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L'échographie Doppler puissance (PDUS) est une technique d'imagerie sensible et non-invasive d'évaluation des synovites dans le rhumatisme psoriasique (RP) [1,2]. L'étude ULTIMATE est le premier essai de phase IIIb randomisé, en double aveugle, contrôlé versus placebo utilisant le PDUS pour évaluer la réponse précoce au traitement par secukinumab (SEC) sur les synovites. L'utilisation du score composite de synovites standardisé par l'EULAR-OMERACT (score GLOESS) a montré un bénéfice significatif du SEC sur les synovites à 12 semaines (S). L'objectif de cette analyse était d'évaluer et valider la valeur discriminative de la réponse GLOESS comparativement aux données articulaires à S12 et à l'efficacité clinique à S24. D'une période en ouvert de 12S puis d'une extension de 6 mois. Tous les patients du groupe placebo (PL) sont passés sous SEC150 mg ou SEC300 mg à partir de S12,3 La variation moyenne du GLOESS par rapport à l'inclusion a été évaluée à S24 et une analyse post-hoc a été conduite pour déterminer valeur discriminative du GLOESS (comparaison intra-group de la réponse moyenne standardisée (SRM) à la composante principale de la réponse ACR sur 12S et 24S). Le GLOESS a montré une amélioration continue sur 24S chez les patients sous SEC et un rattrapage chez les patients du groupe PL initial (PL-SEC) (à S12 : DiffM = −3,2 ; IC95 = −5,5 ; −0,9 p = 0,04 ; à S24 : DiffM = −3,0 ; IC95 = −3,0 ; −3,7 p = 0,83). À S12, la SRM du GLOESS était > 1 et similaire à celle des données cliniques. Les niveaux de réponse étaient comparables à S24 sur l'évaluation clinique des articulations, la peau, les dactylites et la fonction physique pour les groupes SEC et PL-SEC. Ces données confirment la validité et la valeur discriminative du GLOESS dans le RP en cohérence avec l'évaluation des manifestations cliniques et de la fonction physique. [ABSTRACT FROM AUTHOR]

Introduction: Atomoxetine (Strattera) is the first non-stimulant drug to be approved for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children 6 years of age and adolescents. Atomoxetine is a highly specific inhibitor of the presynaptic norepinephrine transporter, with minimal affinity for other transporters or other neurotransmitter receptors. The target dose is 1.2 mg/kg, in a once- or twice-daily oral administration., Clinical Data: Six randomized, double blind, placebo-controlled clinical trials have demonstrated that atomoxetine was more effective than placebo for the treatment of children and adolescents with ADHD. All these trials have shown a consistent improvement in the ADHD rating scale (ADHD-RS) from baseline in the patients treated with atomoxetine, compared with that of the placebo group. The improvement of ADHD symptoms was confirmed by the other secondary efficacy measures (the Clinical Global Impression, CGI, the Conners ADHD rating scale/parent, teacher). The duration of action of atomoxetine on ADHD symptoms extended throughout the waking hours, and the drug effects persisted up to the next morning with a single morning dose. Significant improvements were also observed with atomoxetine compared to placebo, in several aspects of the quality of life measurement (social and family functioning), and the child's self-esteem. In addition, in patients who responded favourably to initial treatment, atomoxetine was shown to be superior to placebo in maintaining a long term-response, up to 18 months. Atomoxetine was effective and safe, both in young children and adolescents with ADHD. Preliminary data also support the potential efficacy of atomoxetine in managing patients with ADHD and comorbid conditions, such as tic disorders, oppositional-defiant and conduct disorders., Discussion: As of June 2004, over 3,000 children and adolescents have been enrolled in clinical trials of atomoxetine, with about 1,200 of them treated for more than 1 year and about 400 of them treated for more than 2 years. Atomoxetine was well tolerated in most individuals, the two more common adverse events reported were gastro-intestinal disorders and decreased appetite. These side effects were generally noted to be transient. No significant changes in weight and height gain was reported over the long-term follow-up. There was no evidence of symptoms rebound and no evidence of an acute discontinuation syndrome when discontinuing treatment. In addition, given the mechanism of action of atomoxetine in the central nervous system, and lack of subjective, physiological and psychomotor effects reported in experimental conditions, it is unlikely that atomoxetine would have abuse potential., Conclusion: Results from clinical trials demonstrated that atomoxetine is effective and well tolerated for the acute and long-term treatment of children and adolescents suffering from ADHD. Atomoxetine should be considered as a new interesting pharmacological option in the treatment of ADHD in association with non pharmacological therapeutic interventions.