Notice bibliographique
Résumé
ORIGINAL ARTICLE, p 1145 Since immunosuppressive monoclonal medications were introduced for the treatment of psoriasis, the focus of safety concerns has shifted. Widely used and ‘time‐honoured’ treatments such as ultraviolet radiation and methotrexate were considered to be understood, and safety issues were discussed with confidence. However, the immunosuppressive effects of therapy were not considered in most discussions. The environment changed. Today when discussing options, including biologics with immunosuppressive effects, a dermatologist can identify with Dustin Hoffman in a classic scene from the movie Marathon Man.1 Sir Laurence Olivier, the villain, has Hoffman tied to a chair and is about to physically torture him for answers. The question is simply ‘Is it safe?’ At first Hoffman says the question is so vague as to be nonsense and he needs more information. The question is repeated and at one turn the answer is a hasty ‘Yes, it is very safe’. When that fails to satisfy, the answer becomes ‘No, it is very dangerous’. How can we answer the safety question in practice today? The current repertoire of biologic treatments has relatively mild, common side‐effects. So the focus is on understanding the rare and severe, such as concerns over infection and cancer. Historically, the earliest clinical reality was exacerbation of tuberculosis from a latent to an active state, mostly identified with antitumour necrosis factor inhibitors. This observation led quickly to processes to mitigate risk. All patients in our practice who will be considered for systemic therapy are evaluated for latent tuberculosis infection (LTBI). The process is not perfect, but the incidence of tuberculosis exacerbation has apparently decreased dramatically. In this issue of BJD, a survey of multiple clinical trials with ustekinumab helped Tsai et al. answer several important questions.2 Firstly, will ustekinumab, an inhibitor of interleukin 12/23 exacerbate LTBI? The answer may be yes. One unusual case, in which chest imaging was abnormal but surrogate tests for tuberculosis were negative, did not qualify to receive isoniazid and did develop active tuberculosis when treated with ustekinumab.3 Secondly, will a regimen of isoniazid prevent this? Again the answer is in the affirmative. While this validates current practice, the proof of the assumptions should strengthen the resolve of practitioners to be vigilant. Proper studies of safety issues are too few4 and ethical concerns abound.5 It is heartening to see a study that addresses key clinical issues and provides a clear, practicable context. This reminds us that safety is a process, not a question. So, ‘Is it safe?’ can lead to a manageable clinical strategy to the benefit of patients and practitioners. Conflicts of interest The author has been a consultant and/or speaker for Abbott, Amgen, Astellas, Celgene, Janssen and Leo Pharma.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,018 | 0,092 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,005 | 0,011 |
| Communication savante | 0,007 | 0,013 |
| Science ouverte | 0,002 | 0,003 |
| Intégrité de la recherche | 0,098 | 0,100 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,009 | 0,007 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».