Carta al Director
Adalimumab en el tratamiento de la sarcoidosis parotídea
Adalimumab in the treatment of parotid sarcoidosis
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true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Adalimumab en el tratamiento de la sarcoidosis parotídea" "tieneTextoCompleto" => true "saludo" => "Sr. Director:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "49" "paginaFinal" => "50" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marta Cufí-Benet, Carles Sabadell, Oriol Codina" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Marta" "apellidos" => "Cufí-Benet" "email" => array:1 [ 0 => "mcufi@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Carles" "apellidos" => "Sabadell" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "Oriol" "apellidos" => "Codina" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Medicina Familiar y Comunitaria, Hospital de Figueres, Figueres, Girona, España" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital de Figueres, Figueres, Girona, España" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital de Figueres, Figueres, Girona, España" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Adalimumab in the treatment of parotid sarcoidosis" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p class="elsevierStylePara elsevierViewall">El adalimumab, de nombre comercial Humira<span class="elsevierStyleSup">®</span>, es un fármaco de origen biológico bloqueador específico de la acción del factor de necrosis tumoral, que provoca una rápida disminución de los reactantes de fase aguda de la inflamación. Sus indicaciones aceptadas en ficha técnica hasta el momento son artritis reumatoide, artritis psoriásica y espondilitis anquilosante<a class="elsevierStyleCrossRefs" href="#bib1"><span class="elsevierStyleSup">1–3</span></a>. Presentamos un caso de sarcoidosis sistémica con brote de parotiditis aguda que no respondió al tratamiento habitual, pero que presentó mejoría clínica importante con este fármaco.</p><p class="elsevierStylePara elsevierViewall">Mujer de 40 años sin alergias médicas conocidas ni hábitos tóxicos, que como antecedentes patológicos presentaba hipertensión arterial en tratamiento con hidroclorotiacida, portadora de marcapasos desde 2000 por disfunción sinusal y 3 abortos espontáneos. En febrero de 2001 desarrolló un cuadro de eritema nudoso en las extremidades inferiores, junto con un brote de parotiditis bilateral que respondió al tratamiento con 30<span class="elsevierStyleHsp" style=""></span>mg de prednisona vía oral. En febrero de 2002 presentó insuficiencia cardíaca por posible afectación sarcoidótica miocárdica, y el ecocardiograma mostró una fracción de eyección del 32% e insuficiencia aórtica moderada. Respondió adecuadamente al tratamiento diurético (furosemida, 40<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h) y con inhibidores de la enzima conversiva de la angiotensina (enalapril, 20<span class="elsevierStyleHsp" style=""></span>mg/día).</p><p class="elsevierStylePara elsevierViewall">En abril de 2008 presentó un nuevo brote de parotiditis bilateral con fiebre, artralgias y disnea. Recibió tratamiento con prednisona a dosis de 30<span class="elsevierStyleHsp" style=""></span>mg/día durante 2 meses, sin experimentar mejoría del cuadro de parotiditis. Dada la falta de respuesta, en junio de 2008 se inició tratamiento con infliximab a dosis de 300<span class="elsevierStyleHsp" style=""></span>mg/día (una dosis mensual), llegando a una dosis máxima de 400<span class="elsevierStyleHsp" style=""></span>mg, sin que se apreciara respuesta clínica. Dado el poco resultado ofrecido hasta entonces por los tratamientos, nos planteamos la opción de probar el adalimumab (Humira<span class="elsevierStyleSup">®</span>). En septiembre de 2008 se inició adalimumab a dosis de 40<span class="elsevierStyleHsp" style=""></span>mg cada 15 días durante 4 meses, con el que la paciente presentó una buena respuesta clínica, con desaparición de los signos clínicos de parotiditis.</p><p class="elsevierStylePara elsevierViewall">A pesar de la escasa experiencia en el uso de este fármaco en cuadros de sarcoidosis que no responden al tratamiento convencional, el adalimumab podría ser una terapéutica alternativa para este tipo de pacientes.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Abbott Laboratories. Highlights of prescribing information. Humira Adalimumab Medication [consultado 30/03/2009]. Disponible en: <a class="elsevierStyleInterRef" href="http://www.rxabbott.com/pdf/humira.pdf">http://www.rxabbott.com/pdf/humira.pdf</a>" ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of therapy-resistant sarcoidosis with adalimumab" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.L. Callejas-Rubio" 1 => "N. Ortego-Centeno" 2 => "L. López-Pérez" 3 => "M.N. Benticuaga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10067-005-0037-9" "Revista" => array:6 [ "tituloSerie" => "Clin Rheumatol" "fecha" => "2006" "volumen" => "25" "paginaInicial" => "596" "paginaFinal" => "597" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16247590" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Infliximab in extrapumonary sarcoidosis: tantalising but inconclusive" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.U. Wells" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur Repir J" "fecha" => "2008" "volumen" => "31" "paginaInicial" => "1148" "paginaFinal" => "1149" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000004600000001/v1_201305150256/S0300289609003081/v1_201305150256/es/main.assets" "Apartado" => array:4 [ "identificador" => "9222" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the Director / Cartas al Director" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000004600000001/v1_201305150256/S0300289609003081/v1_201305150256/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289609003081?idApp=UINPBA00003Z" ]
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