Background and ImportanceAnti-interleukin 23 drugs were approved in the last 5 years. The absence of comparison between alternatives such as risankizumab (RIS) or guselkumab (GUS) needs to be ...fulfilled.Aim and ObjectivesTo evaluate the effectiveness through indirect comparisons of risankizumab and guselkumab in plaque psoriasis.Material and MethodsMulticentric, retrospective and observational study. Comparison made with plaque psoriasis patients with active treatment with risankizumab or guselkumab from June 2021 and June 2022. Demographic (sex, age) and clinical (body surface area (BSA), psoriasis area severity index (PASI) at baseline and in subsequent dermatology controls, PASI clearance (PASI100)) data collected. Comparison made through PASI100 and BSA and PASI reduction.Results59 patients treated with RIS, 64% men, 52,4 ± 15,3 SD years old averaged, and BSA and PASI of 11,4 ± 8,2 SD and 8,7 ± 4,2 SD respectively at baseline. 49 patients treated with GUS, 59,2% men, 50,9 ± 12,1 SD years old averaged, and BSA and PASI of 10,25 ± 10,27 SD and 8 ± 6,69 SD respectively at baseline.RIS achieved at mean 21,6 ± 15,7 SD weeks a BSA and PASI of 2,24 ± 6 SD and 1,81 ± 3,7 SD respectively, with PASI100 reached by 46% of patients. GUS achieved at mean 22,9 ± 13,1 SD weeks a BSA and PASI of 3,87 ± 9,28 SD and 2,89 ± 4,26 SD respectively, with PASI100 reached by 45%.At 39,5 ± 10,8 SD weeks, RIS obtained BSA 0,66 ± 1,27 SD and PASI 0,64 ± 1,01 SD, with PASI100 in 64% of patients, while GUS obtained BSA 1,82 ± 3,28 SD and PASI 1,89 ± 3,3 SD, with PASI100 in 50% of patients in 44,6 ± 17,5 SD weeks.After 63,6 ± 14,5 SD weeks, RIS achieved BSA 0,68 ± 0,94 SD and PASI 0,9 ± 1,14 SD, and PASI100 maintained by 57% patients. GUS achieved BSA 0,95 ± 1,55 SD and PASI 0,53 ± 0,92 SD, and PASI100 maintained by 67% patients.Conclusion and RelevanceRIS and GUS are effective alternatives for plaque psoriasis treatment, although it seems that after a year, the activity of RIS starts to decrease. Further studies should be performed to determine this hypothesis.References and/or AcknowledgementsConflict of InterestNo conflict of interest
Background and importanceTreatment with biologic drugs is indicated in patients with moderate to severe psoriasis, and the therapeutic goal is an improvement equal to or greater than Psoriasis Area ...and Severity Index (PASI) 75.Aim and objectivesTo analyse the use of profile guselkumab in a tertiary hospital and to evaluate the effectiveness, safety and adherence of the treatment in clinical practice in moderate-severe plaque psoriasisMaterial and methodsObservational, retrospective, descriptive study including all the patients who were prescribed guselkumab from 2019 to October 2021.Demographic (sex, age) and clinical data (previous biological treatment, date of initiation of treatment and subsequent doses administered, adverse effects and reason for ending treatment) were collected from the digital medical record and the electronic prescription programme.Effectiveness was derived from PASI levels and recorded over an average of 56 weeks. Safety was measured by the rate of adverse effects.Results33 patients (48.5% male and 51.5% female) with a mean age of 49 years. 6.1% received guselkumab as the first line of treatment, 48.9% as the second line and 45.4% as the third or more lines. The biological drugs which were previously used were etanercept (63.6%), adalimumab (30.3%), ustekinumab (30.3%), secukinumab (27.3%), ixekizumab (12.1%) and apremilast (3%).An average of 57.53 days of difference between medication administration dates was recorded, confirming good adherence to the treatment (100 mg subcutaneous every 56 days).In terms of effectiveness evaluation, the mean baseline PASI was 10.6 and the mean PASI over a 56-week period was 2.17. This represents an average reduction of 79.5% in PASI levels.26 patients achieved a decrease in PASI, and of these 12 reached PASI 100.Adverse effects were detected in 3 patients (9%): diarrhoea, candida spp infection and suppurative outbreak. Treatment discontinuation occurred in 5 patients (15.1%) due to the appearance of adverse effects (2) inefficiency of treatment (2) and desire for pregnancy (1).Conclusion and relevanceThe use of guselkumab is an appropriate therapeutic option in patients diagnosed with moderate-to-severe plaque psoriasis after failure of at least one biologic treatment. The achievement of a PASI 79, as well as the few adverse effects that made it necessary to discontinue treatment, demonstrate its therapeutic effectiveness and safety.References and/or acknowledgementsConflict of interestNo conflict of interest
Background and ImportancePlaque psoriasis is a chronic pathology with an important impact on patients’ quality of life and emotional health. Brodalumab was the last anti-interleukin17 (IL-17) ...arriving to patients.Aim and ObjectivesTo evaluate brodalumab effectiveness in real practiseMaterial and MethodsMulticentric, retrospective and observational study performed to evaluate brodalumab in patients with moderate – severe plaque psoriasis between June 2021 and June 2022. Data extracted from clinical records application and prescribing programme , demographic data (age, sex), and clinical (previous biologic treatment lines, body surface area (BSA) and psoriasis area severity index (PASI) before treatment and in each dermatologic control). Effectiveness was measured comparing AMAGINE clinical trials PASI75 results (efficacy calculated with weighted average).Results41 patients with brodalumab as active treatment, 1 was excluded due to lack of follow up and other due to late start of treatment. 39 patients included, 52.4 years averaged, 66.7% were men. Other lines of treatments approved for moderate-to-severe plaque psoriasis were used as first line in 19 patients, as 2nd line in 5, as 3rd line in 3 and as 4th line in 5 patients.Average BSA and PASI at baseline were 14.32 and 11.55 respectively. After a median of 23 weeks, our patients reached PASI75 in 56%, PASI90 in 51% and PASI100 in 49% of cases. No patient stopped treatment.After 40 weeks, 3 patients had changed their treatment and 4 had not reached the next visit to Dermatology. PASI90 and PASI100 kept in 9 of 23 patients (39%), as PASI75 still was kept by 11 patients (48%).After one year of treatment, only 15 patients were active with treatment, and PASI90 and PASI100 were kept by 5 patients of 10 with recorded data.According to clinical trials, brodalumab achieves a PASI75 in 85% of patients at 12th week and kept a PASI75 in 68% of patients at 52nd week.Limitations: several patients did not have recorded in their clinical history BSA and PASI after 12th week visit.Conclusion and RelevanceOur findings show that brodalumab is less effective in real practice but it can be considered as a potent antipsoriatic agent in clinical practise. Further and longer studies should be made.References and/or AcknowledgementsConflict of InterestNo conflict of interest
Background and importanceImmunotherapy has broken new ground in the treatment of multiple myeloma, with the introduction of monoclonal antibodies into the therapeutic arsenal, representing a paradigm ...shift in treatment. Daratumumab is a human monoclonal antibody IgG1κ, which binds to the CD38 protein that is expressed at a high level on the surface of multiple myeloma tumour cells.Aim and objectivesTo evaluate real life experience of daratumumab in monotherapy for the treatment of adult patients with relapsed refractory multiple myeloma (RRMM), who have previously received a proteasome inhibitor and an immunomodulatory agent and who have experienced disease progression since the last treatment.Material and methodsThis was a multicentre, prospective, observational study, conducted over a period of 3 years in two third level hospitals, in 40 patients diagnosed with RRMM. To evaluate health outcomes, the following variables were measured: age, sex, number of previous lines, daratumumab cycles received, progression free survival (PFS) and adverse reactions.ResultsForty RRMM cases were analysed (80% men, 20% women). Mean age was 62 years. The health outcomes measured in our clinical practice were: 60% of patients received daratumumab as monotherapy, as thirdline treatment, 30% as fourthline treatment, and 10% as sixthline and seventhline treatment. The mean number of daratumab cycles was 7, except for one patient who has now completed cycle 27. Median PFS was 4 months. Only mild gastrointestinal adverse reactions (nausea and vomiting) were observed (20% of patients). The correct premedication was performed before and after daratumumab infusion, including 10 mg of oral montelukast (first infusion) and respecting the infusion times according to the technical datasheet.Conclusion and relevanceHealth outcomes for daratumumab as monotherapy for the treatment of patients with RRMM were similar to those published in the combined trial gene 501 and SIRIUS. According to recent publications, daratumumab is likely to be more effective in combination with other drugs. Daratumumab is well tolerated in most patients and is therefore considered a safe treatment.References and/or acknowledgementsNo conflict of interest.
BackgroundPsoriasis is a disease that requires long-term treatment. Apremilast is indicated in the treatment of psoriasis in patients who have not responded or have contraindicated or cannot tolerate ...other treatment systemics. This drug has a lower accumulated specific organ toxicity, so it seems that it is the first oral systemic drug with which long-term treatments can be planned.PurposeTo estimate the persistence and safety of treatment with apremilast in patients diagnosed with psoriasis.Material and methodsRetrospective observational study of all patients with psoriasis who were treated with apremilast (January 2016 to September 2018). Demographic variables (age, sex) and variables related to the drug were collected (treatment start and discontinuation date, adverse reactions, causes of suspension and previous treatment). Persistence was defined as time (months) from the start of treatment until its discontinuation due to toxicity or inefficiency. Persistence was calculated with Kaplan–Meier survival curves (log rank test).ResultsForty-two patients (54.8% women) were included. Mean age was 46.5 years (SD=13,2). Previous therapies: topical (100%), methotrexate (38.1%), acycretin (30.9%), cyclosporin (23.8%) and etanercept (7.2%). Average of previous treatments/patient: 2 (1–3). Mean persistence was 19.4 months (95% CI 14.9 to 23.9). At the end of the study period, 69% (n=29) of patients continued with apremilast and 31% (n=13) were discontinued. The causes of suspension were inefficacy in 62% (n=8) and toxicity in 38% (n=5). The severe adverse reactions that required the suspension of treatment were: diarrhoea (one), migraine (one), low back pain (one) and psychiatric disorder (two). Two patients required dose reduction (30 mg/24 hour). The estimated median time of treatment until discontinuation due to toxicity is 3 months compared to 4 months for patients who leave treatment due to inefficiency. There are no statistically significant differences between the survival curves of the causes of abandonment of treatment with apremilast (p=0.532). After 15 months of treatment the probability of discontinuing treatment for any of the causes is maintained over time.ConclusionThe role of the pharmacist is essential in detecting the symptoms and signs of toxicity and ineffectiveness in the first year of treatment. Even so it would be of interest to extend the study time to analyse the long-term persistence.References and/or acknowledgementsNo conflict of interest.
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•Brayton hybrid thermosolar plants are modelled.•Multi-stage recuperative configurations and different working fluids are analyzed.•Predicted improvements of performance over a ...reference plant are presented.•Two compression steps and intercooling allow for a considerable efficiency increase.
This paper presents a general thermodynamic model for hybrid Brayton central tower thermosolar plants. These plants have been proved to be technically feasible but research and development efforts need to be done in order to improve its commercial interest. From the thermodynamic viewpoint it is necessary to increase its performance to get larger power production with reduced fuel consumption, and so reduced emissions. A model for multi-step compression and expansion is developed with that aim. The model is flexible and allows to simulate recuperative or non-recuperative plants, with an arbitrary number of stages and working with different subcritical fluids. The results for multi-step configurations are compared with those obtained for a plant with one turbine and one compressor. Different working fluids are analyzed, including air, nitrogen, carbon dioxide, and helium. Several plant layouts and the corresponding optimal pressure ratios are analyzed. Configurations with two-stages compression with intercooling combined with one or two expansion stages can significantly improve overall plant efficiency and lower fuel consumption. Power block efficiencies can reach 0.50 and overall plant efficiency can attain values about 0.40 working with air or carbon dioxide. For instance, comparing with a single-stage plant running with air, a plant working with subcritical carbon dioxide and two compression stages with intercooling can reach an overall efficiency about 19% larger and a fuel conversion rate around 23% larger. For such configuration, the specific fuel consumption is predicted to be about 108 kg/(MW h) at design point conditions.
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