Maintenance and tolerability of infliximab in a cohort of 152 patients with rheumatoid arthritis.

OBJECTIVE: To determine the maintenance, tolerability and safety of infliximab in an unselected cohort of patients with rheumatoid arthritis (RA). PATIENTS AND METHODS: One hundred and fifty-two RA patients receiving at least one course of infliximab between 2000 and 2003 were included in this study. Response to treatment and safety were assessed through recording adverse events, physical examinations and standard laboratory tests. The dosage of infliximab was patient specifically modified, when therapeutic response was judged inadequate by the assessment of a physician. RESULTS: The mean duration of follow-up was 401 days (85-1221). One hundred and twenty-two patients (78%) continued to receive infliximab after one year. 40 patients (26.3%) stopped infliximab therapy: 14 (9.2%) for inefficacy, 21 (13.8%) for adverse events. Fifty nine patients (38.8%) required an increase of the dosage (n=23, 15%) or a shortening of the interval between the infusions (n=20, 13.2%), or both (n=16, 10.5%) for symptomatic control. Infliximab discontinuation tended to be more frequent in smokers (p=0.055). Ninety-four patients (62%) reported at least one adverse event during the study: 64 infections (43%), 35 infusion reaction events (23%) which led to a discontinuation for 10 patients. Infusion reactions were more frequent in patients with a history of allergy. Three cases of tuberculosis and 1 breast carcinoma were reported during the study. CONCLUSIONS: Adjustments in the treatment of RA patients treated with recommended doses of infliximab were common (38.8% of the treated patients). Furthermore, the observed rate of infections (43%), including three cases of tuberculosis, should alert physicians to be vigilant in the routine care of patients treated with infliximab.

Pseudocisto do pancreas. / Pancreatic pseudocyst

Os autores apresentam 34 casos de pseudocisto de pancreas documentados e operados num periodo de 30 anos no HSE. Houve predominancia do sexo masculino (76%) e dos casos provocados por pacreatite (73%), prevalecendo a pancreatite de origem alcoolica. Todos os pacientes foram submetidos a tratamento cirurgico, e a drenagem interna foi realizada na maioria dos casos (68%), dando-se preferencia a pseudocistogastrostomia. Quatro pacientes foram submetidos a exerese do pseudocisto. A mortalidade foi de 23,5%, ocorrendo com maior frequencia, bem como as complicacoes, nos casos em que foi realizada a drenagem externa