Respuesta a medicamentos biológicos en pacientes con artritis reumatoide según nivel de actividad al inicio / Response to biological agents in patients with rheumatoid arthritis according to disease activity state at the beginning of treatmen

Introducción: la Ley Ricarte Soto (LRS) permite a pacientes con artritis reumatoide refractaria acceder a medicamentos biológicos. Sin embargo con esta regulación los pacientes inician éstos con actividad alta de enfermedad por un período prolongado, luego de recibir al menos 3 fármacos sintéticos. Previo a la implementación de esta ley no era necesario cumplir estos requisitos. Objetivos:comparar la respuesta a tratamiento lograda con el uso de medicamentos biológicos según niveles de actividad al inicio mediante la comparación de pacientes con biológicos antes y después de la LRS. Métodos: tomando datos del Programa de atención de pacientes con artritis reumatoide de la Red de Salud UC-Christus se compraró grupos de pacientes que accedieron a biológicos pre y post implementación de la LRS. Se analizó el cambio en DAS28 y la categorización de actividad de enfermedad según DAS28. Se realizó una regresión lineal evaluando edad, seropositividad y DAS28 pre tratamiento. Resultados: se encontró una diferencia significativa en el cambio de DAS28 a los 6 meses de tratamiento (p=0,02) y en la regresión solo con el DAS28 pre tratamiento (p=0,00). Dentro del grupo de pacientes que requirió cambio de biológico, los pacientes post ley iniciaron la terapia más activos y presentaban mayor persistencia de actividad severa a los 6 meses de tratamiento (11% vs 25%).Conclusiones: si bien el nivel de actividad al inicio no influyó en la respuesta a los 6 meses de tratamiento, si influyó en la persistencia de actividad severa en quienes requirieron cambio de biológico.

Introduction: Chilean regulations (Ley Ricarte Soto (RS) allow patients with refractory rheumatoid arthritis to have access to biological agents, but because of the requirements of the law, they spend a long period with active disease. Objectives: To compare the effective-ness of treatment with biological agents according to baseline disease activity by comparing subjects initiating biologics previous to and after ley RS. Methods: Using data from the rheumatoid arthritis clinic at Red Salud UC-Christus, we compared groups of patients who had access to biological agents before and after the implementation of the RS law. Change in DAS 28 was analyzed as well as disease activity categories according to DAS 28. We performed linear regression evaluating age, seropositivity, and baseline DAS28. Results: We found a significant difference in the DAS28 score delta at six months of treatment (p=0.02). In linear statistically significant association in the treatment response with the pre-treatment DAS28 (p=0.00), but in the group of patients that required more than one biological agent, the post-LRS group had a higher pre-treatment DAS28 and a higher rate of high disease activity (11% vs. 25%) after six months of treatment. Discussion: Although the baseline disease activity level did not influence the final response to treatment, it had an impact on the persistence of severe activity in patients that required more than one biologic agent

Fototerapia simples versus dupla no tratamento de recém-nascidos a termo com hiperbilirrubinemia não-hemolítica / Single vs. double phototherapy in the treatment of full-term newborns with nonhemolytic hyperbilirubinemia

OBJETIVO: Comparar a eficácia da fototerapia simples (1 painel) versus dupla (2 painéis) na redução da hiperbilirrubinemia não-hemolítica em recém-nascidos a termo. MÉTODOS: Os recém-nascidos a termo foram randomizados prospectivamente para receber fototerapia simples ou dupla. Os níveis de bilirrubina foram medidos no momento da internação e em intervalos de 12 horas, assim como em seguimento 48 horas após a alta. RESULTADOS: Trinta e sete pacientes receberam fototerapia simples, e 40, dupla. A redução média dos níveis de bilirrubina nas primeiras 24 horas de tratamento foi maior no grupo que recebeu fototerapia dupla (5,1±2,2 mg/dL versus 4,3±2,1 mg/dL), porém sem significância estatística (p = 0,18). As taxas de readmissão foram similares e nenhum dos grupos apresentou efeitos adversos. CONCLUSÃO: A fototerapia dupla não foi mais eficaz do que a fototerapia simples no tratamento da hiperbilirrubinemia não-hemolítica em recém-nascidos a termo. Entretanto, nossos resultados sugerem que a fototerapia dupla possa ser mais eficaz em recém-nascidos a termo com níveis de bilirrubina mais altos no momento da internação.

OBJECTIVES: To compare the effectiveness of single (1 panel) vs. double (2 panels) phototherapy in reducing nonhemolytic hyperbilirubinemia in term newborns. METHODS: Term newborns with hyperbilirubinemia were prospectively randomized to receive double or single phototherapy. Bilirubin levels were measured at admission and at 12-hour intervals, as well as at a follow-up 48 hours after discharge. RESULTS: Thirty-seven patients received single and 40 double phototherapy. The mean decrease in bilirubin level in the first 24 hours of treatment was greater in the double phototherapy group (5.1±2.2 mg/dL vs. 4.3±2.1 mg/dL), but without statistical significance (p = 0.18). Readmission rates were similar and no adverse effects were found in either group. CONCLUSIONS: Double-surface was not more effective than single-surface phototherapy in the treatment of nonhemolytic hyperbilirubinemia in term newborns. However, our results suggest that double phototherapy may be more effective in those term newborns with higher bilirubin levels at admission.