J M Carrascosa

Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain

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Publications (139)104.11 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Identifying patients likely to have very good or bad results from systemic psoriasis therapy could improve efficiency of therapy. Objective: To develop prognostic models for good or bad response to classic systemic drugs, anti-TNFs, and ustekinumab in psoriasis. Methods: Multivariable logistic regression of a prospective multicenter cohort of psoriatic patients in clinical practice (6449 person-years of follow-up). We used as possible predictors: demographic characteristics, comorbidities, characteristics of the psoriasis (type, PASI, arthritis), history of past therapy at entry in the cohort, and history of response to previous cycles while in the cohort. We defined good response to a treatment cycle as either cycle end due to disease remission, or a cycle longer than 2 years that does not end later due to inefficacy in the follow-up period. Bad response to a treatment cycle was defined as a cycle that is finished due to inefficacy, based on physician judgment, after more than three months of treatment. Results: Patients with fewer previous therapies, lower body mass index, older at start of therapy, and with previous history of good responses to therapy are more likely to have positive results of therapy. However, the predictive characteristics of models are poor. Conclusion: Predictive models of clinical response to systemic drugs in psoriasis with the studied variables do not seem to outperform drug selection by a dermatologist.
    Journal of Dermatological Treatment 09/2015; DOI:10.3109/09546634.2015.1088130 · 1.67 Impact Factor
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    ABSTRACT: With the advent of biologic drugs in the management of moderate to severe psoriasis, there may have been a shift in therapeutic approach from rotational strategies to a unidirectional progression from topical treatments to the highest rung of the therapeutic ladder. We studied the frequency of switching from classic to biologic therapy and vice versa in a cohort of patients with psoriasis over a period of up to 5 years. Patients are included in the BIOBADADERM prospective registry when they are first prescribed any specific conventional or biologic systemic treatment. The data for each patient refer to the follow-up period from the time they entered the cohort until October 2013. To describe the pattern of switches from classic to biologic therapy and vice versa, we used the data in the registry on the first day of every 365-day period following the date each patient was included in the cohort. In total, 47.3% of the patients (926/1956) were prescribed a classic systemic drug and 52.7% (1030/1956) a biologic agent on entry into the study. Of the 741 patients who accumulated 5 years of follow-up, 21.9% (155) were receiving nonbiologic drugs and 78.1% (553) were on biologic therapy on the first day of their 5th year of follow-up. The proportion of patients receiving biologic therapy increased with longer follow-up. Copyright © 2015 Elsevier España, S.L.U. and AEDV. All rights reserved.
    Actas Dermo-Sifiliográficas 06/2015; 106(8). DOI:10.1016/j.ad.2015.04.013
  • J.M. Carrascosa · J. Bassas · L. Puig
    Actas Dermo-Sifiliográficas 06/2015; 106(6). DOI:10.1016/j.adengl.2015.05.010
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    ABSTRACT: Introduction and objectives: A great amount of information on systemic and biologic therapies for moderate to severe psoriasis is now available. However, applying the evidence in numerous clinical scenarios has engendered debate; under these circumstances, the consensus of experts is useful. Material and methods: A scientific committee systematically reviewed the literature relevant to 5 clinical scenarios. An online Delphi survey of dermatologists with experience treating moderate to severe psoriasis was then carried out in order to shed light on questions that remained unresolved by the available evidence. Results: Twenty-three dermatologists responded to the survey and consensus was reached on 37 (56%) of the 66 statements proposed. These results led to consensus on various clinical situations even though firm evidence was lacking. Thus, intermittent therapeutic regimens and strategies for reducing the intensity of treatment are considered appropriate for optimizing biologic treatment and reducing costs. The measurement of drug and antidrug antibody levels should be included routinely when following patients on biologics to treat psoriasis. Concomitant psoriatic arthritis or a history of cardiovascular conditions will influence the choice of biologic; in these situations, an agent with anti-tumor necrosis factor properties will be preferred. Tailored management is important when the patient is pregnant or intends to conceive; drug half-life and disease severity are important factors to take into consideration in these scenarios. Conclusions: A combination of systematic review of the literature and structured discussion of expert opinion facilitates decision-making in specific clinical scenarios.
    Actas Dermo-Sifiliográficas 04/2015; 106(4). DOI:10.1016/j.adengl.2015.03.019
  • J.M. Carrascosa · J. Bassas · L. Puig
    Actas Dermo-Sifiliográficas 03/2015; DOI:10.1016/j.ad.2015.01.008
  • J.M. Carrascosa · I. Belinchón · P. de-la-Cueva · R. Izu · J. Luelmo · R. Ruiz
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    ABSTRACT: A great amount of information on systemic and biologic therapies for moderate to severe psoriasis is now available. However, applying the evidence in numerous clinical scenarios has engendered debate; under these circumstances, the consensus of experts is useful.
    Actas Dermo-Sifiliográficas 01/2015; 106(4). DOI:10.1016/j.ad.2014.11.005
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    ABSTRACT: Background Prediction of response to ultraviolet-B (UVB) phototherapy in psoriatic patients mainly relies on clinical criteria, although some genetic predictors have been identified. Toll-like receptors (TLR) have been involved in psoriasis pathogenesis through activation of the innate immune system. Their polymorphisms may condition not only the clinical profile of psoriasis but also the response to therapy.Methods We analyzed the role of functional single-nucleotide polymorphisms (SNPs) of TLR 2, 5, 4 and 9 in clinical response to a standard narrow-band UVB (NBUVB) therapy in 39 patients with moderate to severe psoriasis.ResultsWe found a significant relationship between TLR9-1486T/C SNP variants and a better response to NBUVB phototherapy. Patients with TC and CC genotype showed a higher improvement of Psoriasis Area and Severity Index (PASI) than patients with TT genotype. Results of multivariate analysis indicate that the differences in PASI improvement at the end of phototherapy attributed to TRL9 SNP genotype were not dependent on the patients’ phototype, age, gender, body mass index, basal PASI, or disease evolution.Conclusions We describe a functional genetic variant in TLR-9 gene that might affect the susceptibility to antipsoriatic treatment. The search of genetic predictive factors may be helpful in therapy selection and optimization of therapeutic regimes in psoriatic patients.
    Photodermatology Photoimmunology and Photomedicine 12/2014; 31(2). DOI:10.1111/phpp.12160 · 1.26 Impact Factor
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    ABSTRACT: Objective In this study, we have performed a direct comparison between both T-cell based assays (QFN-G-IT and T-SPOT.TB) and TST in patients with psoriasis taking different immunosuppressant drug-regimens. Methods We have prospectively studied 103 patients with moderate-to-severe psoriasis who required latent tuberculosis infection (LTBI) screening before starting systemic immunosuppressive treatment or during its sustained use. Results Overall number of positive results was 16.5%, 17.5% and 8.7% using T-SPOT.TB, QFN-G-IT and TST respectively. Differences in the percentage of positive results between TST with T-SPOT.TB and QFN-G-IT were significant (p=0.005 and p=0.008, respectively). A total of 24.3% of the subjects enrolled were positive for at least one of the three tests performed. Sixteen patients with negative TST (17%) were positive for one of the two IGRAs. We obtained seven indeterminate results by T-SPOT.TB and two by QFN-G-IT. Seven patients with negative TST presented indeterminate results by either of two IFN-γ assays. Positive TST, T-SPOT.TB and QFN-G-IT results were not affected by clinical therapeutic profile. Conclusions Our results reveal that in vitro assays are useful methods for LTBI diagnosis in patients with psoriasis, suggesting that they might be less influenced by immunosuppression than TST.
    Journal of Infection 12/2014; 69(6). DOI:10.1016/j.jinf.2014.07.026 · 4.44 Impact Factor
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    ABSTRACT: Lupus erythematosus tumidus (LET) is a subtype of cutaneous lupus erythematosus (CLE) that has been well characterized in recent years. However, some controversy still remains concerning the histological features of epidermal involvement. The objective of this report is to describe the clinical and microscopic features of LET in patients diagnosed at Hospital Universitari Germans Trias i Pujol, Spain. We conducted a retrospective study of 25 patients with a diagnosis of LET. All patients presented with typical LET lesions (smooth, erythematous plaques without macroscopic epidermal changes, such as follicular plugs or scale, that resolved without residual scarring or hypopigmentation). None of the patients fulfilled the criteria for systemic lupus erythematosus during follow-up. Test results for antinuclear antibodies were positive in five patients (20%), with titres below one of 320 in all cases. Twenty-two patients (88%) required antimalarial therapy; response was good in 70% and moderate response in 30%. Minor epidermal alterations were observed in 52% of biopsy specimens, with focal basal vacuolization being the most frequent. LET is a variant of CLE that has distinctive clinical, histologic and prognostic features. Unlike the patients in the case series previously described in the literature, most of our patients required treatment with antimalarials. Histology revealed mild epidermal alterations in a significant percentage of patients. Thus, in our opinion, the absence of microscopic epidermal alterations is not constant in LET. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
    Lupus 11/2014; 24(7). DOI:10.1177/0961203314560204 · 2.20 Impact Factor
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    ABSTRACT: Background: The prevalence of cardiovascular risk factors (CVRF) in psoriasis has not been studied in large Spanish samples. Objective: To assess the prevalence of major CVRFs in psoriasis patients requiring systemic treatments. Material and Methods: Cross-sectional study in psoriasis patients from 33 hospital dermatology offices throughout Spain. Blood pressure (BP) was measured and a fasting lab test was performed. Each CVRF was diagnosed according to the recommendations of international societies. Results: In 368 patients (mean age 48 years old, 36% women), 80.2% had at least one CVRF. The prevalence of each CVRF was similar in men and women and slightly higher in patients with psoriatic arthritis and in patients with a history of more severe disease. The percentage of patients treated with drugs to control CVRF was low (∼50% of those with each CVRF). A total of 20.7% had experienced some cardiovascular disease (CVD) episode. Conclusion: The prevalence of CVRF was high, higher than in the general Spanish population, and 20% had already suffered CVD. However, the percentage with drug treatments for CVRF was low.
    European journal of dermatology: EJD 10/2014; 24(6). DOI:10.1684/ejd.2014.2440 · 1.99 Impact Factor
  • J M Carrascosa · L Puig
    Actas Dermo-Sifiliográficas 10/2014; 105S1:6-8. DOI:10.1016/S0001-7310(14)70013-4
  • J.M. Carrascosa · J. Notario
    Actas Dermo-Sifiliográficas 10/2014; 105(8). DOI:10.1016/j.ad.2014.04.004
  • L Puig · J M Carrascosa
    Actas Dermo-Sifiliográficas 10/2014; 105S1:1-5. DOI:10.1016/S0001-7310(14)70012-2
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    ABSTRACT: Background Psoriasis patients over 65 years-old (elderly) constitute a growing group, underrepresented in clinical trials, and likely to be more prone to adverse events.Objective To describe safety of systemic psoriasis therapy in patients over 65 years-old compared to younger patients.Methods Patients registered in Biobadaderm, a Spanish national registry of psoriasis patients treated with systemic therapy, were grouped in elderly (≥ 65 years old) and younger patients. Rates of adverse events were described by severity and type, and the risks compared in both groups, taking into account exposure to classic or biologic drugs, using Cox regression.Results175 (9.8%) of 1793 patients were elderly. Overall risk of adverse events was not higher in elderly (drug group adjusted HR 1.09 (95%CI: 0.93-1.3)). Serious adverse events were more common in elderly (drug group adjusted HR 3.2 (95%CI: 2.0-5.1)). Age adjusted HR of all adverse events was lower for patients exposed to biologics compared to classic drugs in the whole sample (HR 0.7 (95%CI: 0.6-0.7)). Age did not seem to modify the effect of therapy (biologic vs. classic) in the risk of adverse events (likelihood ratio test for interaction, p = 0.12 for all adverse events, p = 0-09 for serious adverse events).Conclusions Serious adverse events are more common in elderly patients, although they may be related to other variants that are associated with this age group and not due to the treatment itself. Use of biologics was associated with lower risk of adverse events in the whole group. We found no differences in this association between young and elderly. These results are reassuring, although uncontrolled confounding could not be excluded as an explanation for these findings, and the power of the study to detect differences was low.
    Journal of the European Academy of Dermatology and Venereology 09/2014; 29(5). DOI:10.1111/jdv.12688 · 2.83 Impact Factor
  • C. Ferrándiz · J.M. Carrascosa · M. Toro
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    ABSTRACT: Introduction The prevalence of psoriasis in Spain was estimated to be 1.4% before the advent of biologic agents. Fifteen years later, new therapeutic options based on biologic agents have led to greater awareness of the disease and better understanding; case detection and diagnosis may have improved as a result. Objective To investigate the current prevalence of psoriasis in Spain and compare the results with those of an earlier study that used the same methodology. Material and methods Population-based cross-sectional survey. Information was collected through computer-assisted telephone interviews with a randomly selected representative sample of the Spanish population (12,711 individuals from 4,754 households). Interviews were conducted by trained personnel using a questionnaire. Results The prevalence was 2.3% and there were no statistically significant differences between the sexes. Prevalence increased with age (range with highest prevalence, 60-69 years). Central Spain—a region with a cold, dry climate—had the highest prevalence, but differences between regions were not significant. Conclusions Psoriasis is substantially more prevalent in Spain than was previously estimated. The increase in prevalence may reflect greater awareness and better diagnosis of the disease rather than a true increase in number of cases.
    Actas Dermo-Sifiliográficas 06/2014; DOI:10.1016/j.ad.2013.12.008
  • J M Carrascosa · J Notario
    Actas Dermo-Sifiliográficas 05/2014; 105(8). DOI:10.1016/j.adengl.2014.04.022
  • J.‐M. Carrascosa · M.B.A. van Doorn · M. Lahfa · F. O. Nestle · D. Jullien · J. C. Prinz
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    ABSTRACT: Biological drugs such as the tumour necrosis factor inhibitors have revolutionized the treatment of psoriasis, but some have the potential to induce an unwanted immune response. This immunogenicity may be associated with low trough drug levels, reduced clinical efficacy, reduced drug survival and an increased risk for adverse events. This article presents a literature review of the evidence on immunogenicity of biologics used in the treatment of psoriasis and considers the implications for therapeutic decision-making in the management of patients with moderate-to-severe psoriasis.
    Journal of the European Academy of Dermatology and Venereology 05/2014; 28(11). DOI:10.1111/jdv.12549 · 2.83 Impact Factor
  • Y. Gilaberte · J.M. Carrascosa
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    ABSTRACT: One of the main goals of all skin cancer prevention campaigns is to protect children from ultraviolet radiation. However, little is known about how sun exposure risks differ between adults and children or about how these risks are best managed. Children's skin is more susceptible to sun damage for a number of reasons, including certain anatomical and functional aspects in children under 2 years of age and habits that predispose to greater sun exposure during the first 2 decades of life. Oil-based emulsions containing inorganic filters appear to be safest sunscreens for children, although the addition of certain organic filters is necessary to achieve a sun protection factor of 50. Oxybenzone, and probably also octocrylene, should be avoided in sunscreens for children. Sunscreen use should be part of an overall sun protection strategy that includes avoidance of exposure to midday sun and the use of protective clothing and hats. The above considerations justify the implementation of primary prevention campaigns focused on sun protection education for children and the continuation of basic and epidemiological research into specific sun protection strategies and sunscreens for each age group.
    Actas Dermo-Sifiliográficas 04/2014; 105(3):253–262. DOI:10.1016/j.ad.2013.05.004
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    J.M. Carrascosa · Y. Gilaberte · I. Belinchón · L. Ferrándiz
    Actas Dermo-Sifiliográficas 03/2014; 105(2). DOI:10.1016/j.ad.2014.01.001
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    ABSTRACT: Background Biobadaderm is the Spanish registry of psoriasis patients receiving systemic treatment in clinical practice.Objective To compare the safety of biologics and classic systemic treatment.Methods Prospective cohort of patients receiving biologics and classic systemic therapies between 2008 and 2013 in 12 hospitals are included. We registered demographic data, diagnoses, comorbidities, treatments and adverse events (AE). We obtained raw relative risks (RR) for specific AE. Multivariate analysis consisted of Cox models adjusting for age, gender, chronic hepatic disease and previous cancer.ResultsA total of 1030 patients received biologics (2061 AE in 3681 person-years), 926 patients classic systemic drugs (1015 AE in 1517 person-years). Ninety-three per cent of AE in both groups were non-serious, 6% serious and 0.003% fatal. The age- and gender-adjusted hazard ratio of AE was lower in the biologics group [hazard ratio 0.6 (95% CI: 0.5–0.7)].We found no differences in rates of serious and mortal AE. Some system organ class AE rates differed between both groups. As limitations: Prescription bias might affect the incidence of AE in both groups. Association of drug and AE was based on timing: associations might not be causal.Conclusion Patients receiving biologics had lower risk of AE. We did not find differences in the risk of serious or fatal AE.
    Journal of the European Academy of Dermatology and Venereology 03/2014; 29(1). DOI:10.1111/jdv.12492 · 2.83 Impact Factor

Publication Stats

651 Citations
104.11 Total Impact Points


  • 1995–2015
    • Hospital Universitari Germans Trias i Pujol
      • Department of Dermatology
      Badalona, Catalonia, Spain
  • 2008–2013
    • Autonomous University of Barcelona
      Cerdanyola del Vallès, Catalonia, Spain
  • 2010
    • Hospital Universitario de La Princesa
      • Servicio de Dermatología
      Madrid, Madrid, Spain
    • Hospital Universitari Sagrat Cor
      Barcino, Catalonia, Spain
  • 2009
    • University of Barcelona
      Barcino, Catalonia, Spain
    • Hospital de la Santa Creu i Sant Pau
      Barcino, Catalonia, Spain
  • 2007
    • Complexo Hospitalario De Pontevedra
      Pontevedra, Galicia, Spain