Hospital Universitario Doctor Peset

Ocular syphilis in the Iberian Peninsula shows a wide clinical spectrum and frequent posterior segment involvement. Most patients achieved favourable serological and visual outcomes. These findings support the effectiveness of standard therapies and highlight the need for early diagnosis, especially in high-risk populations.

B-cell maturation antigen (BCMA)-targeting therapies provide a new approach to treating multiple myeloma (MM). Alnuctamab (ALNUC) is a 2 + 1 immunoglobulin G1-based bispecific antibody binding BCMA and CD3ε receptors on myeloma and T cells, respectively. CC-93269-MM-001 is a first-in-human, phase 1 dose escalation/expansion study investigating ALNUC in relapsed/refractory MM. Patients had ≥3 prior regimens, disease progression ≤60 days of last regimen, and were BCMA-directed therapy-naïve. ALNUC was administered intravenously (IV) and subcutaneously (SC); however, SC was selected for further evaluation due to the more favorable safety profile. Ninety-five patients received ALNUC SC; at data cutoff, 44.2% remained on treatment and median follow-up was 8.0 months. The recommended phase 2 dose was 30 mg. The most common treatment emergent adverse events (any grade/grade 3/4) were CRS (57.9%/0%), and neutropenia (53.7%/43.2%). Infections were also frequent (64.2%/14.7%). ORR was 58.9% for all ALNUC SC-treated patients and 71.4% for the 30-mg cohort; 47/95 (49.5%) were measurable residual disease (MRD) negative. Overall, the safety and efficacy of ALNUC SC were comparable to other BCMA-targeted therapies. These results support improved safety of SC versus IV, and corroborate a step-up dosing strategy to mitigate CRS. Importantly, a schedule that de-intensifies over time provides favorable toxicity that may be applicable to other bispecific engagers.

Atopic dermatitis (AD) involving special areas such as the hands, head and neck, and genital region poses important therapeutic challenges owing to distinct barrier fragility, environmental exposure, and mixed Th1/Th2/Th17 activation. These sites often drive treatment escalation despite limited overall body surface involvement. Evidence on the real-world effectiveness of upadacitinib in these anatomical locations remains limited. A retrospective, observational multicenter study was conducted across five Spanish dermatology departments (November 2024 to November 2025). Adults and adolescents with moderate-to-severe AD and involvement of at least one special area treated with upadacitinib (15 or 30 mg) for ≥ 16 weeks were included. Disease severity was assessed using the Eczema Area and Severity Index (EASI), body surface area (BSA), pruritus numeric rating scale (NRS), Dermatology Life Quality Index (DLQI), Investigator's Global Assessment (IGA), and local 0-4 Physician Global Assessment (PGA). Minimal disease activity (MDA) was defined as EASI ≤ 3 plus pruritus-NRS 0-1. Descriptive statistics were applied. Distribution-shift plots were used to analyze categorical changes in special areas. Overall, 57 patients were included (mean age 47.9 ± 17.6 years, 59.6% women). Facial/neck, hand, and genital involvement were present in 73.7%, 61.4%, and 21.1% of patients, respectively; 31.9% had ≥ 2 special areas affected. Upadacitinib induced rapid improvement, with EASI decreasing from 18.9 to 2.7 at week 16 and 2.4 at week 52. MDA was reached by 61% at week 16 and 69% at week 52. Special-area PGA improved markedly across all sites. Upadacitinib provided rapid, sustained, and clinically meaningful improvement in AD involving special areas, supporting its use in anatomically sensitive areas.

BackgroundIn recent years, generative artificial intelligence and large language models (LLMs) have rapidly advanced, offering significant potential to transform medical education. Several studies have evaluated the performance of chatbots on multiple-choice medical examinations.ObjectiveThe study aims to assess the performance of two LLMs—GPT-4o and OpenAI o1—on the Médico Interno Residente (MIR) 2024 examination, the Spanish national medical test that determines eligibility for competitive medical specialist training positions.MethodsA total of 176 questions from the MIR 2024 examination were analyzed. Each question was presented individually to the chatbots to ensure independence and prevent memory retention bias. No additional prompts were introduced to minimize potential bias. For each LLM, response consistency under verification prompting was assessed by systematically asking, “Are you sure?” after each response. Accuracy was defined as the percentage of correct responses compared to the official answers provided by the Spanish Ministry of Health. It was assessed for GPT-4o, OpenAI o1, and, as a benchmark, for a consensus of medical specialists and for the average MIR candidate. Subanalyses included performance across different medical subjects, question difficulty (quintiles based on the percentage of examinees correctly answering each question), and question types (clinical cases vs theoretical questions; positive vs negative questions).ResultsOverall accuracy was 89.8% (158/176) for GPT-4o and 90% (160/176) after verification prompting, 92.6% (163/176) for OpenAI o1 and 93.2% (164/176) after verification prompting, 94.3% (166/176) for the consensus of medical specialists, and 56.6% (100/176) for the average MIR candidate. Both LLMs and the consensus of medical specialists outperformed the average MIR candidate across all 20 medical subjects analyzed, with ≥80% LLMs’ accuracy in most domains. A performance gradient was observed: LLMs’ accuracy gradually declined as question difficulty increased. Slightly higher accuracy was observed for clinical cases compared to theoretical questions, as well as for positive questions compared to negative ones. Both models demonstrated high response consistency, with near-perfect agreement between initial responses and those after the verification prompting.ConclusionsThese findings highlight the excellent performance of GPT-4o and OpenAI o1 on the MIR 2024 examination, demonstrating consistent accuracy across medical subjects and question types. The integration of LLMs into medical education presents promising opportunities and is likely to reshape how students prepare for licensing examinations and change our understanding of medical education. Further research should explore how the wording, language, prompting techniques, and image-based questions can influence LLMs’ accuracy, as well as evaluate the performance of emerging artificial intelligence models in similar assessments.

Subcutaneous (SC) infliximab biosimilar CT-P13 has shown comparable efficacy and safety to the intravenous (IV) formulation in inflammatory bowel disease (IBD). However, long-term real-world data remain limited. This study assessed the three-year effectiveness, safety, and pharmacokinetics profile of SC CT-P13 in IBD patients switched from IV infliximab. Prospective, observational, multicenter study conducted in eight hospitals (Valencian Community, Spain). Adult patients with ulcerative colitis (UC) or Crohn's disease (CD) receiving IV infliximab were switched to SC CT-P13 and followed for up to 3 years. Clinical activity, inflammatory biomarkers, adverse events, treatment persistence, and infliximab trough levels were assessed, including analyses according to immunomodulatory therapy (IM) use and dosing intensities. Seventy-four patients were included (43% UC, 57% CD). Mean SC CT-P13 trough levels increased significantly from baseline to 3 years (8.15 ± 5.93 to 15.89 ± 7.99 µg/mL, p<0.001), with consistent results across disease type, intensified dosing, and perianal CD subgroups. Inflammatory markers (CRP, calprotectin) remained stable throughout follow-up. Concomitant IM use decreased from 51% at baseline to 26.3% at study end, without changes in pharmacokinetics, clinical outcomes, or biomarkers. Treatment persistence at 3 years was 80% overall and 88% when considering only discontinuations due to loss of efficacy or adverse events. Fourteen patients (19%) experienced adverse events, predominantly mild. Switching from intravenous to subcutaneous infliximab biosimilar CT-P13 was associated with sustained treatment persistence, stable disease control, favorable pharmacokinetics, and good tolerability over 3 years. These real-world findings support SC CT-P13 as a convenient long-term maintenance option in routine clinical practice.