C. Ferrandiz - Academia.edu (original) (raw)

Papers by C. Ferrandiz

Medicine, Jun 1, 2017

To analyze in several immune-mediated inflammatory diseases (IMIDs) the influence of demographic ... more To analyze in several immune-mediated inflammatory diseases (IMIDs) the influence of demographic and clinical-related variables on the prevalence of cardiovascular disease (CVD), and compare their standardized prevalences. Cross-sectional study, including consecutive patients diagnosed with rheumatoid arthritis, psoriatic arthritis, psoriasis, systemic lupus erythematosus, Crohn disease, or ulcerative colitis, from rheumatology, gastroenterology, and dermatology tertiary care outpatient clinics located throughout Spain, between 2007 and 2010. Our main outcome was defined as previous diagnosis of angina, myocardial infarction, peripheral vascular disease, and/or stroke. Bivariate and multivariate logistic and mixed-effects logistic regression models were performed for each condition and the overall cohort, respectively. Standardized prevalences (in subjects per 100 patients, with 95% confidence intervals) were calculated using marginal analysis. We included 9951 patients. For each IMID, traditional cardiovascular risk factors had a different contribution to CVD. Overall, older age, longer disease duration, presence of traditional cardiovascular risk factors, and male sex were independently associated with a higher CVD prevalence. After adjusting for demographic and traditional cardiovascular risk factors, systemic lupus erythematosus exhibited the highest CVD standardized prevalence, followed by rheumatoid arthritis, psoriasis, Crohn disease, psoriatic arthritis, and ulcerative colitis (4.5 [95% confidence interval (CI): 2.2, 6.8], 1.3 [95% CI: 0.8, 1.8], 0.9 [95% CI: 0.5, 1.2], 0.8 [95% CI: 0.2, 1.3], 0.6 [95% CI: 0.2, 1.0], and 0.5 [95% CI: 0.1, 0.8], respectively). Systemic lupus erythematosus, rheumatoid arthritis, and psoriasis are associated with higher prevalence of CVD compared with other IMIDs. Specific prevention programs should be established in subjects affected with these conditions to prevent CVD.

Biologic therapy is a well-established strategy for managing moderate and severepsoriasis. Nevert... more Biologic therapy is a well-established strategy for managing moderate and severepsoriasis. Nevertheless, the high cost of such therapy, the relatively short span of clinical expe-rience with biologics, and the abundance of literature now available on these agents have madeevidence-based and consensus-based clinical guidelines necessary. The ideal goal of psoriasistreatment is to achieve complete or nearly complete clearing of lesions and to maintain it overtime. Failing that ideal, the goal would be to reduce involvement to localized lesions that canbe controlled with topical therapy. Although current evidence allows us to directly or indirectlycompare the efficacy or risk of primary or secondary failure of available biologics based onobjective outcomes, clinical trial findings cannot be directly translated to routine practice. Asa result, the prescribing physician must tailor the treatment regimen to the individual patient.This update of the clinical practice guidelines issued by the Spanish Academy of Dermatologyand Venereology (AEDV) on biologic therapy for psoriasis incorporates information from themost recent publications on this topic.

La terapia biológica representa una alternativa bien establecida en el manejo dela psoriasis mode... more La terapia biológica representa una alternativa bien establecida en el manejo dela psoriasis moderada y grave. Sin embargo, su elevado coste, la experiencia relativamentelimitada en su empleo clínico y la abundancia de publicaciones existentes hacen necesario eldesarrollo de unas directrices basadas en la evidencia científica disponible y en el consenso deun grupo de expertos. El objetivo ideal del tratamiento de la psoriasis es conseguir y mantenera largo plazo un blanqueamiento completo o prácticamente completo o, en su defecto, unamínima afectación localizada y controlable con tratamientos tópicos. Aunque la evidencia dis-ponible permite comparar de forma directa o indirecta la eficacia y las posibilidades de fracasoterapéutico primario o secundario de los diferentes fármacos según parámetros objetivos, laslimitaciones en la extrapolación de los ensayos clínicos a la clínica diaria condicionan que laelección del fármaco y de la pauta de administración se realicen de forma individualizada enfunción de las características de cada paciente. La presente actualización de las directrices parael tratamiento de la psoriasis con agentes biológicos de la Academia Espa˜nola de Dermatologíay Venereología (AEDV) incorpora la información más reciente disponible a este respecto.

El término de psoriasis en localizaciones de difícil tratamiento se emplea para hacer referencia ... more El término de psoriasis en localizaciones de difícil tratamiento se emplea para hacer referencia a la psoriasis localizada en el cuero cabelludo, las uñas, las palmas y las plantas y que requiere un manejo diferenciado. A menudo los pacientes presentan un importante impacto físico y emocional, unido a la dificultad para controlar adecuadamente sus lesiones con tratamientos tópicos, debido a una insuficiente penetración de los principios activos y la escasa cosmeticidad de los vehículos empleados. Esta circunstancia justifica que la psoriasis en estas localizaciones pueda ser considerada grave, a pesar de su extensión limitada. La experiencia con terapias biológicas en estas localizaciones es escasa, en general en el contexto de ensayos clínicos de formas extensas de psoriasis moderada y grave, junto con series limitadas o
casos aislados. En el presente artículo se presenta la calidad de la evidencia científica para los 4 agentes biológicos disponibles en España (infliximab, etanercept, adalimumab y ustekinumab) siendo de nivel i en el caso de la psoriasis ungueal (nivel de recomendación A) y algo inferior
en la psoriasis del cuero cabelludo y palmoplantar.

Psoriatic lesions affecting the scalp, nails, palms, and the soles of the feet are described as d... more Psoriatic lesions affecting the scalp, nails, palms, and the soles of the feet are
described as difficult-to-treat psoriasis and require specific management. Involvement of these sites often has a significant physical and emotional impact on the patient and the lesions are difficult to control with topical treatments owing to inadequate penetration of active ingredients and the poor cosmetic characteristics of the vehicles used. Consequently, when difficult-to treat sites are involved, psoriasis can be considered severe even though the lesions are not extensive. Scant information is available about the use of biologic therapy in this setting, and
published data generally comes from clinical trials of patients who also had moderate to severe extensive lesions or from small case series and isolated case reports. In this article we review the quality of the scientific evidence for the 4 biologic agents currently available in Spain (infliximab, etanercept, adalimumab, and ustekinumab) and report level i evidence for the use of biologics to treat nail psoriasis (level of recommendation A) and a somewhat lower level of
evidence in the case of scalp involvement and palmoplantar psoriasis.

Resumen Las características de nuestro entorno sugieren que enfermedades como la quera-tosis actí... more Resumen Las características de nuestro entorno sugieren que enfermedades como la quera-tosis actínica (QA) aumentarán su prevalencia y, en consecuencia, la demanda asistencial en los próximos años. Deben tenerse en cuenta una extensa lista de características clínicas en el abordaje terapéutico de la QA, hasta hace poco compuesto únicamente por técnicas abla-tivas y exclusivamente dirigidas a las lesiones, sin considerar el campo de cancerización. El incremento del arsenal terapéutico de los últimos años hace necesaria la homogenización de criterios que faciliten la elección de la mejor opción para cada paciente. La formulación de recomendaciones de consenso entre expertos a partir de la revisión de las evidencias científicas en cuanto a diagnóstico y tratamiento disponibles, permite aportar conocimiento dirigido a la mayor calidad en la atención de los pacientes, facilita una mayor homogeneidad en la toma de decisiones y promueve la sensibilización necesaria de todos los agentes sanitarios involucrados. Abstract Current trends in our setting indicate that the prevalence of actinic keratosis and similar diseases will increase in coming years and impose a greater burden on health care resources. A long list of clinical features must be taken into account when approaching the * Autor para correspondencia. Correo electrónico: cferrandiz.germanstrias@gencat.cat (C. Ferrándiz).

Background: Psoriasis is a chronic autoimmune disease in which T cells have a predominant role in... more Background: Psoriasis is a chronic autoimmune disease in which T cells have a predominant role in initiating and perpetuating the chronic inflammation in skin. However, the mechanisms that regulate T cell activation in psoriasis are still incompletely understood. The objective of the present study was to characterize the main genetic pathways associated with T cell activation in psoriasis.

Current trends in our setting indicate that the prevalence of actinic keratosis and similar disea... more Current trends in our setting indicate that the prevalence of actinic keratosis and similar diseases will increase in coming years and impose a greater burden on health care resources. A long list of clinical features must be taken into account when approaching the treatment of actinic keratosis. Until recently, therapeutic approaches focused solely on ablative procedures and the treatment of individual lesions and did not take into account areas of field cancerization. Now that the therapeutic arsenal has grown, standardized criteria are needed to guide the optimal choice of treatment for each patient. The elaboration of evidence-based consensus recommendations for the diagnosis and treatment of actinic keratosis generates knowledge that will help clinicians to deliver the highest level of care possible, standardizing decision-making processes and enhancing awareness among all the health professionals involved in the care pathway.

n Tratamiento %PASI 75 tras ciclo de inducción (6-10 semanas) % PASI 75 semanas 24-26 % PASI 75 s... more n Tratamiento %PASI 75 tras ciclo de inducción (6-10 semanas) % PASI 75 semanas 24-26 % PASI 75 semanas 44-52 % PASI 75 % PASI 90 % PASI 75 % PASI 90 16 Infliximab 5 mg/kg 87 69 Smith et al3 (postcomercialización) 33 Infliximab 5 mg/kg 77 40

Piel, 2002

La razón fundamental de una revista médica es convertirse en un canal de información entre los pr... more La razón fundamental de una revista médica es convertirse en un canal de información entre los profesionales interesados. Esta información es necesaria para estar al día de las novedades en investigación básica e investigación clínica, de lo que se derivará una mayor calidad en la atención a los enfermos. La transmisión de estos conocimientos, en otras palabras, la comunicación científica entre los profesionales puede realizarse por vía oral, en congresos y cursos, y por vía escrita a través de publicaciones científicas en papel o en soporte digital 1,2 .

Piel, 2011

... Psoriatic erythroderma Carlos Ferra´ndiz *, José Manuel Carrascosa e Isabel Bielsa ... Santos... more ... Psoriatic erythroderma Carlos Ferra´ndiz *, José Manuel Carrascosa e Isabel Bielsa ... Santos-Juanes J, Coto-Segura P, Mas-Vidal A, Galache Osuna C. Ustekinumab induces rapid clearing of erythrodermic psoriasis after failure of antitumour necrosis factor therapies. ...

British Journal of Dermatology, 2004

Psoriasis is a chronic, immune-mediated disorder that usually requires long-term treatment for co... more Psoriasis is a chronic, immune-mediated disorder that usually requires long-term treatment for control. Approximately 25% of patients have moderate to severe disease and require phototherapy, systemic therapy or both. Despite the availability of numerous therapeutic options, the long-term management of psoriasis can be complicated by treatment-related limitations. With advances in molecular research and technology, several biological therapies are in various stages of development and approval for psoriasis. Biological therapies are designed to modulate key steps in the pathogenesis of psoriasis. Collectively, biologicals have been evaluated in thousands of patients with psoriasis and have demonstrated significant benefit with favourable safety and tolerability profiles. The limitations of current psoriasis therapies, the value of biological therapies for psoriasis, and guidance regarding the incorporation of biological therapies into clinical practice are discussed.

Medicine, Jun 1, 2017

To analyze in several immune-mediated inflammatory diseases (IMIDs) the influence of demographic ... more To analyze in several immune-mediated inflammatory diseases (IMIDs) the influence of demographic and clinical-related variables on the prevalence of cardiovascular disease (CVD), and compare their standardized prevalences. Cross-sectional study, including consecutive patients diagnosed with rheumatoid arthritis, psoriatic arthritis, psoriasis, systemic lupus erythematosus, Crohn disease, or ulcerative colitis, from rheumatology, gastroenterology, and dermatology tertiary care outpatient clinics located throughout Spain, between 2007 and 2010. Our main outcome was defined as previous diagnosis of angina, myocardial infarction, peripheral vascular disease, and/or stroke. Bivariate and multivariate logistic and mixed-effects logistic regression models were performed for each condition and the overall cohort, respectively. Standardized prevalences (in subjects per 100 patients, with 95% confidence intervals) were calculated using marginal analysis. We included 9951 patients. For each IMID, traditional cardiovascular risk factors had a different contribution to CVD. Overall, older age, longer disease duration, presence of traditional cardiovascular risk factors, and male sex were independently associated with a higher CVD prevalence. After adjusting for demographic and traditional cardiovascular risk factors, systemic lupus erythematosus exhibited the highest CVD standardized prevalence, followed by rheumatoid arthritis, psoriasis, Crohn disease, psoriatic arthritis, and ulcerative colitis (4.5 [95% confidence interval (CI): 2.2, 6.8], 1.3 [95% CI: 0.8, 1.8], 0.9 [95% CI: 0.5, 1.2], 0.8 [95% CI: 0.2, 1.3], 0.6 [95% CI: 0.2, 1.0], and 0.5 [95% CI: 0.1, 0.8], respectively). Systemic lupus erythematosus, rheumatoid arthritis, and psoriasis are associated with higher prevalence of CVD compared with other IMIDs. Specific prevention programs should be established in subjects affected with these conditions to prevent CVD.

Biologic therapy is a well-established strategy for managing moderate and severepsoriasis. Nevert... more Biologic therapy is a well-established strategy for managing moderate and severepsoriasis. Nevertheless, the high cost of such therapy, the relatively short span of clinical expe-rience with biologics, and the abundance of literature now available on these agents have madeevidence-based and consensus-based clinical guidelines necessary. The ideal goal of psoriasistreatment is to achieve complete or nearly complete clearing of lesions and to maintain it overtime. Failing that ideal, the goal would be to reduce involvement to localized lesions that canbe controlled with topical therapy. Although current evidence allows us to directly or indirectlycompare the efficacy or risk of primary or secondary failure of available biologics based onobjective outcomes, clinical trial findings cannot be directly translated to routine practice. Asa result, the prescribing physician must tailor the treatment regimen to the individual patient.This update of the clinical practice guidelines issued by the Spanish Academy of Dermatologyand Venereology (AEDV) on biologic therapy for psoriasis incorporates information from themost recent publications on this topic.

La terapia biológica representa una alternativa bien establecida en el manejo dela psoriasis mode... more La terapia biológica representa una alternativa bien establecida en el manejo dela psoriasis moderada y grave. Sin embargo, su elevado coste, la experiencia relativamentelimitada en su empleo clínico y la abundancia de publicaciones existentes hacen necesario eldesarrollo de unas directrices basadas en la evidencia científica disponible y en el consenso deun grupo de expertos. El objetivo ideal del tratamiento de la psoriasis es conseguir y mantenera largo plazo un blanqueamiento completo o prácticamente completo o, en su defecto, unamínima afectación localizada y controlable con tratamientos tópicos. Aunque la evidencia dis-ponible permite comparar de forma directa o indirecta la eficacia y las posibilidades de fracasoterapéutico primario o secundario de los diferentes fármacos según parámetros objetivos, laslimitaciones en la extrapolación de los ensayos clínicos a la clínica diaria condicionan que laelección del fármaco y de la pauta de administración se realicen de forma individualizada enfunción de las características de cada paciente. La presente actualización de las directrices parael tratamiento de la psoriasis con agentes biológicos de la Academia Espa˜nola de Dermatologíay Venereología (AEDV) incorpora la información más reciente disponible a este respecto.

El término de psoriasis en localizaciones de difícil tratamiento se emplea para hacer referencia ... more El término de psoriasis en localizaciones de difícil tratamiento se emplea para hacer referencia a la psoriasis localizada en el cuero cabelludo, las uñas, las palmas y las plantas y que requiere un manejo diferenciado. A menudo los pacientes presentan un importante impacto físico y emocional, unido a la dificultad para controlar adecuadamente sus lesiones con tratamientos tópicos, debido a una insuficiente penetración de los principios activos y la escasa cosmeticidad de los vehículos empleados. Esta circunstancia justifica que la psoriasis en estas localizaciones pueda ser considerada grave, a pesar de su extensión limitada. La experiencia con terapias biológicas en estas localizaciones es escasa, en general en el contexto de ensayos clínicos de formas extensas de psoriasis moderada y grave, junto con series limitadas o
casos aislados. En el presente artículo se presenta la calidad de la evidencia científica para los 4 agentes biológicos disponibles en España (infliximab, etanercept, adalimumab y ustekinumab) siendo de nivel i en el caso de la psoriasis ungueal (nivel de recomendación A) y algo inferior
en la psoriasis del cuero cabelludo y palmoplantar.

Psoriatic lesions affecting the scalp, nails, palms, and the soles of the feet are described as d... more Psoriatic lesions affecting the scalp, nails, palms, and the soles of the feet are
described as difficult-to-treat psoriasis and require specific management. Involvement of these sites often has a significant physical and emotional impact on the patient and the lesions are difficult to control with topical treatments owing to inadequate penetration of active ingredients and the poor cosmetic characteristics of the vehicles used. Consequently, when difficult-to treat sites are involved, psoriasis can be considered severe even though the lesions are not extensive. Scant information is available about the use of biologic therapy in this setting, and
published data generally comes from clinical trials of patients who also had moderate to severe extensive lesions or from small case series and isolated case reports. In this article we review the quality of the scientific evidence for the 4 biologic agents currently available in Spain (infliximab, etanercept, adalimumab, and ustekinumab) and report level i evidence for the use of biologics to treat nail psoriasis (level of recommendation A) and a somewhat lower level of
evidence in the case of scalp involvement and palmoplantar psoriasis.

Resumen Las características de nuestro entorno sugieren que enfermedades como la quera-tosis actí... more Resumen Las características de nuestro entorno sugieren que enfermedades como la quera-tosis actínica (QA) aumentarán su prevalencia y, en consecuencia, la demanda asistencial en los próximos años. Deben tenerse en cuenta una extensa lista de características clínicas en el abordaje terapéutico de la QA, hasta hace poco compuesto únicamente por técnicas abla-tivas y exclusivamente dirigidas a las lesiones, sin considerar el campo de cancerización. El incremento del arsenal terapéutico de los últimos años hace necesaria la homogenización de criterios que faciliten la elección de la mejor opción para cada paciente. La formulación de recomendaciones de consenso entre expertos a partir de la revisión de las evidencias científicas en cuanto a diagnóstico y tratamiento disponibles, permite aportar conocimiento dirigido a la mayor calidad en la atención de los pacientes, facilita una mayor homogeneidad en la toma de decisiones y promueve la sensibilización necesaria de todos los agentes sanitarios involucrados. Abstract Current trends in our setting indicate that the prevalence of actinic keratosis and similar diseases will increase in coming years and impose a greater burden on health care resources. A long list of clinical features must be taken into account when approaching the * Autor para correspondencia. Correo electrónico: cferrandiz.germanstrias@gencat.cat (C. Ferrándiz).

Background: Psoriasis is a chronic autoimmune disease in which T cells have a predominant role in... more Background: Psoriasis is a chronic autoimmune disease in which T cells have a predominant role in initiating and perpetuating the chronic inflammation in skin. However, the mechanisms that regulate T cell activation in psoriasis are still incompletely understood. The objective of the present study was to characterize the main genetic pathways associated with T cell activation in psoriasis.

Current trends in our setting indicate that the prevalence of actinic keratosis and similar disea... more Current trends in our setting indicate that the prevalence of actinic keratosis and similar diseases will increase in coming years and impose a greater burden on health care resources. A long list of clinical features must be taken into account when approaching the treatment of actinic keratosis. Until recently, therapeutic approaches focused solely on ablative procedures and the treatment of individual lesions and did not take into account areas of field cancerization. Now that the therapeutic arsenal has grown, standardized criteria are needed to guide the optimal choice of treatment for each patient. The elaboration of evidence-based consensus recommendations for the diagnosis and treatment of actinic keratosis generates knowledge that will help clinicians to deliver the highest level of care possible, standardizing decision-making processes and enhancing awareness among all the health professionals involved in the care pathway.

n Tratamiento %PASI 75 tras ciclo de inducción (6-10 semanas) % PASI 75 semanas 24-26 % PASI 75 s... more n Tratamiento %PASI 75 tras ciclo de inducción (6-10 semanas) % PASI 75 semanas 24-26 % PASI 75 semanas 44-52 % PASI 75 % PASI 90 % PASI 75 % PASI 90 16 Infliximab 5 mg/kg 87 69 Smith et al3 (postcomercialización) 33 Infliximab 5 mg/kg 77 40

Piel, 2002

La razón fundamental de una revista médica es convertirse en un canal de información entre los pr... more La razón fundamental de una revista médica es convertirse en un canal de información entre los profesionales interesados. Esta información es necesaria para estar al día de las novedades en investigación básica e investigación clínica, de lo que se derivará una mayor calidad en la atención a los enfermos. La transmisión de estos conocimientos, en otras palabras, la comunicación científica entre los profesionales puede realizarse por vía oral, en congresos y cursos, y por vía escrita a través de publicaciones científicas en papel o en soporte digital 1,2 .

Piel, 2011

... Psoriatic erythroderma Carlos Ferra´ndiz *, José Manuel Carrascosa e Isabel Bielsa ... Santos... more ... Psoriatic erythroderma Carlos Ferra´ndiz *, José Manuel Carrascosa e Isabel Bielsa ... Santos-Juanes J, Coto-Segura P, Mas-Vidal A, Galache Osuna C. Ustekinumab induces rapid clearing of erythrodermic psoriasis after failure of antitumour necrosis factor therapies. ...

British Journal of Dermatology, 2004

Psoriasis is a chronic, immune-mediated disorder that usually requires long-term treatment for co... more Psoriasis is a chronic, immune-mediated disorder that usually requires long-term treatment for control. Approximately 25% of patients have moderate to severe disease and require phototherapy, systemic therapy or both. Despite the availability of numerous therapeutic options, the long-term management of psoriasis can be complicated by treatment-related limitations. With advances in molecular research and technology, several biological therapies are in various stages of development and approval for psoriasis. Biological therapies are designed to modulate key steps in the pathogenesis of psoriasis. Collectively, biologicals have been evaluated in thousands of patients with psoriasis and have demonstrated significant benefit with favourable safety and tolerability profiles. The limitations of current psoriasis therapies, the value of biological therapies for psoriasis, and guidance regarding the incorporation of biological therapies into clinical practice are discussed.