Introducción la psoriasis es una enfermedad inflamatoria crónica mediada por el sistema inmunitario que tiene un impacto significativo en la calidad de vida relacionada con la salud (CVRS), especialmente en los casos moderados y graves que requieren tratamiento sistémico. La integración de medidas de resultados comunicados por los pacientes en formato electrónico (ePROMs) en plataformas de telefarmacia ha adquirido relevancia como herramienta para el seguimiento longitudinal y la atención centrada en el paciente. El estudio TELEPROMpsoriasis tuvo como objetivo evaluar la evolución de la CVRS y la carga de síntomas durante 12 meses en pacientes con psoriasis moderada-grave tratados con fármacos biológicos o pequeñas moléculas y seguidos mediante un programa de telefarmacia, analizar el logro de objetivos clínicos de CVRS (DLQI ≤1 y PSSD-7 días <20) y explorar diferencias según el historial terapéutico y el sexo. Métodos se realizó un estudio multicéntrico y prospectivo utilizando la plataforma de telefarmacia NAVETA en el Sistema Nacional de Salud. Se incluyeron pacientes adultos con psoriasis en placas moderada-grave que iniciaban o cambiaban tratamiento biológico o inmunomodulador. La CVRS se evaluó mediante el Dermatology Life Quality Index (DLQI) y el Psoriasis Symptoms and Signs Diary (PSSD-7 días) en el momento basal y a los 1, 3, 6 y 12 meses. Los análisis longitudinales se realizaron mediante pruebas no paramétricas, teniendo en cuenta la variabilidad en la tasa de respuesta a lo largo del seguimiento. Resultados se incluyeron 210 pacientes, de los cuales 188 aportaron al menos una respuesta válida a los ePROMs y fueron elegibles para los análisis longitudinales. Tanto el DLQI como el PSSD-7 días mostraron una mejoría significativa y progresiva durante los 12 meses de seguimiento, con una fuerte correlación entre ambos instrumentos a lo largo del tiempo (r = 0,74 a los 12 meses). Los pacientes sin tratamiento biológico previo alcanzaron mayores tasas de mejora clínicamente relevante de la CVRS en comparación con los pacientes con experiencia previa en biológicos, especialmente en los meses finales del seguimiento. Las mujeres informaron de forma consistente una mayor carga de síntomas y peor CVRS que los hombres. No se observaron diferencias significativas en la evolución de la CVRS entre las distintas clases farmacológicas. Al finalizar el seguimiento, más de la mitad de la cohorte alcanzó objetivos óptimos de CVRS. La adherencia a la cumplimentación de los cuestionarios fue del 71% y el grado de satisfacción global fue elevado (9/10). Conclusiones el seguimiento mediante telefarmacia apoyado en ePROMs validados permite capturar de forma eficaz la evolución longitudinal de la CVRS y la carga sintomática en pacientes con psoriasis moderada-grave en la práctica clínica real. El logro de objetivos predefinidos de CVRS confirma su relevancia clínica. Estos resultados refuerzan el valor de la atención digital centrada en el paciente y sugieren que determinados subgrupos, como los pacientes con experiencia previa en biológicos y las mujeres, podrían beneficiarse de estrategias de seguimiento más personalizadas.
Background:Erosive esophagitis (EE) is commonly managed with proton pump inhibitors (PPIs), yet many patients experience incomplete healing or recurrence. Potassium-competitive acid blockers (P-CABs) have emerged as potential alternatives, but high-certainty comparative evidence across agents remains limited. We performed a network meta-analysis to evaluate the relative efficacy and safety of P-CABs versus PPIs and to assess the certainty of the evidence. Methods:We systematically searched PubMed, the Cochrane Library, and Web of Science from inception through March 1, 2025, for randomized controlled trials (RCTs) comparing P-CAB, PPI, and/or placebo for the treatment of EE. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Key outcomes were 8-week endoscopic healing and 24-week recurrence. Certainty of evidence was evaluated using GRADE. Risk difference (RD) estimates were calculated using random-effects models. The study protocol was registered with PROSPERO (CRD420251116179). Findings:Thirty-nine RCTs were included; all evaluated once-daily dosing. At 8 weeks, zastaprazan 20 mg, vonoprazan 20 mg, and esomeprazole 40 mg demonstrated moderate-certainty superiority over rabeprazole 20 mg and omeprazole 20 mg with RDs ranging from 0.05 to 0.11, while only vonoprazan 20 mg demonstrated moderate-certainty benefit versus lansoprazole 30 mg (RD: 0.04). In Los Angeles (LA) grade C/D EE, vonoprazan 20 mg, esomeprazole 40 mg, and rabeprazole-ER 50 mg demonstrated moderate-to-high-certainty benefit over lansoprazole 30 mg and omeprazole 20 mg with RDs ranging from 0.05 to 0.15. Vonoprazan 20 mg and rabeprazole-ER 50 mg demonstrated moderate-certainty benefit compared with pantoprazole 40 mg (RDs: 0.12 and 0.09, respectively).At 24 weeks, vonoprazan 10 mg and 20 mg showed moderate-to-high-certainty benefit versus lansoprazole 15 mg (RDs: -0.11 and -0.13, respectively), while in direct comparisons, esomeprazole 20 mg outperformed lansoprazole 15 mg and pantoprazole 20 mg, with approximately 40-50% relative reductions in recurrence. In LA grade C/D EE, vonoprazan 10 mg and 20 mg demonstrated moderate-to-high-certainty superiority over lansoprazole 15 mg and pantoprazole 20 mg with RDs ranging from -0.12 to -0.20. Esomeprazole 20 mg showed a high-certainty benefit compared with pantoprazole 20 mg (RD: -0.16). At 8 and 24 weeks, safety profiles were generally comparable between P-CABs and PPIs. Interpretation:Among once-daily regimens, vonoprazan 20 mg, zastaprazan 20 mg, and esomeprazole 40 mg were most effective for healing EE, while vonoprazan 10 mg and 20 mg and esomeprazole 20 mg were most effective in preventing recurrence. Benefits were most pronounced in LA grade C/D EE and are supported by moderate to high-certainty evidence. Comparative trials evaluating newer P-CABs against optimized PPI strategies, including twice-daily dosing, are needed to evaluate efficacy and long-term safety, particularly with respect to hypergastrinemia and infection risk. Funding:None was received for the study.
INTRODUCTION:Real-world data on dupilumab for eosinophilic esophagitis (EoE), particularly regarding flexible dosing and fibrostenotic phenotypes, are scarce. We aimed to evaluate the effectiveness and safety of dupilumab in clinical practice using the EoE CONNECT registry. METHODS:This cross-sectional analysis included all patients prospectively recruited in the largest European multicenter EoE registry. Baseline characteristics, dosing regimens (300 mg weekly vs semiweekly), clinicohistological response, dose adjustments, and treatment tolerability were assessed. RESULTS:We analyzed 161 patients (145 adults; 16 adolescents). At baseline, 69.1% of patients displayed endoscopic fibrotic features (rings/strictures). After a median of 6.5 months, peak eosinophil count decreased from 57 ± 45 to 8 ± 19 eos/hpf, edema, rings, exudates, furrows, and strictures score declined from 3.0 ± 1.6 to 1.3 ± 1.3, and Dysphagia Symptom Score improved from 5.8 ± 3.7 to 2.5 ± 2.8 (all P < 0.001). Clinicohistological response was achieved by 86.0% of patients on 300 mg weekly and 81.2% on semiweekly dosing ( P = 0.57). Multivariate analysis identified severe atopy as the reason for starting dupilumab as the strongest predictor for semiweekly regimen choice (odds ratio: 26.9; P < 0.001), with conjunctivitis, asthma, and having 2 or more food allergies being significant. Both regimens were equally effective in reducing peak eos/hpf, symptomatology and edema, rings, exudates, furrows, and strictures. Dose tapering from weekly to semiweekly/monthly was successful in all evaluable cases (8/8), whereas dose escalation from semiweekly to weekly rescued 80% (4/5) of nonresponders. Discontinuation occurred only in 8 patients (5%), primarily because of adverse events. DISCUSSION:Dupilumab is effective and safe in real-world EoE management, with no significant differences between weekly and semiweekly induction. Efficacy was generally regained after escalation or maintained after dose tapering.
Background/Objectives: The recommendation of routine gastric and duodenal biopsies at index endoscopy on suspicion of eosinophilic esophagitis (EoE) remains controversial because of the limited supporting evidence. We aimed to evaluate the prevalence, clinical relevance, and predictors of gastric and duodenal histopathology in a large real-world EoE cohort. Methods: This retrospective single-center study included adult and pediatric patients with EoE diagnosed between 2001 and 2024 and enrolled in the EoE CONNECT registry. Gastric and/or duodenal biopsies obtained at diagnosis or follow-up were reviewed. Histologic findings were classified into specific diagnostic categories and analyzed according to clinical presentation, endoscopic features, and age group. Results: We evaluated 340 patients (35.7% children), of whom 88.5% underwent both gastric and duodenal biopsies. The overall diagnostic yield for extra-esophageal findings was 20.9%, predominantly Helicobacter pylori-associated gastritis (18.8%), but with a very low yield of clinically meaningful diagnoses such as celiac disease (0.6%) and eosinophilic gastritis (0.3%). Symptoms and endoscopic abnormalities were not significantly associated with pathological findings (p = 0.11). Moreover, age-stratified analysis revealed no significant differences in specific diagnoses, although patients with pathological extra-esophageal biopsies were significantly older (p < 0.001). Follow-up biopsies demonstrated resolution of most pathological findings after the initial diagnosis, with Helicobacter pylori-associated gastritis accounting for the majority of cases that resolved. Conclusions: Routine extra-esophageal biopsies in the context of patients with EoE have a low diagnostic yield and rarely alter clinical management, regardless of age. Therefore, our findings advocate for a selective rather than universal approach to extra-esophageal sampling in patients with EoE.
