Background and objectives: The efficacy and safety of ustekinumab have been proved in clinical trials. In daily clinical practice, knowing the factors that determine survival differences of biological drugs allows psoriasis treatment to be optimized as a function of patient characteristics. The main objectives of this work are to understand ustekinumab drug survival in patients diagnosed with plaque psoriasis in the Hospital Universitario Central de Asturias (HUCA Dermatology Department, and to identify the predictors of drug discontinuation. Materials and Methods: A retrospective hospital-based study, including data from 148 patients who were receiving ustekinumab (Stelara®) between 1 February 2009 and 30 November 2019, were collected. Survival curves were approximated through the Kaplan–Meier estimator and compared using the log-rank test. Proportional hazard Cox regression models were used for multivariate analyses while both unadjusted and adjusted hazard ratios (HR) were used for summarizing the studied differences. Results: The average duration of the treatment before discontinuation was 47.57 months (SD 32.63 months; median 41 months). The retention rates were 82% (2 years), 66% (5 years), and 58% (8 years). Median survival was 80 months (95% confidence interval. CI 36.9 to 123.01 months). The survival study revealed statistically significant differences between patients with arthritis (log-rank test, p < 0.001) and those who had previously received biological treatment (log-rank test, p = 0.026). The five-year prevalence in patients still under treatment was 80% (those without arthritis) and 54% (arthritis patients). In the multivariate analysis, only the patients with arthritis had a lower rate of drug survival. No statistically significant differences were observed for any of the other comorbidities studied. The first and second most frequent causes of discontinuation were secondary failure and arthritis inefficacy, respectively. Conclusion: Ustekinumab is a biological drug conferring high survival in plaque psoriasis patients. Ustekinumab survival is lower in patients with arthritis.

Dear Editor, Chondrodermatitis nodularis helicis (CNH) is an exceptionally investigated disease. 1 Male sex and old age characterize its demographic profile, 1-3 but this has not been recently investigated. With this aim, we performed this descriptive, retrospective, observational investigation including 215 patients histopathologically diagnosed of CNH at Central University Hospital of Asturias, northern Spain, (years 2000-2017). It was approved by the Hospital's ethics committee. Univariate analyses were conducted by chi-squared test and Fisher's test. A two-sided P value of 0.05 was considered statistically significant (R program, The R Foundation, Indianapolis, IN, USA; R Development Core Team, version 3.6.0).The mean age of patients was 68.1 years (women, 71.7; men, 66.2 years; range 24-95 years). Most patients (72%) had more than 60 years at diagnosis and most (65%) were men. This male excess significantly decreased with age (P < 0.01; Table 1). Women became 51.3% after 80 years at diagnosis (male/female Ratio: 0.9).A 56% increase in the CNH diagnosis number was observed during the periods (2000-2008 vs. 2009-2017 years; Table 2). This was greater in women (216.7%) than in men (12%); and evidenced only in the late-onset subgroup (+98%). The most remarkable increase in number was in women over 60 years at diagnosis (277%).As previous but much smaller studies, 1,2 the mean age at diagnosis was 68 years old (published range varies from 40 to 70 years). 2 71% of patients had CNH diagnosis after 60 years. CNH was diagnosed later in women. Children or adolescent were absent supporting the rarity of CNH at this age 4 . We found a 65% male predominance. Nielsen et al. 1 found 60% of males in a PubMed review of 27 studies (including 628 males and 452 females). Wettle et al. 2 reported published variations of the male/female ratio ranging from 1 to 7.6; and early studies reported males outnumbered females by 10 to 1. 5 Female predominance was rarely described. 6,7 We remark that we described for the first time that male excess was age-dependent, (P < 0.01) and reversed after 80 years at diagnosis. Age differences in Ratio Male/Female 3.6 1.3 Decrease

The long-term prognosis of patients with chondrodermatitis nodularis (CN) has never been investigated. We developed the empirical hypothesis that the survival of these patients could present differences with controls, based in our own previous experience. Our objective is to assess for the first time whether survival in CN patients and matched controls is similar. We investigated the number of natural deaths and survival in patients with histopathologically diagnosed early-onset (EO) (< 61 years at diagnosis) and late onset (LO) CN lesions (= > 61 years at diagnosis); and in matched age, gender and year of diagnosis controls in a Hospital in Asturias, North Spain (years 2000-2017). We have found a small, non-significant excess of mortality in the total CN sample (p= 0.14), but this excess was significant in patients with an early-onset (EO) (< 61 years at diagnosis) of CN lesions in: a) univariate analysis: OR = 6.3; IC: 1.1-44.4; p=0.02; b) Kaplan- Meier survival curve (log-rank test, p=0.02; c) and Cox proportional hazard model (HR for mortality, 5.93; p=0.03; CI: 1.20-29.41). In this pilot, empirical hypothesis - driven, matched, single-centre, case-control study, patients with EO CN lesions (before the age of 61 years) had a decreased survival respect to matched controls. The potential importance for patients of these results outweighs limitations (retrospective and single Hospital design; small number of events); and gives support for construction of multicentric investigations.