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In the period after the 2008 financial crisis, the European Union and Brazil experienced, respectively, periods of regional divergence and convergence. The research developed in these two territories brings new evidence on the importance of non-territorial policies, that worked as indirect regional policy, for these trajectories. In the case of the EU, (direct) regional policy was not strong enough to counteract more non-territorial policies that acted in favour of divergence. In the case of Brazil, the absence of a relevant direct regional policy did not prevent convergence, since the government adopted a set of non-territorial sectoral policies that functioned as indirect regional policy. This is particularly relevant in the current European context, where prolonged social and economic stagnation or decline in many regions has been the source of discontent that is expressed electorally.

As diversas paralisações e escassez observadas no contexto da pandemia da COVID-19 expuseram uma série de contradições e vulnerabilidades, em especial na forma como as estruturas de produção se organizam territorialmente à escala global. Embora tais perturbações não sejam inéditas, os factos chamaram a atenção para a necessidade de que fossem adotadas estratégias para torná-las mais resilientes. Com base na recente literatura que versa sobre esses temas, esse trabalho tem como objetivo apresentar uma reflexão acerca do conteúdo das estratégias de reshoring, diversificação e sustentabilidade, observando-se suas definições (conceituais e significados práticos), complexidades, desafios e implicações na economia e no território. Para complementar a discussão teórica, ilustraremos de que modo essas estratégias estão sendo incorporadas nos documentos oficiais referentes à nova estratégia industrial europeia. Em termos metodológicos, foi realizada pesquisa bibliográfica e pesquisa documental. Entre os documentos analisados, destacam-se as comunicações elaboradas pela Comissão Europeia nos anos de 2020 e 2021. Resultados preliminares mostram que a realocação de ativos fixos possui várias complexidades e barreiras, fazendo com que a diversificação seja uma solução menos onerosa e mais factível de ser praticada no curto e médio prazo. Na União Europeia, além da diversificação, a sustentabilidade tem representado uma importante e necessária oportunidade de investimento financeiro.

This study examines the impact of Cohesion Policy on metropolitan governance and stakeholders’ collaboration practices in the Lisbon region. The financial crisis and subsequent austerity policies have underscored the importance of institutional arrangements and governance processes, particularly at the local and regional levels. Focusing on the Lisbon metropolitan area, which faces fragmented institutional structures and governance challenges, this research highlights the role of Cohesion Policy through Integrated Territorial Investments (ITI) in fostering innovation and collaboration among stakeholders. The EVA (Green and Blue Corridor) project in the Lisbon Metropolitan Area exemplifies the role of EU funding in promoting cooperation and governance innovation. The introduction of ITI under the Cohesion Policy has facilitated the establishment of collaborative networks and innovative practices in the metropolitan area. These initiatives have broken down planning silos, promoting "soft spaces of governance" that encouraged knowledge exchange and institutional learning among territorial stakeholders. However, challenges persist in the absence of a coherent regional strategy and the prioritization of broad EU objectives over tailored regional needs. This hampers the potential for integrated and proactive territorial management. Nevertheless, Cohesion Policy has stimulated stakeholder collaboration and innovation in metropolitan governance, paving the way for sustainable and inclusive development in the Lisbon region.

Multicomponent oxide microspheres with interconnected macroporosity (MICROSCAFS®) are new materials with great potential as support materials for photocatalysis, optimized for real life applications and for other uses that are still being explored. They are obtained from an adapted sol–gel process combined with phase separation phenomena that occur within the water droplets of an emulsion. We present here a methodology based on cryogenic scanning electron microscopy (cryo-SEM) that allows, with minimal specimen preparation, the direct and in situ visualization of ‘wet’ alkoxide-derived microstructures, for the mechanistic study of the complex process of MICROSCAFS® generation. It is simultaneously combined with energy dispersive X-ray spectroscopy (EDS) to visualize phase separation phenomena and study the chemical elemental composition at specific regions of the sample and reaction times.

This paper is a short reflection on the evolution of the meaning of the term cyberspace for geographers. We argue that the concept of cyberspace has become a rhizomatic one as spatial thinkers have unveiled its complex inner and outer networkings. While cyberspace was initially understood as a new open space ripe for exploration, its intricate connections with real space through the technological infrastructures that make cyberspace possible have led geographers to consider the multiple points of access and types of cyberspace. More recently, there has been renewed attention to the inner geographies of cyberspace and its cyberdivides have been exposed. We briefly retrace this evolution to argue that the way forward is to shift from an idea of cyberspace as a predefined space to a notion of cyberspatialities as ongoing spatial digital formations.

Abstract In this paper, inorganic silica microspheres with interconnected macroporosity are tested as a platform for designing robust and efficient photocatalytic systems for a continuous flow reactor, enabling a low cost and straightforward purification of wastewater through solar‐driven photocatalysis. The photocatalytically active microspheres are prepared by wet impregnation of porous silica scaffolds with Trizma‐functionalized anatase titania (TiO2) nanoparticles (NPs). NPs loading of 22 wt% is obtained in the form of a thin and well‐attached layer, covering the external surface of the microspheres as well as the internal surface of the pores. The TiO2 loading leads to an increase of the specific surface area by 26%, without impacting the typically interconnected macroporosity (≈60%) of the microspheres, which is essential for an efficient flow of the pollutant solution during the photocatalytic tests. These are carried out in a liquid medium for the decomposition of methyl orange and paracetamol. In addition to photocatalytic activity under continuous flow, the microspheres offer the advantage that they can be easily removed from the reaction medium, which is an appealing aspect for industrial applications. In this work, the typical issues of TiO2 NPs photocatalysts are circumvented, without the need for elaborate chemistries, and for low availability and expensive raw materials.

Vivemos um momento único na história das nossas vidas. O vírus que provocou esta pandemia não é certamente o pior que a humanidade enfrentou, apesar da complexidade da crise que gerou e da rutura socioeconómica sem precedentes que está a causar, em todas as escalas do planeta. Os danos nas economias locais e cadeias globais de fornecimento são incalculáveis, afetando a segurança e a qualidade de vida, entre tantos outros aspetos da nossa existência. Para milhares de pessoas, a vida nunca mais será a mesma (Couclelis, 2020). Como toda a atividade económica, social, cultural e política, também a investigação científica foi profundamente afetada pela atual pandemia da COVID-19. Esta emergência obrigou a comunidade científica a encontrar novas formas, nem sempre as mais eficazes, de trabalhar e de continuar a produzir e disseminar conhecimento, desde logo sobre a própria doença, a sua natureza, difusão, efeitos e consequências. No caso do Centro de Estudos Geográficos, além das atividades específicas dos seus diversos grupos de trabalho, foram empreendidas duas importantes iniciativas gerais, de certa forma complementares, de resposta ao quadro pandémico. (+)

There is increasing concern regarding the inequalities produced by digital platforms based on volunteered geographic information (VGI). Several forms of inequalities have been observed, namely the unequal spatial coverage and the uneven levels of usage even in territories with good coverage. However, VGI platforms under the logic of platform economy have generated other forms of spatial inequality that require more attention. The cyberspace within VGI platforms is producing different cyberspatialities, especially with the platformisation processes that have made this type of inequality more evident. With this in mind, this paper aims to explore the making of cyberdivisions under the platform economy. We argue that the design of VGI within digital platforms is generating cyberdivisions in the urban economy. This research is particularly interested in exploring the restaurant sector in the TripAdvisor platform in the city of Lisbon. In this paper, we draw on a representative survey by questionnaire to restaurant firm owners. We obtained 385 responses out of a universe of 3453 restaurants. This sample provides a confidence level of 95% and a confidence interval of 5%. In addition, we webscraped data from TripAdvisor to assess its coverage in Lisbon. This study reveals that there are different forms of online presence and engagement which have generated cyberdivisions.

Smart specialization strategies are a new EU approach to cohesion policy, meant to deliver growth and development at EU national and regional level. Bearing in mind its focus on place-based development strategies, this paper intends to shed some light on its appropriateness to tackle uneven development and regional growth divergence. The paper showcases Spanish Extremadura growth trajectory. Extremadura is a poor region in the European context that between 2008 and 2014 diverged from the EU average, despite being eligible for EU funding as a convergence region by cohesion policy. In the 2014–2020 programming period, there was a positive dynamic at the beginning, but from 2017 onwards convergence stopped, which indicates that thematic and regional programmes have not delivered results or have not compensated for higher growth level of other Spanish regions. Moreover, research and innovation strategies for smart specialization (RIS3) seem to have limited impacts on place-based economic transformation in less developed regions. From this example, the suitability of the smart specialisation strategy as the core of cohesion policy in the programming period is discussed. It concludes that this strategy is interesting for intermediate development regions with some industrial base but does not seem appropriate as a convergence driver for poorer regions.

Na VII Conferência Anual do Instituto de Geografia e Ordenamento do Território (IGOT) discutiu-se o tema do planeamento de cidades habitáveis no século XXI, de que resultaram dois artigos, que se publicam neste número da Finisterra – Revista Portuguesa de Geografia, da autoria de Jorge Gaspar e de Horacio Capel, sobre o futuro das cidades. Este comentário sublinha os principais contributos destes dois textos para uma agenda de investigação geográfica alternativa das cidades e do desenvolvimento urbano.

Knowledge, innovation and territory. The process of globalization and the knowledge-based economy pose new challenges for the development of cities and regions, due to the establishment of new organizational architectures and spatial networks of knowledge. The combination of local and distant networks of knowledge have profound implications on innovation and territorial development, requiring a renewed role in the action of regional and local institutions, traditionally trained to promote local dynamics of innovation. This article specifically discusses the issues of buzz, geographical proximity and agglomeration and distant innovation networks, and provides the theoretical “background” for the papers published in this special issue on the theme “Knowledge, Innovation and Territory.”

A ideia de territórios (in)justos e o conceito de justiça espacial podem ser perspetivados a várias escalas. Neste texto, discute-se a génese da ideia de justiça territorial e a sua aplicação à escala regional, à luz também das ideias subjacentes às políticas de coesão da UE, incluindo a de coesão territorial. Como exemplo de (in)justiça territorial, são apresentadas sumariamente as dinâmicas socioeconómicas nas regiões da UE na fase mais intensa da globalização neoliberal contemporânea. Finalmente, discute-se a relação fundamental entre capitalismo, direito à cidade e justiça territorial, com relação às principais variedades do capitalismo e as suas variações nacionais e sua repercussão no desempenho económico e social das regiões.

INDUSTRIAL DIVESTMENT AND PORTUGUESE REGIONS WITHIN THE CHANGES IN THE INTERNATIONAL ECONOMIC SPACE. The spatial impacts of capital mobility, especially foreign capital, are becoming increasingly complex and are extent, divestment is, in essence, another strategic option of firms and it may not be necessarily negative for regions. Still, the impacts are not identical to investment. In economic analysis, divestment in certain activities is seen as necessary to achieve regional economic restructuring. However, the time gap between the creation and destruction of activities frequently causes social and economic problems in regions. Starting with a conceptual framework of divestment, we then analyse the recent evolution of industrial employment and product in order to provide a macro-economic framework for the analysis of employment creation and destruction flows that follows. This analysis has a sectorial and regional perspective aimed at identifying different paths by regions. Finally, specific cases of foreign divestment, which have recently occurred in Portugal, are discussed, illustrating not only a micro-economic perspective of divestment but also the changes in the global value chains that point to a (re)positioning of the country in the international division of labour.

EMBEDDEDNESS OF TRANSNATIONAL CORPORATIONS: A STUDY OF THEAUTOMOBILE CLUSTER IN PORTUGAL. The research carried out in this paper aims at understanding the economic action of embeddedness on ongoing socio-spatial structures and to conceptualise the role of inward investment in the regional development process. The stereotypical plundering of regional resources by foreign capital seems, in many cases, to belong to the past. Large firms, such as the transnationals, tend to emulate some organisational models characteristic to firms established in industrial districts, so that they develop strong ties with the socio-spatial structure. The study of the automobile cluster polarised by Autoeuropa comprehends the analysis of linkages between Autoeuropa and the suppliers, corporate culture and institutional relations in different domains. The results of the study are clearly against the stereotype of «cathedral in the desert» and somehow lend support to the possibilities of transnational corporations embeddedness in the spatial structures of ongoing social relations.

The industrial policy in the UK and in Portugal, as in most EU countries, seeks to attract new investment capacity, to create jobs and to promote the impact of the so-called "demonstration efect" of "greenfield" development strategies pursued in the new plants of inward investors on existing or "brownfield" plants. This industrial policy focus is particularly evident in the automobile industry.This paper compares the industrial policy oriented towards the automobile industry in the UK and in Portugal. Two recent "greenfield" investments are analised: Nissan in the North-East region (UK) and Ford/VW in the Setúbal Peninsula (Portugal), as well as three "brownfield" plants: Ford Halewood and GM Vauxhall Ellesmere Port in the North-West region (UK) and Renault in Setúbal (Portugal). The first part starts with a discussion of industrial policy in the automobile sector, the role of "greenfield" development strategies and the "demonstration effect" on "brownfield" plants. Then, the limits of new inward investment are pointed out, basically their problems and restrictions. Afterwards, the structural barriers to the "demonstration effect" within "brownfield" plants are outlined and some possabilities for alternative "brownfield" development strategies are presented.

Innovation holds an important role in the economic development process. The competitive potential of national and regional economies is based on the ability to manage the changing technological process. Economic competition does no longer exclusively depend on the factor costs, which vary geographicaly, because technology can now eliminate the territory disadvantages. Productivity is the crucial element in the competitive capacity of any economy. Productivity, as can easily be proved, is deeply dependent on technological development; this is only possible if there is constant innovation. This paper starts with a brief discussion on the theoretical issues regarding innovation in relation to regional economies. In the second section the Portuguese R&D system is analised in terms of finance and human resources. Particular attention is paid to the entrepreneurial R&D effort, namely in manufacturing activity. Finally, some limitations of the innovation policy in the EU are pointed out, together with its consequences for the least favoured regions.

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Innovation holds an important role in the economic development process. The competitive potential of national and regional economies is based on the ability to manage the changing technological process. Economic competition does no longer exclusively depend on the factor costs, which vary geographicaly, because technology can now eliminate the territory disadvantages. Productivity is the crucial element in the competitive capacity of any economy. Productivity, as can easily be proved, is deeply dependent on technological development; this is only possible if there is constant innovation. This paper starts with a brief discussion on the theoretical issues regarding innovation in relation to regional economies. In the second section the Portuguese R&D system is analised in terms of finance and human resources. Particular attention is paid to the entrepreneurial R&D effort, namely in manufacturing activity. Finally, some limitations of the innovation policy in the EU are pointed out, together with its consequences for the least favoured regions.

The industrial policy in the UK and in Portugal, as in most EU countries, seeks to attract new investment capacity, to create jobs and to promote the impact of the so-called "demonstration efect" of "greenfield" development strategies pursued in the new plants of inward investors on existing or "brownfield" plants. This industrial policy focus is particularly evident in the automobile industry.This paper compares the industrial policy oriented towards the automobile industry in the UK and in Portugal. Two recent "greenfield" investments are analised: Nissan in the North-East region (UK) and Ford/VW in the Setúbal Peninsula (Portugal), as well as three "brownfield" plants: Ford Halewood and GM Vauxhall Ellesmere Port in the North-West region (UK) and Renault in Setúbal (Portugal). The first part starts with a discussion of industrial policy in the automobile sector, the role of "greenfield" development strategies and the "demonstration effect" on "brownfield" plants. Then, the limits of new inward investment are pointed out, basically their problems and restrictions. Afterwards, the structural barriers to the "demonstration effect" within "brownfield" plants are outlined and some possabilities for alternative "brownfield" development strategies are presented.

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Abstract Introduction Guselkumab, a human monoclonal antibody targeting the p19 subunit of interleukin-23 (IL-23), has shown efficacy in psoriasis and psoriatic arthritis. However, long-term real-world data on its effectiveness in patients with inadequate response to ustekinumab are limited. This study investigates guselkumab’s long-term effectiveness and safety in patients with psoriasis with partial response to ustekinumab. Methods We performed a retrospective multicentric study analyzing data of patients with psoriasis from seven Italian hospitals between January 2021 and May 2024. The study included 169 patients who switched from ustekinumab to guselkumab. Primary endpoints were Psoriasis Area and Severity Index (PASI) 75, PASI 90, PASI 100, and absolute PASI ≤ 2. Site-specific Physician Global Assessment (PGA) scores were also collected for difficult-to-treat areas. Results The study included 169 patients. After 3 years of treatment, PASI 75, PASI 90 and PASI 100 were achieved by 88.4%, 55.8%, and 32.6% of patients, respectively. Site-specific PGA showed significant improvements, especially in the scalp and genital areas. After 3 years of treatment, no significant impact of higher body mass index (BMI) or cardiometabolic comorbidities on guselkumab effectiveness was detected. No severe adverse events were reported during the study period. Conclusions In our study, guselkumab provided significant long-term effectiveness and safety in patients partially responsive to ustekinumab, improving both PASI score and site-specific PGA and confirming its potential use for patients with psoriasis switching from ustekinumab.

Abstract Resistant starch from plantain (Macho Musa paradisiaca L.) and banana (Roatan Musa sapientum L.) varieties was chemically modified by crosslinking using epichlorohydrin (EPI). These modified starches were subjected to in vitro digestibility studies using the Englyst method to determine the content of rapidly digestible starch (RDS), slowly digestible starch (SDS) and resistant starch (RS). The thermal stability of these crosslinked starches was evaluated by gelatinization and retrogradation analyses, and their enthalpies were determined using differential scanning calorimetry (DSC). Additionally, their functional properties were evaluated. Chemical modification with EPI significantly increased the RS content in both starch varieties compared to that in native starch. The enthalpy and gelatinization temperature decreased in the EPI-modified starches of both varieties, indicating lower thermal stability during the gelatinization process compared to that of native starch. In general, both varieties of crosslinked plantain starch had lower viscosity (0.43 Pa*s) than did native starch (0.58 Pa*s). The results indicates that this starch crosslinked with EPI constitutes an alternative for use in food for people with health problems such as high cholesterol levels or postprandial insulin concentrations. Graphical Abstract

In the latest autism observation, autism spectrum disorder (ASD) is more frequently diagnosed in males than in females. Efforts have been made in recent years to detect specific clinical patterns in females, improving their detection and diagnosis. Despite advancements, there are still challenges in detecting ASD in females. This preliminary study explores whether the age at the time of diagnosis of ASD in females is related to a higher severity index compared to male participants. A total of 202 participants (52 females; M = 5.51) in Spain underwent ADOS-2 assessment for ASD clinical severity. The results indicate a significant inverse association between the severity index and the age of diagnosis, which was independent of sex. Despite this, the present results revealed that the age at diagnosis was higher in females compared to males. Further analyses also revealed a tendency toward higher severity levels in females. Factors contributing to this difference in the age of diagnosis of ASD between females and males are discussed concerning the presumed differential characteristics of ASD in females.

Quando consideramos as dificuldades de universalizar o saneamento básico no Brasil, elas parecem ainda maiores nas pequenas cidades. Este artigo tem como objetivo comparar as condições de esgotamento sanitário entre os grupos de municípios com mais e menos de 50 mil habitantes na Região Metropolitana do Vale do Paraíba e Litoral Norte, buscando identificar as desigualdades no acesso aos serviços de esgotamento sanitário e como essas disparidades podem afetar as populações. Adotamos uma abordagem de análise crítica e um procedimento metodológico fundamentado em pesquisa documental indireta, utilizando dados estatísticos do Instituto Brasileiro de Geografia e Estatística e revisão bibliográfica. Os resultados revelaram os desafios enfrentados por ambos os grupos de municípios e a gravidade do impacto desses contrastes na qualidade de vida especialmente das pequenas cidades. Constatou-se a necessidade essencial de políticas públicas e ações concretas, com uma abordagem igualitária e humanística, para melhorar o bem-estar dessas populações e garantir o acesso universal aos serviços de saneamento básico.

Este artigo tem o objetivo de analisar a relação entre o racismo e o preconceito de classe com a falta de serviços de esgotamento sanitário em assentamentos precários. A análise é conduzida por meio de um diálogo apoiado nas teorias dos intelectuais brasileiros Lélia Gonzalez e Milton Santos, utilizando o estudo de caso do Jardim Nova Esperança, no município de São José dos Campos, SP. A pesquisa adota uma abordagem dialética e um procedimento metodológico baseado na estratégia da documentação secundária, utilizando fontes estatísticas provenientes de órgãos públicos e entidades ligadas ao saneamento, bem como na revisão bibliográfica de obras e pesquisas relacionadas ao tema. Os resultados revelam as dificuldades enfrentadas pelos habitantes desses assentamentos, a maioria dos quais pertencentes a grupos de baixa renda e com ascendência afrodescendente, no acesso aos serviços de saneamento básico. Este estudo contribui para uma compreensão mais ampla das complexas interações entre racismo, preconceito de classe e a precariedade do saneamento básico, enfatizando a necessidade de adotar medidas concretas para abordar as disparidades estruturais em comunidades que sofrem processos de vulnerabilização. Suas conclusões podem contribuir na formulação de políticas inclusivas e no desenvolvimento de estratégias voltadas para a melhoria da qualidade de vida nesses contextos, além de estimular pesquisas futuras capazes de impulsionar ações para mitigar as desigualdades e aprimorar as condições de saneamento, independentemente da origem social ou étnico-racial dos indivíduos.

Purpose Tildrakizumab is a selective inhibitor of IL-23 approved for the treatment of moderate-to-severe plaque psoriasis in two dosages. We conducted a 16-week multicenter retrospective study to compare the effectiveness and safety of tildrakizumab 200 mg versus tildrakizumab 100 mg in patients with a high disease burden or high body weight.Materials and methods Our retrospective study included 134 patients treated with tildrakizumab 200 mg and 364 patients treated with tildrakizumab 100 mg from 28 Italian Dermatology Units affected by moderate-to-severe plaque psoriasis. The patients had a body weight above 90 kg or a high disease burden (Psoriasis Area and Severity Index [PASI] ≥ 16 or the involvement of difficult-to-treat areas). We evaluated the effectiveness of tildrakizumab at the week-16 visit in terms of PASI90, PASI100 and absolute PASI ≤ 2.Results After 16 weeks of treatment with tildrakizumab 200 mg, PASI90 was reached by 57.5% of patients and PASI100 by 39.6% of patients. At the same time point, 34.3% and 24.2% of patients treated with tildrakizumab 100 mg achieved PASI90 and PASI100, respectively.Conclusions Our data suggest that tildrakizumab 200 mg has better effectiveness than tildrakizumab 100 mg in patients with a body weight ≥ 90 kg and a high disease burden.

Background Genital involvement in atopic dermatitis(AD) can have a significant impact on the patient’s quality of life. However, inspection of genital areas is not usually conducted during routine examination and patients may be reluctant to inform the clinician or show this area.Objective to evaluate the efficacy of tralokinumab in AD patients with genital involvement.Methods Adult patients with moderate/severe AD and genital involvement receiving tralokinumab have been analyzed. Primary endpoints were EASI, DLQI, PP-NRS, genital-IGA (g-IGA) and genital itching (GI) at week 16.Results out of 48 patients with moderate/severe AD under treatment with tralokinumab, 12 patients (25%) showed a genital involvement. Seven patients reported itching in the genital area (58%), while none reported a positive history of genital infections. Median scores at T0 were EASI 17.5, PP-NRS 8 and DLQI 14. After 16 weeks of treatment, we observed a median EASI of 3, a median PP-NRS of 1 and a median DLQI of 1. Finally, concerning the genital response, after 16 weeks of treatment, we observed a statistically significant decrease in mean GI and g-IGA scores.Conclusion despite the small size of our sample, tralokinumab can be considered as a valid treatment option for AD with genital involvement.

Background: Psoriasis is a chronic skin disease driven by immune system dysfunction and associated with increased cardiovascular risk and metabolic disorders. Risankizumab is an anti-interleukin-23 humanized monoclonal antibody approved for the treatment of moderate-to-severe plaque psoriasis.Objective: We conducted a 3-year retrospective study to evaluate the effectiveness and the safety of risankizumab in patients with moderate-to-severe psoriasis, comparing those with and without the presence of at least one cardiometabolic comorbidity (CMD).Results: Our study included 333 patients treated with risankizumab for at least one year. One hundred and sixty-two patients had at least one CMD. After one year of treatment, a reduction of at least 90% and 100% in Psoriasis Area and Severity Index (PASI) score compared with baseline (PASI90 and PASI100, respectively) was observed in 80.3% and 63% of patients with CMDs compared to 83% and 63.2% of patients without CMDs. No statistically significant differences were observed between the two cohorts of patients in terms of effectiveness and rates of adverse events. No significant safety findings were observed throughout the study period. Our study supports data from clinical trials and real-world studies, even in patients with concomitant cardiometabolic comorbidities.

Psoriasis is a chronic immune-mediated disease primarily affecting the skin. The most common subtype is plaque psoriasis, which can affect any body area, with a predilection for the knees, elbows, scalp, lumbosacral region, and genitalia. The European guidelines adopted in Italy recommend systemic therapies for moderate-to-severe psoriasis, defined by a Psoriasis Area and Severity Index (PASI) ≥ 10, Dermatology Life Quality Index (DLQI) ≥ 10, and/or Body Surface Area (BSA) ≥ 10. Over the past two decades, the development of biological agents has revolutionized psoriasis management, targeting specific cytokines such as TNF-α, IL-23, and IL-17. Among these, ixekizumab, secukinumab, brodalumab, and bimekizumab are approved for the treatment of moderate-to-severe plaque psoriasis. However, some patients require switching therapy because of primary/secondary ineffectiveness or side effects. We retrospectively analyzed 20 patients who had switched from one anti-IL-17 drug to another, assessing both safety and effectiveness. 70% of patients was represented by males, with a median age of 49.5 years. The most frequent comorbidities were arterial hypertension and hypercholesterolemia. Effectiveness was evaluated in terms of a 90% (PASI90) and 100% (PASI100) reduction in PASI compared to baseline at 16 and 52 weeks. Before switching to the current IL-17 inhibitor, seven patients had failed at least two biologics. Thirteen patients experienced a loss of effectiveness after more than 6 months (secondary ineffectiveness), whereas the other seven never showed improvement with the previous drug (primary ineffectiveness). Fourteen patients completed at least one year of follow-up. Two patients were lost during the follow-up, while four more are currently still under treatment without having completed the established temporal cut-off. Two patients switched to bimekizumab, nine to brodalumab, and nine to ixekizumab. At baseline, the median PASI was 10 (IQR 4.5). After 16 weeks, the median PASI decreased to 2 (IQR 5.5), and after one year, it was 1 (IQR 2). Eight patients (40%) and six patients (30%) achieved PASI 90 and PASI 100 at 16 weeks, respectively. After one year, sustained effectiveness was observed with PASI 90 (57.1%), PASI 100 (35.7%), and PASI ≤ 2 (78.6%). No serious adverse events or discontinuations due to adverse events were observed during the study period. Our study confirms the safety and effectiveness of intraclass switching among IL-17 antagonists, highlighting that an inter-class switch can be a valid option when patients fail to respond or lose effectiveness with an IL-17 inhibitor. However, further larger and longer studies are needed for a deeper understanding.

Introduction: Psoriasis and hidradenitis suppurativa (HS) are chronic inflammatory diseases with significant overlap in their immunologic pathways, which involve cytokines such as tumor necrosis factor-alfa, interleukin (IL)-17, and IL-23. Current treatment options for HS are limited, as only adalimumab and secukinumab are approved for severe cases. Given the overlapping pathogenetic features between HS and psoriasis, anti-IL-17 and anti-IL-23 drugs could represent valuable treatments for the management of HS. Objectives: We sought to evaluate the effectiveness and safety of anti-IL-17 and anti-IL-23 drugs in patients with HS and concomitant moderate-to-severe plaque psoriasis. Methods: We conducted a multicenter retrospective study in 11 Italian Dermatology Units. The effectiveness of the drugs was evaluated by assessing the percentage of patients achieving HS Clinical Response (HiSCR) each week. Results: We enrolled 41 patients with at least 16 weeks of follow-up, with 17 of them completing 52 weeks of treatment. The most commonly prescribed anti-IL drug was secukinumab (27 patients), followed by ixekizumab (5) and guselkumab (5). The HiSCR was achieved by 39%, 74.3%, and 77.8% of patients after 16, 32, and 52 weeks, respectively. No severe adverse events (AEs) or AEs leading to discontinuation were observed during the study. The most common AE was nasopharyngitis (4 patients). Conclusion: In this real-world study, we highlight the effectiveness of anti-IL-23 and anti-IL-17 drugs in the treatment of concomitant plaque psoriasis and severe HS. Longer and larger studies are needed to further evaluate the long-term effectiveness and safety of these treatments in patients affected by HS.

Abstract Introduction The introduction of biological therapies has revolutionized the treatment of moderate-to-severe plaque psoriasis. In particular, ixekizumab, an inhibitor of interleukin-17A, has shown great results in terms of efficacy and safety in both clinical trials and real-world experiences. However, there is a lack of long-term real-world data available for ixekizumab. Methods We conducted a multicenter real-life study to evaluate the effectiveness and safety of ixekizumab in patients with moderate-to-severe plaque psoriasis. Psoriasis Area and Severity Index score (PASI) was collected at baseline and after 1, 2, 3, 4, and 5 years. The occurrence of any adverse events was recorded at each time point. Results We enrolled 1096 patients treated with ixekizumab for at least 1 year. At week 52, the percentages of PASI 90 and PASI 100 were 85.04% and 69.07%, respectively. After 5 years of treatment with ixekizumab, out of 145 patients, a PASI 90 response was achieved by 86.90% of patients, while complete skin clearance was reached by 68.28% of patients. We did not observe any new significant safety findings throughout the study period. Conclusion This study supports the long-term effectiveness and safety of ixekizumab in a real-world setting.

Background and Objectives: Janus kinase inhibitors (JAKi) have significantly advanced the treatment of various dermatological conditions by modulating the JAK-STAT signalling pathway. While these inhibitors have proven effective, they also pose challenges due to associated increase in serum lipid levels and relative potential cardiovascular risks. This perspective work aims to discuss the implications of these lipid alterations proposing management strategies for patients with dermatological disorders under JAKi treatments. Materials and Methods: This manuscript reviews existing and recent literature on the metabolic effects of JAKi, particularly focusing on their impact on lipid profiles in patients treated for dermatological diseases. Results: JAK inhibitors are consistently associated with an increase in both LDL and HDL levels shortly after treatment initiation, which tend to stabilise over time. Despite these changes, there is no clear evidence linking these alterations to an increased risk of major adverse cardiovascular events (MACE), indicating a complex interaction between lipid metabolism and JAK-STAT signalling. Conclusions: Although JAKi may induce lipid changes in patients, raising concerns, especially in ones with existing cardiovascular risks, currently there is no proven link to increased MACE in this population. Monitoring lipid levels, alongside lifestyle modifications and possible statin use, can manage these effects without the need to stopping treatment.