ABSTRACT
Objetivos: 1.- Conocer la respuesta a etanercept biosimilar (E-BS) en pacientes naive y en pacientes a los que se realizó cambio desde el de referencia (E-R), diagnosticados de enfermedades reumáticas. 2.- Evaluar el impacto económico de estas actuaciones.Métodos: Estudio observacional retrospectivo de 110 pacientes en tratamiento con etanercept (referencia y/o biosimilar). Se analizaron dos grupos de pacientes: 62 pacientes que iniciaron tratamiento con E-BS y 48 pacientes a los que se les realizó cambio desde E-R (switch), y se compararon con grupos control. Variables analizadas: edad, sexo, diagnóstico, tratamiento, unidades dispensadas, modificaciones del tratamiento, motivo de suspensión o cambio, fecha de suspensión y tiempo de seguimiento. Se comparó el coste de la utilización del biosimilar y del que hubiera supuesto el de referencia.Resultados: Las tasas de retención observadas fueron: 65% en los naive (p=0,002) y 90% en los switch. En pacientes naive, el principal motivo de cambio fue respuesta parcial o insuficiente (90%) y en switch posible efecto nocebo (60%). No se observaron reacciones adversas. Al comparar estos grupos con poblaciones control, la principal diferencia fue la proporción de pacientes en los que se mantuvo tratamiento con E-BS frente a E-R, en pacientes naive (65% vs 34%; p=0,003) y switch (90% vs 27%; p<0,0001). La utilización de E-BS supuso un ahorro de 653.668 .Conclusiones: La utilización de E-BS no fue diferente del E-R en cuanto a resultados clínicos y, desde el punto de vista económico, supone un ahorro sustancial que se debe considerar como medida que ayude a la sostenibilidad del sistema. (AU)
Objetive: 1.- To know the response to biosimilar etanercept (E-BS) in naive patients and in patients who change from the reference (E-R), diagnosed with rheumatic diseases. 2.- To evaluate the economic impact of these actions.Methods: Retrospective observational study of 110 patients in treatment with etanercept (reference and/or biosimilar). Two groups of patients were analyzed: 62 patients who started with E-BS and 48 patients who change from E-R (switch), and they were compared with control groups. Variables analyzed: age, sex, diagnosis, treatment, units dispensed, treatment modifications, reason for suspension or change, date of suspension and follow-up time. The cost of using the biosimilar was compared with that of the reference one.Results: The retention rates observed were: 65% in the naive (p=0.002) and 90% in switch. In naive patients, the main reason for change was partial or insufficient response (90%) and a possible nocebo effect in switch (60%). No adverse reactions were observed. When comparing these groups with control populations, the main difference was the proportion of patients in whom treatment with E-BS was maintained versus ER, in naive patients (65% vs 34%; p=0.003) and in switch (90% vs 27%; p<0.0001). The use of E-BS meant a saving of 653,668.Conclusions: The use of E-BS was not different from the E-R in terms of clinical results and, from the economic point of view, represents a substantial saving that should be considered as a measure that helps the sustainability of the system. (AU)
Subject(s)
Humans , Etanercept , Arthritis, Rheumatoid , Spondylitis, Ankylosing , Arthritis, Psoriatic , TherapeuticsSubject(s)
Humans , Male , Middle Aged , Gout/diagnosis , Ultrasonography , Carpal Bones/pathology , Carpal Bones , Prednisone/therapeutic use , Allopurinol/therapeutic use , Colchicine/therapeutic use , Risk Factors , Gout , Musculoskeletal Physiological Phenomena/radiation effects , Body Mass IndexABSTRACT
Renal involvement in systemic lupus erythematosus (SLE) is an important cause of morbidity and mortality, reaching a prevalence of 39% during the course of the disease. Currently, the therapy for severe lupus nephritis is based on the use of high-dose corticosteroids and immunosuppressive drugs, being traditionally cyclophosphamide the most frequently used agent. Recent studies have demonstrated the efficacy of mycophenolate mofetil as induction therapy for lupus nephritis. Azathioprine, a safe drug during pregnancy, has not been demonstrated to be as effective as mycophenolate or cyclophosphamide as induction therapy, although it is an effective drug for maintenance of remission.
Subject(s)
Lupus Nephritis/drug therapy , HumansABSTRACT
La afectación renal en el lupus eritematoso sistémico (LES) es una causa importante de morbilidad y mortalidad, llegando a afectar hasta al 39% de los pacientes diagnosticados de LES durante su evolución. Actualmente, el tratamiento de la nefritis lúpica grave se basa en el uso de dosis altas de corticosteroides y fármacos inmunosupresores, de entre los cuales, tradicionalmente, la ciclofosfamida ha sido el más utilizado. Estudios recientes han demostrado la eficacia del micofenolato de mofetilo como terapia de inducción para la nefritis lúpica. La azatioprina, de uso seguro durante la gestación, no ha demostrado ser tan eficaz como el micofenolato o la ciclofosfamida como terapia de inducción, aunque sí ha resultado ser efectiva para el mantenimiento de la remisión
Renal involvement in systemic lupus erythematosus (SLE) is an important cause of morbidity and mortality, reaching a prevalence of 39% during the course of the disease. Currently, the therapy for severe lupus nephritis is based on the use of high-dose corticosteroids and immunosuppressive drugs, being traditionally cyclophosphamide the most frequently used agent. Recent studies have demonstrated the efficacy of mycophenolate mofetil as induction therapy for lupus nephritis. Azathioprine, a safe drug during pregnancy, has not been demonstrated to be as effective as mycophenolate or cyclophosphamide as induction therapy, although it is an effective drug for maintenance of remission (AU)
Subject(s)
Humans , Lupus Nephritis/drug therapy , Lupus Erythematosus, Systemic/complications , Mycophenolic Acid/therapeutic use , Cyclophosphamide/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Immunosuppressive Agents/therapeutic use , Azathioprine/therapeutic use , Controlled Clinical Trials as TopicSubject(s)
Arthritis/etiology , Durapatite/metabolism , Peritoneal Dialysis/adverse effects , Shoulder Joint , Adult , Crystallization , Female , HumansSubject(s)
Osteoarthritis, Hip/diagnosis , Female , Humans , Middle Aged , Osteoarthritis, Hip/complications , Pain/etiologyABSTRACT
No disponible
Subject(s)
Female , Middle Aged , Humans , Osteoarthritis, Hip/complications , Osteoarthritis, Hip/diagnosis , Pain/etiologyABSTRACT
No disponible
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Humans , Consensus Development Conferences as Topic , Biological Therapy , Arthritis, Rheumatoid/therapy , Societies, Medical , Spain , Clinical ProtocolsABSTRACT
No disponible
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Male , Humans , Osteoporosis, Postmenopausal , Estrogen Replacement Therapy , Bone and BonesABSTRACT
No disponible
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Adult , Female , Humans , Knee , Staphylococcal Infections , Osteomyelitis , Arthritis, Infectious , Diagnosis, Differential , AbscessABSTRACT
No disponible
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Adult , Female , Humans , Shoulder Joint , Humerus , Adenocarcinoma , Joint Diseases , Bone Neoplasms , Breast NeoplasmsSubject(s)
B-Lymphocytes/pathology , Cryoglobulinemia/complications , Glomerulonephritis, Membranoproliferative/etiology , Leukemia, Lymphocytic, Chronic, B-Cell/etiology , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Azathioprine/therapeutic use , Cell Division , Cryoglobulinemia/drug therapy , Cryoglobulinemia/pathology , Cyclophosphamide/therapeutic use , Disease Progression , Doxorubicin/therapeutic use , Female , Glomerulonephritis, Membranoproliferative/drug therapy , Glomerulonephritis, Membranoproliferative/pathology , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Leukemia, Lymphocytic, Chronic, B-Cell/pathology , Middle Aged , Prednisone/therapeutic use , Vincristine/therapeutic useABSTRACT
During the last decade, antiphospholipid antibodies and their clinical manifestations have given rise to increasing interest and have been associated with a wide spectrum of clinic expression, including arterial and venous thrombosis, thrombocytopenia, recurrent fetal wastage, Coombs positive haemolysis, livedo reticularis and neurological abnormalities, commonly present as isolated recurrent events, and rarely characterized by fatal outcome. Recently, an acutely disseminated vasculopathy, the so-called "catastrophic antiphospholipid syndrome" (CAS) characterized by non-inflammatory vascular occlusion and frequency of fatal outcome, has been described. We present yet another case report of this new and poorly understood entity and review its antecedents, clinical manifestations, serological profile, treatment and outcome.
Subject(s)
Antiphospholipid Syndrome/pathology , Thrombosis/pathology , Antiphospholipid Syndrome/complications , Antiphospholipid Syndrome/therapy , Female , Humans , Middle Aged , Thrombosis/etiology , Thrombosis/therapyABSTRACT
A case of coexistence of adult onset Still's disease and idiopathic inflammatory myopathy is reported in a patient with antecedent of Graves-Basedow disease. Although myalgias are common during the flares of adult onset Still's disease, a review of literature only disclosed two previous cases of polymyositis associated to adult onset Still's disease. A high index of suspicion is needed in order to diagnose such a rare association which has relevant prognostic and therapeutic implications. Treatment with methotrexate was started in order to control myopathy, resulting in improvement of both polymyositis and adult onset Still disease. A possible role of methotrexate in the management of adult onset Still's disease is suggested.
