ABSTRACT
Abstract INTRODUCTION We conducted a cost-utility analysis of available interferon-free treatments for patients with early-stage genotype 1 chronic hepatitis C based on a Brazilian public health system perspective. METHODS A Markov model was derived using a cohort of stage F0-F2 patients treated as recommended by the Brazilian national guidelines. RESULTS: Glecaprevir plus pibrentasvir was superior to all other treatments, followed by sofosbuvir plus velpatasvir. Sofosbuvir plus daclatasvir was identified as the least cost-effective option. CONCLUSIONS: The above findings were confirmed via probabilistic sensitivity analysis and the tested scenarios.
Subject(s)
Humans , Antiviral Agents/economics , Hepacivirus/genetics , Hepatitis C, Chronic/economics , Hepatitis C, Chronic/drug therapy , Drug Therapy, Combination/economics , Antiviral Agents/administration & dosage , Cost-Benefit Analysis , Drug Therapy, Combination/methods , GenotypeABSTRACT
Embora a doença de Chagas seja endêmica em certas regiões da América Latina, os fluxos migratórios recentes permitiram sua expansão para áreas onde antes era desconhecida. Mais de 8 milhões de pessoas estão infectadas pelo Trypanosoma cruzi, o que resulta em aproximadamente 10.000 mortes por ano. Esta revisão tem como objetivo fornecer uma compilação sobre os tópicos mais importantes da doença de Chagas em um único trabalho: a descoberta por Carlos Chagas (1909), sua ocorrência, epidemiologia, vetores, via de transmissão, patologia, sinais e sintomas, diagnóstico, e tratamentos, ainda limitado a duas drogas utilizadas há mais de 40 anos: nifurtimox e benzonidazol
Although Chagas disease is endemic in certain regions of Latin America, recent migratory flows have allowed it to expand into areas where it was previously unknown. More than 8 million people are infected with Trypanosoma cruzi, causing around 10,000 deaths a year. This review aims to provide a compilation on the most important topics about the Chagas disease in a single place: its discovery by Carlos Chagas (1909), its occurrence, epidemiology, vectors, transmission route, pathology, signs and symptoms, diagnosis, and current treatments, which is still limited to two drugs for more than 40 years: nifurtimox and benzonidazole
Subject(s)
Humans , Animals , Trypanosoma cruzi , Chagas Disease , Neglected Diseases , Nifurtimox , Epidemiology , Triatominae , Endemic DiseasesABSTRACT
The aim of this study was to evaluate interruption of treatment with biological drugs and tofacitinib due to adverse events in patients with rheumatoid arthritis. A systematic review was performed in the electronic databases MEDLINE, Cochrane, Scopus, CRD, IPA, Lilacs and Scielo. Case reports addressing interruption of treatment due to any adverse event related to abatacept (ABA), adalimumab (ADA), anakinra (ANA), certolizumab pegol (CER), etanercept (ETA), golimumab (GOL), infliximab (IFX), rituximab (RTX), secukinumab (SEC), tocilizumab (TCZ), tofacitinib (TOF) or ustekinumab (UST) in rheumatoid arthritis patients were evaluated. Baseline data, patient profile, previous and current treatments, cause of discontinuation and information on reintroduction of treatment were extracted from the case reports. One hundred and fifty-four studies (154 patients) reported 162 discontinuations of rheumatoid arthritis treatment due to adverse events (ETA = 57; IFX = 46; ADA = 32; TCZ = 13; RTX = 5; ANA = 3; GOL = 2; ABA = 2; TOF = 1; CER = 1; SEC = 0 and UST = 0). The mean age of patients was 56 (± 12.1) years and 82% were female. Seventy-four adverse events were confirmed (related to used drug), and 138 were observed in patients using anti-TNF. The most common adverse events were infections (21%), skin disease (15%), autoimmune disease (13%) and hematological disorders (9%). Case reports are important in the detection of rare adverse events and should be considered in the choice of appropriate therapy for patients.