A draft of the interdisciplinary guidelines for diagnosis, methods for assessment of the degree of inflammatory activity, therapeutic efficacy, and for the use of biological agents in patients with concomitant immunoinflammatory diseases (psoriasis, psoriatic arthritis, Crohn's disease)

Cover Page

Cite item

Abstract

Psoriasis, psoriatic arthritis (PsA) and inflammatory bowel disease (IBD) are multifactorial chronic immunoinflammatory disorders  with  characteristic common  genetic markers that determine their common  pathophysiology and similar immune abnormalities. In particular, IL12/23 signaling pathway of the  immune  pathogenesis of the  above mentioned diseases  is related  to the  IL23R gene polymorphism. Common  pathophysiological features, in their turn, produce  a high risk and prevalence   of  comorbidity.  Clinicians' unawareness of these  particulars  of the  immunoinflammatory disorders  might  lead  to the  absence  of interdisciplinary collaboration, late  diagnosis  of one  of these  disorders and polypharmacy, because  each specialist (i.e., a dermatologist, a rheumatologist, a  gastroenterologist) would  administer  his/hers treatments  independently.  In  this  context,  the issues  of the  multidisciplinary  approach   to  this problem  are becoming  highly relevant  for earlier diagnosis  and  adequate treatment choice that  is optimal  for all disorders  which contribute to the pathological   process, taking  into  account  common mechanism  of their development. Therefore, there  is the  necessity  to  establish  an  interdisciplinary working group  consisting  of the  leading specialists of the  Russian Federation  in rheumatology,  dermatology,  and  gastroenterology,  with a purpose  to elaborate a consensus  on the immunoinflammatory  comorbidities. At the  discretion of the Russian Association of Rheumatologists (RAR), Russian Society of Dermatovenerologists and  Cosmetologists  (RSDVC),  Russian IBD  Study Society (RIBDS),  such  a group  has  been  formed of 11 experts corresponding to their scientific expertise in the area. The main aim of the Working Group was to develop  a universal interdisciplinary questionnaire for detection of the  signs and symptoms  of the immunoinflammatory disorders (psoriasis,  PsA,  IBD),  as  well as  development  of a draft project  of the  interdisciplinary guidelines on  the  early diagnosis, methods of activity assessment  and indications to the use of genetically engineered biological agents  in patients  with comorbid immunoinflammatory comorbidities (psoriasis, PsA, IBD). Procedure of the interdisciplinary guidelines elaboration. The Working Group elaborated a draft project  of the  up-to-date evidence-based guidelines and proposed a multidisciplinary questionnaire. An interdisciplinary expert council of specialists in dermatology, rheumatology and gastroenterology discussed  each position of the  proposed guidelines  and  was adopted by a simple majority of votes through an open votingat the Second Russian Debates “Dermatology, Rheumatology, Gastroenterology: focus on the interdisciplinary interaction” (Moscow, December 12–13, 2017). Results: 1. A universal interdisciplinary questionnaire to detect  clinical signs of immunoinflammatory  disorders (psoriasis, PsA, IBD) hasbeen  created. It contains  the main questions  the answers to which are needed for a specialist physician (a dermatologist, a rheumatologist or a gastroenterologist)  to  suspect   comorbidity  and  to refer the patient to a corresponding specialist. The questionnaire has three  parts, each of them  with questions  to the  patient  aimed  at the  detection of the symptoms  of psoriasis, PsA, and IBD. 2. An algorithm for interaction between dermatologists, rheumatologists   and    gastroenterologists   has been  developed  aimed  at optimal  management of patients  with comorbid  immunoinflammatory disorders. 3. Goals of treatment of immunoinflammatory disorders  (psoriasis, PsA, Crohn's disease) have been  formulated  according  to the “treat-to-target”  (Т2Т) concept.  4. Criteria for assessment of activity and severity of the  immunoinflammatory disorders (psoriasis, PsA, and Crohn's disease) have been  formulated. 5. The draft describes  the indications  for the  administration of genetically engineered biological agents (GEBA), factors influencing  the  choice of treatment, criteria for GEBA efficacy assessment,  indications  to  a  change  of a GEBA in primary or secondary treatment failure. Conclusion: In accordance  with the results of discussion  with  specialists  from various  regions  of the  Russian  Federation  and  with the  decision  ofthe  Expert  Council,  it  is  planned  to  validate  thequestionnaire, with subsequent inclusion  of the position of the draft project into the clinical guidelines on the management of patients  with psoriasis, PsA, and Crohn's disease.

About the authors

D. I. Abdulganieva

Kazan State Medical University

Email: fake@neicon.ru

Diana I. Abdulganieva - MD, PhD, Professor, Head of the Chair of Hospital Therapy.

49 Butlerova ul., Kazan, 420012.

Russian Federation

A. L. Bakulev

Saratov State Medical University named after V.I. Razumovsky

Email: fake@neicon.ru

Andrey L. Bakulev - MD, PhD, Professor, Chair of Dermatovenereology and Cosmetology.

112 Bol'shaya Kazach'ya ul., Saratov, Saratovskaya oblast', 410012.

Russian Federation

E. A. Belousova

Moscow Regional Research and Clinical Institute (MONIKI)

Author for correspondence.
Email: eabelous@yandex.ru

Elena A. Belousova - MD, PhD, Professor, Head of Department of Gastroenterology and Hepatology; Head of the Chair of Gastroenterology, Postgraduate Training Faculty.

61/2-9 Shchepkina ul., Moscow, 129110.

Tel.: +7 (495) 684 48 58.

Russian Federation

L. F. Znamenskaya

State Research Center for Dermatology, Venereology and Cosmetology

Email: fake@neicon.ru

Lyudmila F. Znamenskaya - MD, PhD, Leading Research Fellow, Department of Dermatology.

3 Korolenko ul., Moscow, 107076.

Russian Federation

T. V. Korotaeva

V.A. Nasonova Research Institute of Rheumatology

Email: tatianakorotaeva@gmail.com

Tatyana V. Korotaeva - MD, PhD, Leading Research Fellow, Laboratory of Innovative Methods for Diagnosis and Treatment of Psoriatic Arthritis.

34A Kashirskoe shosse, Moscow, 115522.

Tel.: +7 (916) 319 25 71.

Russian Federation

L. S. Kruglova

Central State Medical Academy of Department of Presidential Affairs

Email: fake@neicon.ru

Larisa S. Kruglova - MD, PhD, Head of the Chair of Dermatovenereology and Cosmetology.

19–1А Marshalа Timoshenko ul., Moscow, 121359.

Russian Federation

M. M. Kokhan

Ural Research Institute of Dermatovenerology and Immunopathology

Email: fake@neicon.ru

Muza M. Kokhan - MD, PhD, Professor, Head of the Department of Dermatology Clinical Research.

8 Shcherbakova ul., Ekaterinburg, 620076.

Russian Federation

A. M. Lila

V.A. Nasonova Research Institute of Rheumatology

Email: fake@neicon.ru

Aleksandr M. Lila - MD, PhD, Professor, Director.5

34A Kashirskoe shosse, Moscow, 115522.

Russian Federation

V. R. Khayrutdinov

Military Medical Academy named after S.M.Kirov

Email: fake@neicon.ru

Vladislav R. Khayrutdinov - MD, PhD, Assistant, Chair of Skin and Venereal Diseases.

6G Akademika Lebedeva ul., Saint Petersburg, 194044.

Russian Federation

I. L. Khalif

Ryzhikh State Scientific Center of Coloproctology

Email: fake@neicon.ru

Igor L. Khalif - MD, PhD, Professor, Head of the Department of Inflammatory and Functional Bowel Diseases.

2 Salyama Adilya ul., Moscow, 123423.

Russian Federation

M. M. Khobeysh

Pavlov First Saint Petersburg State Medical University

Email: mkhobeysh@yandex.ru

Marianna M. Khobeysh - MD, PhD, Associate Professor, Chair and Clinic of Dermatovenereology, Head of the Center of Genetically Engineered Biologic Therapy.

6-8 L'va Tolstogo ul., Saint Petersburg, 197022.

Tel.: +7 (812) 338 71 72.

Russian Federation

References

  1. Kavanaugh A, Helliwell P, Ritchlin CT. Psoriatic arthritis and burden of disease: patient perspectives from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) Survey. Rheumatol Ther. 2016;3(1):91-102. doi: 10.1007/s40744-016-0029-z.
  2. Баткаева НВ, Коротаева ТВ, Баткаев ЭА. Распространенность псориатического артрита и коморбидных заболеваний у больных тяжелым псориазом: данные ретроспективного анализа госпитальной когорты. Современная ревматология. 2017;11(1):19-22. doi: 10.14412/1996-7012-2017-1-19-22.
  3. Davidovici BB, Sattar N, Prinz J, Puig L, Emery P, Barker JN, van de Kerkhof P, Stahle M, Nestle FO, Girolomoni G, Krueger JG. Psoriasis and systemic inflammatory diseases: potential mechanistic links between skin disease and comorbid conditions. J Invest Dermatol. 2010;130(7):1785-96. doi: 10.1038/jid.2010.103.
  4. Ogdie A, Schwartzman S, Husni ME. Recognizing and managing comorbidities in psoriatic arthritis. Curr Opin Rheumatol. 2015;27(2): 118-26. doi: 10.1097/B0R.0000000000000152.
  5. Oliveira Mde F, Rocha Bde O, Duarte GV. Psoriasis: classical and emerging comorbidities. An Bras Dermatol. 2015;90(1):9-20. doi: 10.1590/abd1806-4841.20153038.
  6. Benson JM, Peritt D, Scallon BJ, Heavner GA, Shealy DJ, Giles-Komar JM, Mascelli MA. Discovery and mechanism of ustekinumab: a human monoclonal antibody targeting interleukin-12 and interleukin-23 for treatment of immune-mediated disorders. MAbs. 2011;3(6): 535-45. doi: 10.4161/mabs.3.6.17815.
  7. Puig L, Carrascosa JM, Carretero G, de la Cueva P, Lafuente-Urrez RF, Belinchon I, Sanchez-Regana M, Garcfa-Bustfnduy M, Ribera M, Alsina M, Ferrandiz C, Fonseca E, Garcia-Patos V, Herrera E, Lopez-Estebaranz JL, Marron SE, Moreno JC, Notario J, Rivera R, Rodriguez-Cerdeira C, Romero A, Ruiz-Villaverde R, Taberner R, Vidal D; Spanish Psoriasis Group of the Spanish Academy of Dermatology and Venereology. Spanish evidence-based guidelines on the treatment of psoriasis with biologic agents, 2013. Part 1: on efficacy and choice of treatment. Spanish Psoriasis Group of the Spanish Academy of Dermatology and Ve¬nereology. Actas Dermosifiliogr. 2013;104(8): 694-709. doi: 10.1016/j.adengl.2013.04.013.
  8. Canadian Dermatology Association. Canadian guidelines for the management of plaque psoriasis. [Internet. Accessed December 14, 2016.] Available from: www.dermatology.ca/wp-content/uploads/2012/01/cdnpsoriasisguidelines.pdf.
  9. Armstrong AW, Brezinski EA, Follansbee MR, Armstrong EJ. Effects of biologic agents and other disease-modifying antirheumatic drugs on cardiovascular outcomes in psoriasis and psoriatic arthritis: a systematic review. Curr Pharm Des. 2014;20(4):500-12. doi: 10.2174/138161282004140213123505.
  10. Shah K, Paris M, Mellars L, Changolkar A, Mease PJ. Real-world burden of comorbidities in US patients with psoriatic arthritis. RMD Open. 2017;3(2):e000588. doi: 10.1136/rmdopen-2017-000588.
  11. Coates LC, Gossec L, Ramiro S, Mease P, van der Heijde D, Smolen JS, Ritchlin C, Kavanaugh A. New GRAPPA and EULAR recommendations for the management of psoriatic arthritis. Rheumatology (Oxford). 2017;56(8):1251-3. doi: 10.1093/rheumatology/kew390.
  12. Gladman DD, Antoni C, Mease P, Clegg DO, Nash P. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005;64 Suppl 2:ii14-7. doi: 10.1136/ard.2004.032482.
  13. Theander E, Husmark T, Alenius GM, Larsson PT, Teleman A, Geijer M, Lindqvist UR. Early psoriatic arthritis: short symptom duration, male gender and preserved physical functioning at presentation predict favourable outcome at 5-year follow-up. Results from the Swedish Early Psoriatic Arthritis Register (SwePsA). Ann Rheum Dis. 2014;73(2):407-13. doi: 10.1136/annrheumdis-2012-201972.
  14. Egeberg A, Mallbris L, Warren RB, Bachelez H, Gislason GH, Hansen PR, Skov L. Association between psoriasis and inflammatory bowel disease: a Danish nationwide cohort study. Br J Dermatol. 2016;175(3):487-92. doi: 10.1111/bjd.14528.
  15. Loftus E, Augustin M, Bissonnette R, Krueger G, Calabro S, Langholff W, Popp J, Goyal K, Sloan S. P626 prevalence of inflammatory bowel disease amongst patients with psoriasis and incidence of serious infections in this subset: results from the PSOLAR Registry. Poster Presentation at European Crohn's and Colitis Annual Meeting 2016 [Internet]. Available from: https://www.ecco-ibd.eu/publications/congress-abstract-s/abstracts-2016/item/p626-prevalence-of-inflammatory-bowel-disease-amongst-patients-with-psoriasis-and-incidence-of-serious-infections-in-this-subset-results-from-the-psolar-registry.html.
  16. Vavricka SR, Brun L, Ballabeni P, Pittet V, Prinz Vavricka BM, Zeitz J, Rogler G, Schoepfer AM. Frequency and risk factors for extraintestinal manifestations in the Swiss inflammatory bowel disease cohort. Am J Gastroenterol. 2011;106(1):110-9. doi: 10.1038/ajg.2010.343.
  17. Cohen R, Robinson D Jr, Paramore C, Fraeman K, Renahan K, Bala M. Autoimmune dis-ease concomitance among inflammatory bowel disease patients in the United States, 2001-2002. Inflamm Bowel Dis. 2008;14(6): 738-43. doi: 10.1002/ibd.20406.
  18. Coates LC, Moverley AR, McParland L, Brown S, Navarro-Coy N, O'Dwyer JL, Meads DM, Emery P, Conaghan PG, Helliwell PS. Effect of tight control of inflammation in early psoriatic arthritis (TICOPA): a UK multicentre, open-label, randomised controlled trial. Lancet. 2015;386( 10012):2489-98. doi: 10.1016/S0140-6736(15)00347-5.
  19. Coates LC, Helliwell PS. Treating to target in psoriatic arthritis: how to implement in clinical practice. Ann Rheum Dis. 2016;75(4):640-3. doi: 10.1136/annrheumdis-2015-208617.
  20. Gulliver W, Lynde C, Dutz JP, Vender RB, Yeung J, Bourcier M, Dion PL, Hong CH, Searles G, Poulin Y. Think beyond the skin: 2014 Canadian Expert Opinion Paper on treating to target in plaque psoriasis. J Cutan Med Surg. 2015;19(1): 22-7. doi: 10.2310/7750.2014.13151.
  21. Российское общество дерматовенерологов и косметологов. Федеральные клинические рекомендации по ведению больных псориазом. М.; 2015. 59 с.
  22. Carretero G, Puig L, Carrascosa JM, Ferrandiz L, Ruiz-Villaverde R, de la Cueva P, Belinchon I, Vilarrasa E, Del Rio R, Sanchez-Carazo JL, Lopez-Ferrer A, Peral F, Armesto S, Eiris N, Mitxelena J, Vilar-Alejo J, A Martin M, Soria C; from the Spanish Group of Psoriasis. Redefining the therapeutic objective in psoriatic patients candidates for biological therapy. J Dermatolog Treat. 2018;29(4):334-46. doi: 10.1080/09546634.2017.1395794.
  23. Smolen JS, Schols M, Braun J, Dougados M, FitzGerald O, Gladman DD, Kavanaugh A, Landewe R, Mease P, Sieper J, Stamm T, Wit M, Aletaha D, Baraliakos X, Betteridge N, Bosch FVD, Coates LC, Emery P, Gensler LS, Gossec L, Helliwell P, Jongkees M, Kvien TK, Inman RD, McInnes IB, Maccarone M, Machado PM, Molto A, Ogdie A, Poddubnyy D, Ritchlin C, Rudwaleit M, Tanew A, Thio B, Veale D, Vlam K, van der Heijde D. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis. 2018;77(1):3-17. doi: 10.1136/annrheum-dis-2017-211734.
  24. Gossec L, McGonagle D, Korotaeva T, Lubrano E, de Miguel E, 0stergaard M, Behrens F. Minimal disease activity as a treatment target in psoriatic arthritis: a review of the literature. J Rheumatol. 2018;45(1 ):6-13. doi: 10.3899/jrheum.170449.
  25. Логинова EЮ, Коротаева TB, Смирнов AB, Колтакова AД, Насонов ЕЛ. Достижение минимальной активности болезни и динамика рентгенологических изменений при раннем псориатическом артрите через год лечения в рамках стратегии «Лечение до достижения цели» (предварительные результаты исследования РЕМАРКА). Научно-практическая ревматология. 2017;55(6):610-5. doi: 10.14412/1995-4484-2017-610-615.
  26. Allen PB, Olivera P, Emery P, Moulin D, Jouzeau JY, Netter P, Danese S, Feagan B, Sandborn WJ, Peyrin-Biroulet L. Review article: moving towards common therapeutic goals in Crohn's disease and rheumatoid arthritis. Aliment Pharmacol Ther. 2017;45(8):1058-72. doi: 10.1111/apt.13995.
  27. Peyrin-Biroulet L, Sandborn W, Sands BE, Reinisch W, Bemelman W, Bryant RV, D'Haens G, Dotan I, Dubinsky M, Feagan B, Fiorino G, Gearry R, Krishnareddy S, Lakatos PL, Loftus EV Jr, Marteau P, Munkholm P, Murdoch TB, Ordas I, Panaccione R, Riddell RH, Ruel J, Rubin DT, Samaan M, Siegel CA, Silverberg MS, Stoker J, Schreiber S, Travis S, Van Assche G, Danese S, Panes J, Bouguen G, O'Donnell S, Pariente B, Winer S, Hanauer S, Colombel JF. Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE): determining therapeutic goals for Treat-to-target. Am J Gastroenterol. 2015;110(9):1324-38. doi: 10.1038/ajg.2015.233.
  28. Colombel JF, Narula N, Peyrin-Biroulet L. Management Strategies to Improve Outcomes of Patients With Inflammatory Bowel Diseases. Gastroenterology. 2017;152(2):351-61.e5. doi: 10.1053/j.gastro.2016.09.046.
  29. Chandran V, Gottlieb A, Cook RJ, Duffin KC, Garg A, Helliwell P, Kavanaugh A, Krueger GG, Langley RG, Lynde C, McHugh N, Mease P, Olivieri I, Rahman P, Rosen CF, Salvarani C, Thaci D, Toloza SM, Wong MY, Zhou QM, Gladman DD. International multicenter psoriasis and psoriatic arthritis reliability trial for the assessment of skin, joints, nails, and dactylitis. Arthritis Rheum. 2009;61(9):1235-42. doi: 10.1002/art.24562.
  30. Walsh JA, McFadden M, Woodcock J, Clegg DO, Helliwell P, Dommasch E, Gelfand JM, Krueger GG, Duffin KC. Product of the Physician Global Assessment and body surface area: a simple static measure of psoriasis se-verity in a longitudinal cohort. J Am Acad Dermatol. 2013;69(6):931-7. doi: 10.1016/j.jaad.2013.07.040.
  31. Gladman DD, Poulin Y, Adams K, Bourcier M, Barac S, Barber K, Chandran V, Dutz J, Flanagan C, Gooderham MJ, Gulliver WP, Ho VC, Hong CH, Karsh J, Khraishi MM, Lynde CW, Papp KA, Rahman P, Rohekar S, Rosen CF, Russell AS, Vender RB, Yeung J, Ziouzina O, Zummer M. Treating psoriasis and psoriatic arthritis: Position Paper on Applying the Treat-to-target Concept to Canadian Daily Practice. J Rheumatol. 2017;44(4):519-34. doi: 10.3899/jrheum.161473.
  32. Chandran V, Maharaj AB. Assessing disease activity in psoriasis and psoriatic arthritis: impact on management and therapy. Expert Rev Clin Immunol. 2016;12(5):573-82. doi: 10.1586/1744666X.2016.1146133.
  33. Гайдукова ИЗ, Ребров АП, Коротаева ТВ, Дубинина ТВ, Оттева ЭН, Бадокин ВВ, Бочкова АГ, Бугрова ОВ, Годзенко АА, Дубиков АИ, Иванова ОН, Лапшина СА, Несмеянова ОБ, Никишина ИП, Раскина ТА, Румянцева ОА, Смирнов АВ, Ситало АВ, Эрдес ШФ. Ремиссия при аксиальных спондилоартритах - определение и инструменты оценки (рекомендации Экспертной группы по изучению спондилоартритов при Общероссийской общественной организации «Ассоциация ревматологов России»). Научно-практическая ревматология. 2018;56(1 ):10-4. doi: 10.14412/1995-4484-2018-10-14.
  34. Ивашкин ВТ, Шелыгин ЮА, Халиф ИЛ, Белоусова ЕА, Шифрин ОС, Абдулганиева ДИ, Абдулхаков РА, Алексеева ОП, Алексеенко СА, Ачкасов СИ, Барановский АЮ, Болихов КВ, Валуйских ЕЮ, Варданян АВ, Веселов АВ, Веселов ВВ, Головенко АО, Головенко ОВ, Григорьев ЕГ, Губонина ИВ, Жигалова ТН, Кашников ВН, Кизова ЕА, Князев ОВ, Костенко НВ, Куляпин АВ, Морозова НА, Муравьев АВ, Низов АА, Никитина НВ, Николаева НН, Никулина НВ, Одинцова АХ, Осипенко МФ, Павленко ВВ, Парфенов АИ, Полуэктова ЕА, Потапов АС, Румянцев ВГ, Светлова ИО, Ситкин СИ, Тимербулатов ВМ, Ткачев АВ, Ткаченко ЕИ, Фролов СА, Хубезов ДА, Чашкова ЕЮ, Шапина МВ, Щукина ОБ, Яковлев АА. Клинические рекомендации российской гастроэнтерологической ассоциации и ассоциации колопроктологов России по диагностике и лечению болезни Крона. Колопроктология. 2017;(2):7-29.
  35. Kerdel F, Zaiac M. An evolution in switching therapy for psoriasis patients who fail to meet treatment goals. Dermatol Ther. 2015;28(6): 390-403. doi: 10.1111/dth.12267.
  36. Feagan BG, Sandborn WJ, Gasink C, Jacobstein D, Lang Y, Friedman JR, Blank MA, Johanns J, Gao LL, Miao Y, Adedokun OJ, Sands BE, Hanauer SB, Vermeire S, Targan S, Ghosh S, de Villiers WJ, Colombel JF, Tulassay Z, Seidler U, Salzberg BA, Desreumaux P, Lee SD, Loftus EV Jr, Dieleman LA, Katz S, Rutgeerts P; UNI-TI-IM-UNITI Study Group. Ustekinumab as induction and maintenance therapy for Crohn's disease. N Engl J Med. 2016;375(20):1946-60. doi: 10.1056/NEJMoa1602773.
  37. Amin M, No DJ, Egeberg A, Wu JJ. Choosing first-line biologic treatment for moderate-to-severe psoriasis: what does the evidence say? Am J Clin Dermatol. 2018;19(1): 1-13. doi: 10.1007/s40257-017-0328-3.
  38. Инструкция по применению лекарственного препарата для медицинского применения Стелара®, ЛП-001104 [Интернет]. Доступно на: https://www.janssen.com/russia/sites/www_janssen_com_russia/files/stelara_pfs_1.pdf.
  39. Kim BS, Lee WK, Pak K, Han J, Kim GW, Kim HS, Ko HC, Kim MB, Kim SJ. Ustekinumab treatment is associated with decreased systemic and vascular inflammation in patients with moderate to severe psoriasis: Feasibility study using 18F-fluorodeoxyglucose positron emission tomography-computed tomography. J Am Acad Dermatol. 2018. pii: S0190-9622(18)30461-4. doi: 10.1016/j.jaad.2018.03.011.
  40. No DJ, Inkeles MS, Amin M, Wu JJ. Drug survival of biologic treatments in psoriasis: a systematic review. J Dermatolog Treat. 2018;29(5): 460-6. doi: 10.1080/09546634.2017.1398393.
  41. Egeberg A, Ottosen MB, Gniadecki R, Broesby-Olsen S, Dam TN, Bryld LE, Rasmussen MK, Skov L. Safety, efficacy and drug survival of biologics and biosimilars for moderate-to-severe plaque psoriasis. Br J Dermatol. 2018;178(2): 509-19. doi: 10.1111/bjd.16102.
  42. Daperno M, D'Haens G, Van Assche G, Baert F, Bulois P, Maunoury V, Sostegni R, Rocca R, Pera A, Gevers A, Mary JY, Colombel JF, Rutgeerts P. Development and validation of a new, simplified endoscopic activity score for Crohn's disease: the SES-CD. Gastrointest Endosc. 2004;60(4):505-12. doi: 10.1016/S0016-5107(04)01878-4.

Copyright (c) 2018 Abdulganieva D.I., Bakulev A.L., Belousova E.A., Znamenskaya L.F., Korotaeva T.V., Kruglova L.S., Kokhan M.M., Lila A.M., Khayrutdinov V.R., Khalif I.L., Khobeysh M.M.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies