Maintained activity in ankylosing spondylitis patients treated with TNFi and/or NSAID for at least 12 weeks: a cross-sectional study in Brazil

Abstract Background The aim of this study was to evaluate disease activity among patients with axial spondyloarthritis (AS) treated with tumor necrosis factor inhibitors (TNFi) and/or nonsteroidal anti-inflammatory drugs (NSAIDs) for at least 12 weeks in private outpatient settings in Brazil. Methods This was a cross-sectional, real-world study conducted in 17 Brazilian private health care institutes. Patients were selected if diagnosed with AS or axial radiographic spondyloarthritis (AxSpA) and treated with NSAIDs or TNFi for at least 12 weeks within the last 26 weeks prior to enrollment. The data were collected from interviewed-based and self-administered questionnaires from patients and physicians. Disease activity was defined as active (≥ 4), low /suboptimal (≥ 2 and < 4) and inactive (< 4) by Bath AS Disease Activity Index (BASDAI) and/or very high (≥ 3.5), high (≥ 2.1 to < 3.5), low (≥ 1.3 to < 2.1), and inactive (< 1.3) by AS Disease Activity Score (ASDAS-CRP). Both patients and physicians' perceptions of disease control were assessed using a numeric rating scale (NRS; 0—inactive to 10—very active disease). Results The cohort included 378 patients with a mean age of 46 years, and the median time since diagnosis until enrollment was 5.4 years (interquartile range 2.7-10.5). Most patients were treated with TNFi alone (74%), followed by TNFi in combination with NSAID (15%), and NSAID alone (11%). About half AS patients showed active disease and 24% of patients showed low activity/suboptimal disease control despite having been treated for at least 12 weeks. Although TNFi showed better disease control than NSAID, inactive disease was experienced by few patients. The NRS (mean [standard deviation]) score for disease perception was 4.24 (3.3) and 2.85 (2.6) for patients and physicians, respectively. Conclusion This real-world study showed that most AS patients on TNFi and/or NSAID had not achieved an adequate disease control, as almost 75% of them exhibited active disease or low activity/suboptimal disease control. There remains a need for improved disease management among patients with AS.

Gefitinibe na Primeira Linha de Tratamento para o Câncer de Pulmão de não Pequenas Células / Gefitinib as Non-Small Cell Lung Cancer First Line Treatment

Introdução: os inibidores de tirosina quinase (TKIs - tyrosine kinase inhibitor) são o tratamento de primeira linha no câncer de pulmão de não pequenas células (CPNPC) localmente avançado ou metastático com mutação do EGFR (receptor do fator de crescimento epidérmico - epidermal growth factor receptor). Esta revisão compara o tratamento do CPNPC com o gefitinibe, um TKI de primeira geração, versus o tratamento quimioterápico. Método: foi realizada revisão de literatura com palavras-chave relevantes e análise descritiva dos resultados. Resultados: os pacientes com CPNPC e mutação do EGFR apresentaram melhora da sobrevida livre de progressão (SLP), taxa de resposta objetiva (TRO) e taxa de controle da doença (TCR) em relação à quimioterapia citotóxica. A taxa de eventos adversos graves, eventos adversos que levaram à descontinuação do tratamento e os que levaram à redução de dose foram menores com o gefitinibe. O gefitinibe também foi relacionado à melhora da qualidade devida. Conclusão: o uso do gefitinibe em primeira linha no tratamento do CPNPC com mutação EGFR demonstrou superioridade de eficácia, segurança e qualidade de vida, quando comparado ao tratamento quimioterápico.

Introduction: tyrosine kinase inhibitors (TKIs) are the first line treatment for EGFR (epidermal growth factor receptor) mutated non-small cells lung cancer (NSCLC) locally advanced or metastatic. The aim of this review is to compare the treatment of NSCLC with the first-generation EGFR-TKI gefitinib versus chemotherapy . Methods: a review of the literature was performed using relevant keywords and descriptive analysis of the results. Results: patients with NSCLC and EGFR mutation showed improved progression-free survival (PFS), objective response rate (ORR) and disease control rate (DCR) compared cytotoxic chemotherapy. The rate of serious adverse events, adverse events leading to discontinuation of treatment and that led to dose reduction were lower with gefitinib. Quality of life improvement was also related to the treatment with gefitinib. Conclusion: the use of gefitinib as first-line treatment of EGFR mutated NSCLC showed improved efficacy, safety and quality of life when compared to chemotherapy.