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i&#41; psor&#237;ase em placas moderada a grave &#40;definida como PASI &#62; 10 e&#47;ou ASC &#62; 10 e&#47;ou DLQI &#62; 10&#41; diagnosticada pelo menos um ano antes da inclus&#227;o&#59; ii&#41; idade &#60; 18 anos&#59; iii&#41; per&#237;odo de <span class="elsevierStyleItalic">washout</span> maior ou igual a quatro semanas para terapias sist&#234;micas &#40;tratamento com UV inclu&#237;do&#41; e maior ou igual a duas semanas para terapias t&#243;picas&#59; iv&#41; indiv&#237;duos iniciando tratamento biol&#243;gico &#40;adalimumabe ou etanercepte&#44; original ou biossimilar&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">O tratamento foi feito em dosagem pedi&#225;trica&#44; com base no peso corporal do paciente&#46; No momento base foram coletados&#58; i&#41; dados pessoais e demogr&#225;ficos&#59; ii&#41; dura&#231;&#227;o e localiza&#231;&#227;o da psor&#237;ase&#59; iii&#41; presen&#231;a de artrite psori&#225;tica &#40;AP&#41; e dura&#231;&#227;o&#59; iv&#41; comorbidades&#59; v&#41; terapias sist&#234;micas anteriores&#59; vi&#41; gravidade da psor&#237;ase utilizando o &#205;ndice de &#193;rea e Gravidade da Psor&#237;ase &#40;PASI&#44; <span class="elsevierStyleItalic">Psoriasis Area and Severity Index</span>&#41; e a &#193;rea de Superf&#237;cie Corporal &#40;ASC&#41;&#59; vii&#41; escore no &#205;ndice de Qualidade de Vida em Dermatologia &#40;DLQI&#44; <span class="elsevierStyleItalic">Dermatology Life Quality Index</span>&#41; de pacientes e cuidadores&#59; viii&#41; exames de sangue &#40;hemograma&#44; transaminases&#44; creatinina&#44; azotemia&#44; glicemia&#44; velocidade de hemossedimenta&#231;&#227;o&#44; prote&#237;na C&#8208;reativa&#44; n&#237;veis de colesterol e triglic&#233;rides&#44; eletroforese de prote&#237;nas&#41; foram registrados&#46; Em cada consulta de acompanhamento &#40;a cada 12 semanas&#41;&#44; PASI e ASC foram avaliados&#46; Al&#233;m disso&#44; o perfil de seguran&#231;a foi avaliado por eventos adversos &#40;EAs&#41; decorrentes do tratamento&#44; exame f&#237;sico e monitoramento de exames laboratoriais&#46; A Declara&#231;&#227;o de Helsinque foi respeitada durante todo o estudo e o consentimento informado foi obtido e assinado por cada paciente ou cuidador antes do in&#237;cio do estudo&#46; As vari&#225;veis cont&#237;nuas foram apresentadas como m&#233;dia &#177; desvio&#8208;padr&#227;o e as vari&#225;veis categ&#243;ricas como n&#250;mero e propor&#231;&#227;o de pacientes&#46; O teste <span class="elsevierStyleItalic">t</span> de Student n&#227;o pareado foi usado para calcular a signific&#226;ncia das diferen&#231;as nos valores m&#233;dios em diferentes momentos do tratamento&#46; Um valor de p &#60; 0&#44;05 foi considerado estatisticamente significante&#46; Todas as an&#225;lises estat&#237;sticas foram realizadas no software GraphPad Prism 4&#46;0 &#40;GraphPad Software Inc&#46;&#44; La Jolla&#44; CA&#44; EUA&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Dez pacientes foram inclu&#237;dos&#58; 60&#44;0&#37; &#40;n &#61; 6&#41; do sexo feminino e 40&#44;0&#37; &#40;n &#61; 4&#41; do sexo masculino&#44; com m&#233;dia de idade de 13&#44;90 &#177; 4&#44;25 anos&#46; Todos tinham psor&#237;ase em placas&#44; com dura&#231;&#227;o m&#233;dia de 5&#44;20 &#177; 3&#44;36 anos&#44; e nenhum tinha AP&#46; Um paciente apresentou anemia&#59; n&#227;o foram encontradas outras comorbidades&#46; Todos os pacientes haviam sido tratados anteriormente com agentes t&#243;picos&#46; Em rela&#231;&#227;o ao tratamento sist&#234;mico pr&#233;vio&#44; quatro &#40;40&#44;0&#37;&#41; e dois &#40;20&#44;0&#37;&#41; deles receberam fototerapia e terapia sist&#234;mica convencional &#40;acitretina e em seguida ciclosporina&#44; e ciclosporina isoladamente&#41;&#44; respectivamente&#46; A maioria &#40;60&#44;0&#37;&#44; n &#61; 6&#41; est&#225; atualmente em tratamento com etanercepte original ou biossimilar &#40;dura&#231;&#227;o m&#233;dia de 32&#44;20 &#177; 10&#44;35 meses&#41;&#44; enquanto os demais pacientes &#40;40&#44;0&#37;&#44; n &#61; 4&#41; est&#227;o em tratamento com adalimumabe original ou biossimilar &#40;dura&#231;&#227;o m&#233;dia de 12&#44;33 &#177; 12&#44;09 meses&#41;&#46; Um paciente que est&#225; atualmente sob tratamento com etanercepte falhou no tratamento anterior com adalimumabe por inefic&#225;cia secund&#225;ria &#40;perda da resposta PASI75 ap&#243;s 12 semanas&#41;&#46; O PASI m&#233;dio melhorou em ambos os pacientes tratados com adalimumabe e etanercepte desde o in&#237;cio at&#233; a semana 12&#44; e da semana 24 at&#233; a semana 72 foram relatados valores est&#225;veis para ambos os grupos &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; O PASI m&#233;dio basal geral foi de 15&#44;8 &#177; 5&#44;0 &#40;14&#44;8 &#177; 6&#44;5 para adalimumabe <span class="elsevierStyleItalic">versus</span> 16&#44;4 &#177; 4&#44;4 para o grupo etanercepte&#41; e diminuiu para 2&#44;2 &#177; 2&#44;7 na semana 72 &#40;3&#44;0 &#177; 5&#44;2 para adalimumabe <span class="elsevierStyleItalic">versus</span> 2&#44;0 &#177; 1&#44;5 para o grupo etanercepte&#41;&#46; Embora o grupo etanercepte tenha inclu&#237;do pacientes com PASI basal mais alto&#44; PASI m&#233;dio mais baixo foi alcan&#231;ado nas visitas de seguimento &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A&#41;&#46; N&#227;o foram encontradas diferen&#231;as estatisticamente significantes&#46; A m&#233;dia da ASC mostrou tend&#234;ncia semelhante&#44; embora tenha aumentado ligeiramente em ambos os grupos a partir da semana 24 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>B&#41;&#46; A melhora significativa da doen&#231;a tamb&#233;m se refletiu na redu&#231;&#227;o do impacto na qualidade de vida&#58; o escore no DLQI diminuiu de 18&#44;5 &#177; 5&#44;5 no momento basal para 4&#44;1 &#177; 3 na semana 12&#44; at&#233; 2&#44;5 &#177; 1&#44;3 na semana 72&#46; Em rela&#231;&#227;o aos EAs&#44; apenas um paciente relatou um &#250;nico epis&#243;dio de epistaxe ap&#243;s a primeira inje&#231;&#227;o de adalimumabe&#44; tratada com compress&#227;o&#46; O paciente com anemia preexistente apresentou persist&#234;ncia dos n&#237;veis de hemoglobina abaixo do limiar &#40;11&#44;0<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#41;&#44; sem piora&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">O presente estudo da pr&#225;tica di&#225;ria mostrou boa seguran&#231;a e efic&#225;cia dos biol&#243;gicos em crian&#231;as e adolescentes encaminhados ao centro para tratamento de psor&#237;ase moderada a grave&#46; Embora a popula&#231;&#227;o do estudo seja limitada&#44; as respostas ao PASI e ASC refletem os resultados relatados em ensaios cl&#237;nicos&#44; pois o PASI m&#233;dio diminuiu desde o momento basal &#40;15&#44;79 &#177; 5&#44;03&#41; at&#233; a semana 24 &#40;1&#44;74 &#177; 2&#44;59&#41; sob tratamento com adalimumabe e etanercepte&#46; A mesma tend&#234;ncia foi observada para ASC m&#233;dia&#58; 28&#44;50 &#177; 15&#44;16 &#40;momento basal&#41; <span class="elsevierStyleItalic">versus</span> 2&#44;80 &#177; 3&#44;33 &#40;semana 24&#41;&#46; Curiosamente&#44; ambos os valores cl&#237;nicos mostraram aumento discreto a partir da semana 48 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#44; embora nenhuma diferen&#231;a estatisticamente significante tenha sido alcan&#231;ada&#46; Al&#233;m disso&#44; mesmo que os escores PASI e ASC tenham permanecido est&#225;veis ou levemente aumentados a partir da semana 24&#44; os pacientes e especialmente os cuidadores experimentaram melhora nos escores do DLQI&#46; Com rela&#231;&#227;o aos EAs&#44; esses resultados da pr&#225;tica di&#225;ria evidenciam incid&#234;ncia menor de infec&#231;&#245;es do que as relatadas em ensaios cl&#237;nicos&#44; o que pode ser atribu&#237;do ao tamanho diferente das popula&#231;&#245;es entre os ensaios cl&#237;nicos e os estudos com base na pr&#225;tica di&#225;ria&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> Experi&#234;ncias da pr&#225;tica di&#225;ria podem aumentar a popula&#231;&#227;o estudada de pacientes psori&#225;sicos pedi&#225;tricos tratados com agentes biol&#243;gicos&#46; O tratamento eficaz e seguro da psor&#237;ase em crian&#231;as ecoa no ambiente familiar&#44; com benef&#237;cios que se estendem aos pais&#47;respons&#225;veis&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0025" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0030" class="elsevierStylePara elsevierViewall">Todos os autores contribu&#237;ram para a concep&#231;&#227;o e planejamento do estudo&#46; A prepara&#231;&#227;o do material&#44; a coleta e a an&#225;lise dos dados foram realizadas por Matteo Megna&#44; Gabriella Fabbrocini&#44; Lucia Gallo&#44; Angelo Ruggiero&#44; Elisa Camela&#44; Sonia Sofia Ocampo&#8208;Garza e Eleonora Cinelli&#46; A primeira vers&#227;o do manuscrito foi redigida por Eleonora Cinelli&#44; Gabriella Fabbrocini e Matteo Megna&#44; e todos os autores comentaram as vers&#245;es anteriores do manuscrito&#46; Todos os autores leram e aprovaram vers&#227;o final do manuscrito&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0045" class="elsevierStylePara elsevierViewall">O Dr&#46; Matteo Megna atuou como palestrante ou consultor da Novartis&#44; Eli Lilly e Abbvie&#46; A Professora Gabriella Fabbrocini atuou como palestrante ou consultora para Janssen&#44; Leo Pharma&#44; Novartis&#44; Eli Lilly&#44; Abbvie e Almirall&#46; A Dra&#46; Lucia Gallo atuou como palestrante ou consultora da Lilly e da Pfizer&#46; A Dra&#46; Eleonora Cinelli&#44; o Dr&#46; Angelo Ruggiero&#44; a Dra&#46; Elisa Camela e a Dra&#46; Sonia Sof&#237;a Ocampo&#8208;Garza n&#227;o t&#234;m conflito de interesses a declarar&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Como citar este artigo&#58; Megna M&#44; Fabbrocini G&#44; Gallo L&#44; Ruggiero A&#44; Camela E&#44; Ocampo&#8208;Garza SS&#44; et al&#46; Treatment of pediatric psoriasis with TNF&#8208;antagonists&#58; a real&#8208;life single&#8208;center case series&#46; An Bras Dermatol&#46; 2022&#59;97&#58;819&#8211;22&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Trabalho realizado no Departamento de Dermatologia&#44; University of Naples Federico&#160;II&#44; N&#225;poles&#44; It&#225;lia&#46;</p>"
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          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Tend&#234;ncias dos escores m&#233;dios do PASI em toda a popula&#231;&#227;o do estudo &#40;linha azul&#41;&#44; no grupo adalimumabe &#40;linha vermelha&#41; e no grupo etanercepte &#40;linha verde&#41; no momento basal e nos seguimentos&#46; &#40;b&#41; Tend&#234;ncias dos escores m&#233;dios de ASC em toda a popula&#231;&#227;o do estudo &#40;linha azul&#41;&#44; no grupo adalimumabe &#40;linha vermelha&#41; e no grupo etanercepte &#40;linha verde&#41; no momento e nos seguimentos&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;8 &#177; 5&#44;0&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>Semana 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;7 &#177; 2&#44;5&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>Semana 24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;7 &#177; 2&#44;9&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>Semana 48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;2 &#177; 2&#44;6&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>Semana 72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;2 &#177; 2&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Grupo adalimumabe &#40;4&#160;pacientes&#44; 40&#37;&#41;</span></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>Basal&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&#44;8 &#177; 6&#44;5&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>Semana 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8 &#177; 3&#44;3&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>Semana 24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;3 &#177; 3&#44;9&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>Semana 48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;7 &#177; 4&#44;6&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>Semana 72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;7 &#177; 4&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Grupo etanercepte &#40;6&#160;pacientes&#44; 60&#37;&#41;</span></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>Basal&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">16&#44;4 &#177; 4&#44;4&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>Semana 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;7 &#177; 2&#44;1&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>Semana 24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;4 &#177; 1&#44;7&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>Semana 48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;0 &#177; 2&#44;2&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>Semana 72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;0 &#177; 1&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ASC</span></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>Basal&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">28&#44;5 &#177; 15&#44;2&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>Semana 12&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">5&#44;8 &#177; 3&#44;6&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>Semana 24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;8 &#177; 3&#44;3&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>Semana 48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;7 &#177; 4&#44;0&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>Semana 72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;7 &#177; 3&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Grupo adalimumabe &#40;4&#160;pacientes&#44; 40&#37;&#41;</span></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>Basal&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">26&#44;0 &#177; 21&#44;9&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>Semana 12&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">5&#44;3 &#177; 3&#44;8&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>Semana 24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;0 &#177; 4&#44;2&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>Semana 48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;0 &#177; 5&#44;2&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>Semana 72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;0 &#177; 5&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Grupo etanercepte &#40;6&#160;pacientes&#44; 60&#37;&#41;</span></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>Basal&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">30&#44;2 &#177; 10&#44;9&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>Semana 12&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">6&#44;2 &#177; 3&#44;8&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>Semana 24&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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Carta ‐ Investigação
Tratamento da psoríase pediátrica com antagonistas do TNF – série de casos de centro único na prática diária
Matteo Megnaa,
Autor para correspondência
mat24@libero.it

Autor para correspondência.
, Gabriella Fabbrocinia, Lucia Galloa, Angelo Ruggieroa, Elisa Camelaa, Sonia Sofía Ocampo‐Garzaa,b, Eleonora Cinellia
a Seção de Dermatologia, Departamento de Clínica Médica e Cirurgia, University of Naples Federico II, Nápoles, Itália
b Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José Eleuterio González”, Departamento de Dermatologia, Monterrey, Nuevo León, México
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          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Tend&#234;ncias dos escores m&#233;dios do PASI em toda a popula&#231;&#227;o do estudo &#40;linha azul&#41;&#44; no grupo adalimumabe &#40;linha vermelha&#41; e no grupo etanercepte &#40;linha verde&#41; no momento basal e nos seguimentos&#46; &#40;b&#41; Tend&#234;ncias dos escores m&#233;dios de ASC em toda a popula&#231;&#227;o do estudo &#40;linha azul&#41;&#44; no grupo adalimumabe &#40;linha vermelha&#41; e no grupo etanercepte &#40;linha verde&#41; no momento e nos seguimentos&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A psor&#237;ase &#233; uma doen&#231;a inflamat&#243;ria cr&#244;nica da pele<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> e cerca de 30&#37; s&#227;o de pacientes pedi&#225;tricos&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> Isso impacta n&#227;o apenas as pr&#243;prias crian&#231;as&#44; mas tamb&#233;m seus pais e cuidadores&#44; afetando sua qualidade de vida&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a> A maioria dos casos &#233; de pequena gravidade e se beneficia de terapia t&#243;pica&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> Entretanto&#44; quando os casos s&#227;o n&#227;o responsivos ou mais graves&#44; podem exigir tratamentos sist&#234;micos&#44; incluindo fototerapia&#44; agentes convencionais &#40;acitretina&#44; metotrexato e ciclosporina&#41; ou biol&#243;gicos&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">4&#44;5</span></a> A terapia com agentes biol&#243;gicos representa uma nova e preciosa op&#231;&#227;o terap&#234;utica para pacientes pedi&#225;tricos&#44; embora os dados sobre sua efic&#225;cia e seguran&#231;a sejam escassos&#44; pois a maioria dos ensaios cl&#237;nicos dispon&#237;veis &#233; realizada em pequenas popula&#231;&#245;es de estudo e em formas menos graves da doen&#231;a&#46; Da&#237; a import&#226;ncia de fornecer informa&#231;&#245;es sobre experi&#234;ncias da pr&#225;tica di&#225;ria sobre psor&#237;ase pedi&#225;trica tratada com agentes biol&#243;gicos&#46; Atualmente&#44; o uso de antifatores de necrose tumoral &#40;TNF&#41;&#8208;&#945; &#40;adalimumabe e etanercepte&#41; foi aprovado para crian&#231;as a partir de 4 e 6 anos de idade&#44; respectivamente&#59; o anti&#8208;interleucina &#40;IL&#41; 12&#47;23 &#40;ustequinumabe&#41; para pacientes a partir de 6 anos&#59;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">6&#8211;8</span></a> e anti&#8208;IL&#8208;17 &#40;secuquinumabe e ixequizumabe&#41; em crian&#231;as a partir de 6 anos de idade&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">9&#44;10</span></a> Na It&#225;lia&#44; apenas os agentes anti&#8208;TNF&#8208;&#945; s&#227;o reembols&#225;veis pelo Sistema Nacional de Sa&#250;de&#44; enquanto o ustequinumabe e os anti&#8208;IL&#8208;17 est&#227;o aguardando libera&#231;&#227;o do reembolso&#46; Aqui&#44; relatamos a experi&#234;ncia na pr&#225;tica di&#225;ria do uso de biol&#243;gicos reembols&#225;veis para pacientes pedi&#225;tricos com psor&#237;ase encaminhados &#224; Unidade de Psor&#237;ase do Hospital Federico II&#44; N&#225;poles&#44; de setembro de 2018 a setembro de 2020&#46; Os crit&#233;rios de inclus&#227;o no estudo retrospectivo foram&#58; i&#41; psor&#237;ase em placas moderada a grave &#40;definida como PASI &#62; 10 e&#47;ou ASC &#62; 10 e&#47;ou DLQI &#62; 10&#41; diagnosticada pelo menos um ano antes da inclus&#227;o&#59; ii&#41; idade &#60; 18 anos&#59; iii&#41; per&#237;odo de <span class="elsevierStyleItalic">washout</span> maior ou igual a quatro semanas para terapias sist&#234;micas &#40;tratamento com UV inclu&#237;do&#41; e maior ou igual a duas semanas para terapias t&#243;picas&#59; iv&#41; indiv&#237;duos iniciando tratamento biol&#243;gico &#40;adalimumabe ou etanercepte&#44; original ou biossimilar&#41;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">O tratamento foi feito em dosagem pedi&#225;trica&#44; com base no peso corporal do paciente&#46; No momento base foram coletados&#58; i&#41; dados pessoais e demogr&#225;ficos&#59; ii&#41; dura&#231;&#227;o e localiza&#231;&#227;o da psor&#237;ase&#59; iii&#41; presen&#231;a de artrite psori&#225;tica &#40;AP&#41; e dura&#231;&#227;o&#59; iv&#41; comorbidades&#59; v&#41; terapias sist&#234;micas anteriores&#59; vi&#41; gravidade da psor&#237;ase utilizando o &#205;ndice de &#193;rea e Gravidade da Psor&#237;ase &#40;PASI&#44; <span class="elsevierStyleItalic">Psoriasis Area and Severity Index</span>&#41; e a &#193;rea de Superf&#237;cie Corporal &#40;ASC&#41;&#59; vii&#41; escore no &#205;ndice de Qualidade de Vida em Dermatologia &#40;DLQI&#44; <span class="elsevierStyleItalic">Dermatology Life Quality Index</span>&#41; de pacientes e cuidadores&#59; viii&#41; exames de sangue &#40;hemograma&#44; transaminases&#44; creatinina&#44; azotemia&#44; glicemia&#44; velocidade de hemossedimenta&#231;&#227;o&#44; prote&#237;na C&#8208;reativa&#44; n&#237;veis de colesterol e triglic&#233;rides&#44; eletroforese de prote&#237;nas&#41; foram registrados&#46; Em cada consulta de acompanhamento &#40;a cada 12 semanas&#41;&#44; PASI e ASC foram avaliados&#46; Al&#233;m disso&#44; o perfil de seguran&#231;a foi avaliado por eventos adversos &#40;EAs&#41; decorrentes do tratamento&#44; exame f&#237;sico e monitoramento de exames laboratoriais&#46; A Declara&#231;&#227;o de Helsinque foi respeitada durante todo o estudo e o consentimento informado foi obtido e assinado por cada paciente ou cuidador antes do in&#237;cio do estudo&#46; As vari&#225;veis cont&#237;nuas foram apresentadas como m&#233;dia &#177; desvio&#8208;padr&#227;o e as vari&#225;veis categ&#243;ricas como n&#250;mero e propor&#231;&#227;o de pacientes&#46; O teste <span class="elsevierStyleItalic">t</span> de Student n&#227;o pareado foi usado para calcular a signific&#226;ncia das diferen&#231;as nos valores m&#233;dios em diferentes momentos do tratamento&#46; Um valor de p &#60; 0&#44;05 foi considerado estatisticamente significante&#46; Todas as an&#225;lises estat&#237;sticas foram realizadas no software GraphPad Prism 4&#46;0 &#40;GraphPad Software Inc&#46;&#44; La Jolla&#44; CA&#44; EUA&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Dez pacientes foram inclu&#237;dos&#58; 60&#44;0&#37; &#40;n &#61; 6&#41; do sexo feminino e 40&#44;0&#37; &#40;n &#61; 4&#41; do sexo masculino&#44; com m&#233;dia de idade de 13&#44;90 &#177; 4&#44;25 anos&#46; Todos tinham psor&#237;ase em placas&#44; com dura&#231;&#227;o m&#233;dia de 5&#44;20 &#177; 3&#44;36 anos&#44; e nenhum tinha AP&#46; Um paciente apresentou anemia&#59; n&#227;o foram encontradas outras comorbidades&#46; Todos os pacientes haviam sido tratados anteriormente com agentes t&#243;picos&#46; Em rela&#231;&#227;o ao tratamento sist&#234;mico pr&#233;vio&#44; quatro &#40;40&#44;0&#37;&#41; e dois &#40;20&#44;0&#37;&#41; deles receberam fototerapia e terapia sist&#234;mica convencional &#40;acitretina e em seguida ciclosporina&#44; e ciclosporina isoladamente&#41;&#44; respectivamente&#46; A maioria &#40;60&#44;0&#37;&#44; n &#61; 6&#41; est&#225; atualmente em tratamento com etanercepte original ou biossimilar &#40;dura&#231;&#227;o m&#233;dia de 32&#44;20 &#177; 10&#44;35 meses&#41;&#44; enquanto os demais pacientes &#40;40&#44;0&#37;&#44; n &#61; 4&#41; est&#227;o em tratamento com adalimumabe original ou biossimilar &#40;dura&#231;&#227;o m&#233;dia de 12&#44;33 &#177; 12&#44;09 meses&#41;&#46; Um paciente que est&#225; atualmente sob tratamento com etanercepte falhou no tratamento anterior com adalimumabe por inefic&#225;cia secund&#225;ria &#40;perda da resposta PASI75 ap&#243;s 12 semanas&#41;&#46; O PASI m&#233;dio melhorou em ambos os pacientes tratados com adalimumabe e etanercepte desde o in&#237;cio at&#233; a semana 12&#44; e da semana 24 at&#233; a semana 72 foram relatados valores est&#225;veis para ambos os grupos &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46; O PASI m&#233;dio basal geral foi de 15&#44;8 &#177; 5&#44;0 &#40;14&#44;8 &#177; 6&#44;5 para adalimumabe <span class="elsevierStyleItalic">versus</span> 16&#44;4 &#177; 4&#44;4 para o grupo etanercepte&#41; e diminuiu para 2&#44;2 &#177; 2&#44;7 na semana 72 &#40;3&#44;0 &#177; 5&#44;2 para adalimumabe <span class="elsevierStyleItalic">versus</span> 2&#44;0 &#177; 1&#44;5 para o grupo etanercepte&#41;&#46; Embora o grupo etanercepte tenha inclu&#237;do pacientes com PASI basal mais alto&#44; PASI m&#233;dio mais baixo foi alcan&#231;ado nas visitas de seguimento &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>A&#41;&#46; N&#227;o foram encontradas diferen&#231;as estatisticamente significantes&#46; A m&#233;dia da ASC mostrou tend&#234;ncia semelhante&#44; embora tenha aumentado ligeiramente em ambos os grupos a partir da semana 24 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>B&#41;&#46; A melhora significativa da doen&#231;a tamb&#233;m se refletiu na redu&#231;&#227;o do impacto na qualidade de vida&#58; o escore no DLQI diminuiu de 18&#44;5 &#177; 5&#44;5 no momento basal para 4&#44;1 &#177; 3 na semana 12&#44; at&#233; 2&#44;5 &#177; 1&#44;3 na semana 72&#46; Em rela&#231;&#227;o aos EAs&#44; apenas um paciente relatou um &#250;nico epis&#243;dio de epistaxe ap&#243;s a primeira inje&#231;&#227;o de adalimumabe&#44; tratada com compress&#227;o&#46; O paciente com anemia preexistente apresentou persist&#234;ncia dos n&#237;veis de hemoglobina abaixo do limiar &#40;11&#44;0<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#41;&#44; sem piora&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">O presente estudo da pr&#225;tica di&#225;ria mostrou boa seguran&#231;a e efic&#225;cia dos biol&#243;gicos em crian&#231;as e adolescentes encaminhados ao centro para tratamento de psor&#237;ase moderada a grave&#46; Embora a popula&#231;&#227;o do estudo seja limitada&#44; as respostas ao PASI e ASC refletem os resultados relatados em ensaios cl&#237;nicos&#44; pois o PASI m&#233;dio diminuiu desde o momento basal &#40;15&#44;79 &#177; 5&#44;03&#41; at&#233; a semana 24 &#40;1&#44;74 &#177; 2&#44;59&#41; sob tratamento com adalimumabe e etanercepte&#46; A mesma tend&#234;ncia foi observada para ASC m&#233;dia&#58; 28&#44;50 &#177; 15&#44;16 &#40;momento basal&#41; <span class="elsevierStyleItalic">versus</span> 2&#44;80 &#177; 3&#44;33 &#40;semana 24&#41;&#46; Curiosamente&#44; ambos os valores cl&#237;nicos mostraram aumento discreto a partir da semana 48 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#44; embora nenhuma diferen&#231;a estatisticamente significante tenha sido alcan&#231;ada&#46; Al&#233;m disso&#44; mesmo que os escores PASI e ASC tenham permanecido est&#225;veis ou levemente aumentados a partir da semana 24&#44; os pacientes e especialmente os cuidadores experimentaram melhora nos escores do DLQI&#46; Com rela&#231;&#227;o aos EAs&#44; esses resultados da pr&#225;tica di&#225;ria evidenciam incid&#234;ncia menor de infec&#231;&#245;es do que as relatadas em ensaios cl&#237;nicos&#44; o que pode ser atribu&#237;do ao tamanho diferente das popula&#231;&#245;es entre os ensaios cl&#237;nicos e os estudos com base na pr&#225;tica di&#225;ria&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> Experi&#234;ncias da pr&#225;tica di&#225;ria podem aumentar a popula&#231;&#227;o estudada de pacientes psori&#225;sicos pedi&#225;tricos tratados com agentes biol&#243;gicos&#46; O tratamento eficaz e seguro da psor&#237;ase em crian&#231;as ecoa no ambiente familiar&#44; com benef&#237;cios que se estendem aos pais&#47;respons&#225;veis&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0025" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0030" class="elsevierStylePara elsevierViewall">Todos os autores contribu&#237;ram para a concep&#231;&#227;o e planejamento do estudo&#46; A prepara&#231;&#227;o do material&#44; a coleta e a an&#225;lise dos dados foram realizadas por Matteo Megna&#44; Gabriella Fabbrocini&#44; Lucia Gallo&#44; Angelo Ruggiero&#44; Elisa Camela&#44; Sonia Sofia Ocampo&#8208;Garza e Eleonora Cinelli&#46; A primeira vers&#227;o do manuscrito foi redigida por Eleonora Cinelli&#44; 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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">Pacientes&#44; n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13&#44;90 &#177; 4&#44;25&#160;&#40;varia&#231;&#227;o&#58; 5&#8208;17&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Feminino&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>Masculino&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">4&#47;10 &#40;40&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></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">Dura&#231;&#227;o da psor&#237;ase&#44; anos</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#44;20 &#177; 3&#44;36&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" 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="elsevierStyleHsp" style=""></span>Terapia t&#243;pica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#47;10 &#40;100&#44;0&#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>Fototerapia com NB&#8208;UVB&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">4&#47;10 &#40;40&#44;0&#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>Ciclosporina&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">2&#47;10 &#40;20&#44;0&#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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Acitretina&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">1&#47;10 &#40;10&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="2" 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="elsevierStyleHsp" style=""></span>Basal&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">15&#44;8 &#177; 5&#44;0&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>Semana 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;7 &#177; 2&#44;5&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>Semana 24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;7 &#177; 2&#44;9&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>Semana 48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;2 &#177; 2&#44;6&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>Semana 72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;2 &#177; 2&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Grupo adalimumabe &#40;4&#160;pacientes&#44; 40&#37;&#41;</span></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>Basal&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&#44;8 &#177; 6&#44;5&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>Semana 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8 &#177; 3&#44;3&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>Semana 24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;3 &#177; 3&#44;9&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>Semana 48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;7 &#177; 4&#44;6&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>Semana 72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;7 &#177; 4&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Grupo etanercepte &#40;6&#160;pacientes&#44; 60&#37;&#41;</span></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>Basal&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">16&#44;4 &#177; 4&#44;4&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>Semana 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;7 &#177; 2&#44;1&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>Semana 24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;4 &#177; 1&#44;7&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>Semana 48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;0 &#177; 2&#44;2&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>Semana 72&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&#44;0 &#177; 1&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">ASC</span></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>Basal&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;5 &#177; 15&#44;2&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</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#44;8 &#177; 3&#44;6&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>Semana 24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;8 &#177; 3&#44;3&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>Semana 48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;7 &#177; 4&#44;0&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>Semana 72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;7 &#177; 3&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Grupo adalimumabe &#40;4&#160;pacientes&#44; 40&#37;&#41;</span></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>Basal&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">26&#44;0 &#177; 21&#44;9&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</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">5&#44;3 &#177; 3&#44;8&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</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;0 &#177; 4&#44;2&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
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;0 &#177; 5&#44;2&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>Semana 72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;0 &#177; 5&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" 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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Basal&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
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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
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Semana 12&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
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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="elsevierStyleHsp" style=""></span>Semana 24&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="elsevierStyleHsp" style=""></span>Semana 48&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"><span class="elsevierStyleHsp" style=""></span>Semana 72&nbsp;\t\t\t\t\t\t\n
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                          "autores" => array:6 [
                            0 => "M&#46; Megna"
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                            2 => "A&#46; Balato"
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                          "etal" => false
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                            4 => "J&#46;C&#46; Szepietowski"
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ISSN: 26662752
Idioma original: Português
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