title: Anti-TNFα therapy in the management of psoriasis: experience of a state referral center.
abstract: BACKGROUND
  Psoriasis is a chronic immune-mediated disease, characterized by increased levels of TNFα. Anti-TNFα agents have revolutionized the treatment of severe psoriasis by targeting an important molecule involved in its pathogenesis.
  
  
  OBJECTIVE
  We report the experience of a state referral center that uses anti-TNFα agents for psoriasis.
  
  
  METHODS
  We conducted a retrospective case series. Seventy-four out of 120 patients met the inclusion criteria. Clinical and laboratory data was analyzed using the chi-squared, Wicoxon and McNemar's tests. Associations were considered statistically significant when p-value<0.05.
  
  
  RESULTS
  Forty-one subjects (55.40%) were male, with a mean age of 47.69 ± 14.99 years. Median disease duration and pre-treatment PASI were 14.0 months (IQR 9.0-20.0), and 13.55 points (IQR 8.5-20.32). Sixty patients (81.10%) had arthropathic psoriasis. Forty-six subjects (62.20%) had comorbidities; the most frequent was dyslipidemia (25.70%). In 55.40% of patients, insufficient response to conventional therapies was the principal indication for using anti-TNFα drugs. Clinical improvement occurred in 93.20% of cases, and the post-treatment PASI median was 0.0 points (IQR 0.0-0.0). Adverse effects occurred in 6.80% of patients. Infections and elevation of transaminases occurred in 28.40% and 8.10% of cases, respectively.
  
  
  CONCLUSIONS
  Post-treatment reduction in PASI was satisfactory and the occurrence of adverse effects was minor, mostly mild infusion effects and local reactions at drug administration sites.
authors.affiliation: Universidade Federal da Bahia, Salvador, BA, Brazil.
authors.forename: Laura Maria Andrade
authors.initials: LM
authors.lastname: Silva
authors.affiliation: Universidade Federal da Bahia, Salvador, BA, Brazil.
authors.forename: Bruno de Oliveira
authors.initials: Bde O
authors.lastname: Rocha
authors.affiliation: Universidade Federal da Bahia, Salvador, BA, Brazil.
authors.forename: Ana Cláudia Pinto
authors.initials: AC
authors.lastname: Nobre
authors.affiliation: Universidade Federal da Bahia, Salvador, BA, Brazil.
authors.forename: Vitória Regina Pedreira de Almeida
authors.initials: VR
authors.lastname: Rêgo
authors.affiliation: Universidade Federal da Bahia, Salvador, BA, Brazil.
authors.forename: Ivonise
authors.initials: I
authors.lastname: Follador
authors.affiliation: Universidade Federal da Bahia, Salvador, BA, Brazil.
authors.forename: Maria de Fátima Santos Paim de
authors.initials: Mde F
authors.lastname: Oliveira
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy*; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D007155:Immunologic Factors; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept