Terapia biológica en psoriasis: experiencia de siete años en un hospital de tercer nivel de Ecuador

Introduction: Psoriasis is a chronic inflammatory disease characterized by generalized erythematous scaly plaques and manifestations; it can occur at any age and generates a significant physical and emotional impact that affects the quality of life of patients. The management depends on the degree of affectation, which is evaluated through the PASI scale. For cases with moderate, severe or refractory psoriasis, systemic medications are required that have adverse effects and an important relapse rate that limits their use. Biological therapy has revolutionized the management of psoriasis, with better clinical outcomes, as well as fewer relapses. In Ecuador, there are no data on the use of these drugs in psoriasis because of their high cost and difficult access, as well as a lack of long-term follow-up studies. Objective: To determine the epidemiological profile and the percentage of improvement of the patients with moderatesevere psoriasis using biological therapy. Material and methods: Retrospective, observational study with 115 patients diagnosed of psoriasis with PASI = 10, with therapeutic failure of topical, systemic or phototherapy treatments, and who had already been using biological therapy for at least six months, belonging to the Dermatology Department of the Carlos Andrade Marín Hospital from 2010 to 2017. Results: 46.1% of the patients used infliximab, 33.1% etanercept, 19.1% adalimumab and 1.7% secukinumab. 35.7% had a drug change: 20.9% due to therapeutic failure and 14.8% due to lack of availability of the medication. Those who used infliximab had an improvement of 76.4% (± 21.7), etanercept 65.88%, adalimumab 86.2 (± 13.6), and secukinumab 94.1% (± 5.3). Conclusions: Biological therapy achieves a high percentage of improvement in the majority of patients, regardless of the selection of the biological medication-which depended not on the demographic characteristics of the population but on its availability. This selection did not influence the final clinical response, because a PASI = 75 was obtained with all of them.