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Background: Methotrexate (MTX) is frequently used in the treatment of moderate-to-severe psoriasis, however, there is limited data on health-related quality-of-life (HRQoL), psoriasis clinical outcomes and hepatic fibrosis in MTX-treated patients in routine clinical practice. Objectives: To investigate the impact of moderate-to-severe psoriasis in MTX-treated patients in Spain regarding to HRQoL, psoriasis clinical data and risk of hepatic fibrosis. Methods: Observational, non-interventional, cross-sectional, retrospective, multicentre study, performed in Spain in moderate-to-severe plaque psoriasis patients treated with MTX > 16 weeks prior to inclusion. Results: Despite ongoing treatment, 17.1% of 457 evaluable patients reported moderate-to-extreme impact on HRQoL (DLQI > 5); 21.4% BSA > 5 and 35.2% moderate-to-severe pruritus (VAS ! 4). Persistent severe psoriasis (PASI ! 10 and/or DLQI ! 10) was observed in 10.7%. Hepatic steatosis was identified in 64.1% of patients (HSI ! 36) and 37.2% of the patients were at-risk of advanced fibrosis which was associated to the MTX treatment duration. Conclusions: The study identified unmet needs in moderate-to-severe plaque psoriasis patients treated with MTX, revealing a significant proportion of sub-optimally controlled patients in terms of HRQoL and different domains of the disease. This study also found patients at-risk of advanced fibrosis, with evidence suggesting a correlation between longer exposures to MTX and higher risk of advanced fibrosis.

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BackgroundThere is limited evidence over the real‐life secukinumab survival in psoriatic patients, especially in the long‐term bio‐naïve subjects, and to date biological treatments have been assessed in patients with a chronic and recalcitrant psoriasis. It has been hypothesised that early intensive treatment with biological therapies could decrease pathogenic tissue resident memory (TRm) cells migration and potentially modify the natural course of psoriasis and related comorbidities.ObjectivesTo analyze long‐term secukinumab efficacy, safety and survival, and its predictive factors for psoriasis treatment determining also whether early intervention may result in better outcomes for patients.MethodsBio‐naïve psoriatic patients under treatment with secukinumab (n = 128 patients) in a daily practice setting were analyzed in a retrospective multicentric study and followed up to 8 years. Drug survival rate, efficacy, posology and safety were reported.ResultsThe overall secukinumab survival was 81.9% for an average treatment exposure of 147.9 weeks. The approved posology was the most commonly prescribed regimen (78.7%), and 17.7% could be optimized. An absolut‐PASI ≤3 was reached by 86.6%, 82.6% and 91.7% at the weeks 48,156 and 264, respectively. The incidence of arthritis or psoriasis related comorbidities was low. The response was not influenced by weight, age (>65), gender or the presence of arthritis. No severe adverse events were reported.ConclusionsIn our bio‐naïve series, the high efficacy and long‐term survival rates observed and the low prevalence of arthritis and comorbidities might suggest that early intervention could contribute to modify the course of the disease, but further studies are needed.

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Background: Invasive aspergillosis ia an actual problem of patients with B-cell lymphoma todayAims: To study frequency, etiology, diagnostics and treatment of invasive aspergillosis (IA) in patients with B-cell lymphoma (Hodgkin lymphoma and non-Hodgkin lymphoma), who received cytostatic chemotherapy. Methods: The study included 817 patients with B-cell lymphoma: Hodgkin lymphoma (HL) -363, age from 16 to 65 years (median -33), non-Hodgkin lymphoma (NHL) -450, age from 19 to 74 years (median -50). For the IA diagnosis criteria EORTS/MSG 2008 were used. Results: Frequency of IA in patients with B-cell lymphoma was 4,98% (HL -5,6%; NHL -4,5%, p = 0,49). In patients with NHL, who received anti-relapse therapy, frequency of IA was 10,25%, during induction therapy -2,88% (p = 0,004). The main etiological agents were: A. fumigatus (41%), A. niger (39%), A. flavus (14%). The main risk factors for IA in patients with B-cell lymphoma were: relapse of lymphoma (p = 0,005), B-symptoms and radiation therapy in anamnesis (p = 0,035 and p = 0,041), profound neutropenia (p = 0,000), concurrent lung and renal pathology (p = 0,007 and p = 0,03). The lungs were involved in 100% cases, 4,5% NHL patients had ≥2 organs involvement. Clinical symptoms of IA were nonspecific: fever 68%, cough 48%, dyspnea 32,5%, hemoptysis and pain in the chest were rare -4,7% vs 4% respectively. CT-sings of IA of lungs were also nonspecific: focal changes 63,5%, infiltrates 58,7% and ''ground-glass opacity" 23%; bilateral lung damage -62,7%. Galactomannan test was positive in BAL fluid and serum in 83,6% patients with B-cell lymphoma. The presence of septate mycelium in BAL was observed at microscopy in 15,5% patients. Aspergillus spp. in BAL culture was obtained in 34,7% patients with B-cell lymphoma (HL -20,4%; NHL -46,3%, p = 0,004). ''Probable" IA was diagnosed in 92,9%, ''proven" -in 7,1% of cases. The main antifungal drug was voriconazole -79%. Overall 12-weeks survival in patients with B-cell lymphoma was 84,9% (HL -88,1%; NHL -82,1%). Summary/Conclusion: Frequency of IA in patients with B-cell lymphoma was 4,98% (HL -5,6%; NHL -4,5%), in patients with relapse of NHL -10,25%. The main risk factors for IA were: relapse of lymphoma (p = 0,005), B-symptoms and radiation therapy in anamnesis (p = 0,035 and p = 0,041), profound neutropenia (p = 0,000), concurrent lung and renal pathology (p = 0,007 and p = 0,03). Etiology agents were: A. fumigatus (41%), A. niger (39%), A. flavus (14%). Clinical and CT-signs were nonspecific. The main antifungal drug was voriconazole -79%. Overall 12-weeks survival in patients with B-cell lymphoma was 84,9%.