Documento de consenso sobre el uso de la combinación paracetamol/tramadol en pacientes con dolor moderado-intenso / Consensus statement on the use of acetaminophen/tramadol in patients with moderate-severe pain

OBJETIVOS: Desarrollar recomendaciones sobre el uso de la combinación paracetamol/tramadol (P/T) en pacientes con dolor moderado-intenso, basadas en la mejor evidencia y experiencia. MÉTODOS: Se siguió la metodología de grupos nominales y Delphi apoyados por una revisión sistemática de la literatura (RSL). Se seleccionó un panel multidisciplinar de 12 expertos en el manejo del dolor. En la primera reunión de grupo nominal se definió el objetivo, alcance, usuarios, apartados del documento de consenso, así como recomendaciones generales preliminares. Para la RSL se definieron los criterios de inclusión y exclusión, y las estrategias de búsqueda. Dos revisores seleccionaron y analizaron los artículos. Esta evidencia se discutió en una segunda reunión de grupo nominal y se generaron las recomendaciones definitivas. Para cada recomendación, el nivel de evidencia y el grado de recomendación se clasificaron según el modelo de Oxford, y el grado de acuerdo por técnica Delphi. Se definió acuerdo si al menos el 70% de los participantes contestaron ≥ 7 en cada recomendación (1 = total desacuerdo a 10 = total acuerdo). RESULTADOS: Se generaron 20 recomendaciones que cubren aspectos generales, como la evaluación del dolor, y específicos del manejo de P/T. Estos últimos abarcan la indicación de la combinación P/T (perfil de paciente, dosificación, pauta, formulaciones), gestión del riesgo (contraindicaciones, precauciones, interacciones, uso concomitante con otras medicaciones, seguimiento, situaciones especiales) y la educación del paciente. CONCLUSIONES: Estas recomendaciones pretenden resolver algunos interrogantes clínicos habituales y facilitar la toma de decisiones respecto al uso de la combinación P/T en pacientes con dolor moderado-intenso

OBJECTIVES: To present recommendations on the use of the paracetamol/tramadol (P/T) combination in patients with moderate-intense pain based on best evidence and experience. METHODS: The method of nominal groups and Delphi was followed, and supported by a systematic literature review (SLR). A multidisciplinary panel of 12 experts in pain management was selected. In the first nominal group meeting, the aim, scope, users, and sections of the consensus document, were defined, along with the preliminary general recommendations. For the SLR, the inclusion and exclusion criteria, as well as the search strategies, were defined. Two reviewers selected and analysed the articles. This evidence was discussed in a second nominal group meeting, and definitive recommendations were developed. For each recommendation, the evidence levels and grade of recommendation grades were classified according to the Oxford model, and the grade according to the Delphi technique. It was defined as an agreement if at least 70% of the participants scored ≥ 7 for each recommendation (1 = total disagreement to 10 = total agreement). RESULTS: A total of 20 recommendations were produced, which covered general aspects, such as the assessment of pain, and those specific to P/T management. These latter included the indications of the P/T combination (patient profile, dosing, prescription, formulations), risk management (contraindications, precautions, interactions, concomitant use with other medications, follow-up, special situations), and patient education. CONCLUSIONS: These recommendations attempt to resolve any of the routine clinical questions, and help in the making of decisions on the use of the P/T combination in patients with moderate-intense pain

Platelet-lymphocyte and neutrophi-lymphocyte ratios are prognostic but not predictive of response to abiraterone acetate in metastatic castration-resistant prostate cancer

Purpose. Recently neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have been reported to be inflammatory parameters that confer poorer outcome in metastatic castration-resistant prostate cancer (mCPRPC). However, these ratios have not been analyzed in patients treated with abiraterone acetate. We explored the relationship between different values of PLR and NLR and survival in mCPRCP treated with abiraterone and their possible relation with a prostate specific antigen (PSA) response. Methods. We retrospectively analyzed 101 patients with mCRPC treated with abiraterone from January of 2012 to November of 2015 in two different hospitals. A cut-off value of 5 for NLR and 150 for PLR were used to compare survival by Kaplan-Meier method. Moreover, an association between these cut-off values and the PSA response was analyzed by a χ2 test. Results. In the case of NLR, the median DFS were 12, 1 months for NLR <5 and 7 months for NLR ≥5, p = 0.061. The median OS were 23.9 months for NLR <5 and 16.3 months for NLR ≥5, p = 0.046. In the case of PLR, the median DFS were 11.8 months for PLR <150 and 10.6 months for PLR ≥150, p = 0.549. The median OS were 27.4 months for PLR <150 and 15.9 months for PLR ≥150, p = 0.005. It was not observed a correlation between the different cut-off values of PLR or NLR and a PSA response ≥25% (p = 0.31). Conclusions. It is shown a better prognostic relationship between PLR and NLR low values and OS that is statistically significant in mCPRC patients treated with abiraterone. Furthermore, it was not shown a relation between PLR and NLR values and PSA response (AU)

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