#41;&#46; A dura&#231;&#227;o m&#233;dia do tratamento com secuquinumabe foi de 19&#44;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;76 meses&#46; O secuquinumabe foi descontinuado em 14 &#40;26&#44;4&#37;&#41; dos pacientes virgens de tratamento e em 28 &#40;58&#44;3&#37;&#41; dos pacientes n&#227;o virgens de tratamento em um &#250;nico momento do tratamento &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; O evento adverso mais comuns nos pacientes foi infec&#231;&#227;o mucocut&#226;nea por <span class="elsevierStyleItalic">Candida</span> &#40;8&#37;&#41;&#46; Nenhum caso de reativa&#231;&#227;o de hepatite B ou C e nenhum caso de tuberculose ativa ou reativa&#231;&#227;o foi observado em nenhum dos pacientes durante o per&#237;odo de seguimento&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Limita&#231;&#245;es do estudo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Este &#233; um estudo retrospectivo de centro &#250;nico e tem relativamente poucos pacientes&#44; incluindo apenas a popula&#231;&#227;o turca&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclus&#227;o</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O secuquinumabe parece ser eficaz na psor&#237;ase em placas&#44; particularmente em pacientes n&#227;o submetidos anteriormente a tratamento com biol&#243;gicos e n&#227;o fumantes&#46; Al&#233;m disso&#44; &#233; seguro em pacientes com hepatite inativa e tuberculose&#46;</p></span>"
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          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Melhora da m&#233;dia do PASI de acordo com as semanas&#46; &#42;Teste T de amostras independentes&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#250;mero de pacientes&#44; n &#40;&#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  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\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"><span class="elsevierStyleItalic">Idade &#40;anos&#41;&#44; m&#233;dia</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DP</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">50&#44;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#44;60 &#40;20&#8208;77&#41;&nbsp;\t\t\t\t\t\t\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 ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\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"><span class="elsevierStyleItalic">Dura&#231;&#227;o m&#233;dia da doen&#231;a &#40;anos&#41;&#44; m&#233;dia</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DP</span>&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
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                  \t\t\t\t"><span class="elsevierStyleItalic">IMC&#44; m&#233;dia</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DP</span>&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">28&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;74&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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sobrepeso ou obeso &#40;IMC &#8805; 25&#41;&#44; n &#40;&#37;&#41;</span>&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</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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Artrite psori&#225;sica&#44; n &#40;&#37;&#41;</span>&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</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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Psor&#237;ase ungueal&#44; n &#40;&#37;&#41;</span>&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">38 &#40;&#37;38&#41;&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
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                  \t\t\t\t"><span class="elsevierStyleItalic">PASI basal&#44; m&#233;dia</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#177;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">DP</span>&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 ; entry_with_role_rowhead " 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\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ciclosporina&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;40&#37;&#41;&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>UVB&#8208;NB&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">33 &#40;33&#37;&#41;&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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Terapia biol&#243;gica anterior&#44; n &#40;&#37;&#41;</span>&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">53 &#40;52&#37;&#41;&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Adalimumabe&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33 &#40;33&#37;&#41;&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Infliximabe&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;13&#37;&#41;&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Etanercepte&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">2 &#40;2&#37;&#41;&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>Certolizumabe&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;3&#37;&#41;&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>Ustequinumabe&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">14 &#40;14&#37;&#41;&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="elsevierStyleItalic">Teste PPD positivo&#44; n &#40;&#37;&#41;</span>&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">21 &#40;37&#37;&#41; &#40;Total 57 pacientes&#41;&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="elsevierStyleItalic">Teste QuantiFERON TB positivo&#44; n &#40;&#37;&#41;</span>&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;23&#37;&#41; &#40;Total 83 pacientes&#41;&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="elsevierStyleItalic">Profilaxia com isoniazida</span>&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 &#40;48&#37;&#41;&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="elsevierStyleItalic">Profilaxia antiviral para hepatite B</span>&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">20 &#40;20&#37;&#41;&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="elsevierStyleItalic">Pelo menos uma comorbidade</span>&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;37&#37;&#41;&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="elsevierStyleItalic">Dura&#231;&#227;o m&#233;dia do uso de secuquinumabe &#40;meses&#41;</span>&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&#44;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;76 &#40;4&#8208;52&#41;&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="elsevierStyleItalic">Causa da descontinua&#231;&#227;o do secuquinumabe&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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"><span class="elsevierStyleHsp" style=""></span>Inefic&#225;cia prim&#225;ria&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;6&#37;&#41;&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>Inefic&#225;cia secund&#225;ria&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">9 &#40;9&#37;&#41;&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>Efeitos adversos e outros&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;4&#37;&#41;&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>N&#227;o seguimento&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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;21&#37;&#41;&nbsp;\t\t\t\t\t\t\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"><span class="elsevierStyleItalic">Total de pacientes&#44; n &#40;&#37;&#41;</span>&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">101 &#40;100&#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">53 &#40;100&#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">48 &#40;100&#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
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                  \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
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                  \t\t\t\t"><span class="elsevierStyleItalic">N&#250;mero de pacientes na semana 16</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">101&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">53&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&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PASI&#8208;75&#44; n &#40;&#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">73 &#40;72&#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">47 &#40;88&#44;6&#41;&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\ttop\n
                  \t\t\t\t">26 &#40;54&#44;1&#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"><span class="elsevierStyleBold">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&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="elsevierStyleHsp" style=""></span>PASI&#8208;90&#44; n &#40;&#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">51 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">N&#250;mero de pacientes na semana 52</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">N&#250;mero de pacientes na semana 76</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">N&#250;mero de pacientes na semana 100</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">N&#250;mero de pacientes na semana 124</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">N&#250;mero de pacientes na semana 148</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;00&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">N&#250;mero de pacientes na semana 172</span>&nbsp;\t\t\t\t\t\t\n
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          "pt" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Resultados das respostas PASI dos grupos de pacientes de acordo com as semanas</p>"
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Article information
ISSN: 26662752
Original language: Portuguese
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