High rates of stopping or switching biological medications in veterans with rheumatoid arthritis.

OBJECTIVES: To define the characteristics of a population of veterans with rheumatoid arthritis (RA) who have stopped or switched their first biologic agent, and to assess if measures of disease activity are predictors in the decision to alter the regimen. METHODS: A retrospective analysis of the VA electronic medical record system identified RA patient demographic and disease activity parameters from 1999 to 2007. Demographic data included age, race/ethnicity, sex, and tobacco use. Disease-specific data included date of RA onset, past DMARD therapies, prednisone use, as well as the disease activity score (DAS-28) and the health assessment questionnaire (HAQ) at each clinic visit. The use of six biologicals (infliximab, etanercept, adalimumab, abatacept, rituximab, anakinra) was identified in order to compare those who continued with the medication to those discontinuing or switching to another biological. Descriptive and parametric statistics were applied to define differences between the two groups. RESULTS: Of 454 RA patients identified, 212 have been on a biologic agent at one point in time, and 100 patients (47%) had either stopped or switched their first biologic agent. Among these 100 patients, the most common reasons for stopping or switching a biologic agent were adverse events (in 48%) and inefficacy (43%) Adverse events included malignancies (23% of 48 patients), rash (23%), infections (18.8%), and cardiac complications (18.8%). When comparing the 100 patients versus the 112 that did not stop or switch their first agent, the DAS-28 correlated significantly with a change of regimen with an OR 2.1 (p<0.001). The HAQ score had an OR of 2.0 (p<0.04). CONCLUSION: RA patients who continue taking their initial biologic medication have similar age, RA disease duration, ethnicity, and smoking status to those requiring switching or discontinuation. The DAS28 and HAQ scores significantly correlated with stopping or switching of a first biologic agent. Adverse event rates were high and their distributions differed in this population compared to previous studies of younger Caucasian females.

Determination of vitamin A in liver and liver-containing products using narrow-bore normal, phase HPLC.

Vitamin A concentrations in livers of fattening animals and liver-containing products may reach much higher values than was assumed up to now. This effect may be caused by animal feed, which is usually supplemented with vitamins. To support this supposition, 57 liver samples of different species of animals, 97 liver sausages and 106 samples of liver-containing infant food were analysed. For isolation of retinol from the sample matrix the sample was saponified for 16 h under a nitrogen atmosphere at room temperature. Retinol was extracted from the saponification solution by using disposable cartridges. For chromatographic determination a normal-phase HPLC system using a narrow-bore analytical column and a photodiode array detector was used. It was possible to separate all-trans-retinol from other isomers. The identity of the peaks could be confirmed by recording the UV spectra.--The results of the retinol contents found in the analysed samples ranged from 11.6 to 160.7 mg/100 g in liver, from 1.4 to 31.1 mg/100 g in liver sausages and from 0.5 to 3.8 mg/100 g in infant food containing between 5 and 11% liver. By consuming liver-containing meals frequently a multiple amount of the recommended dietary intake ranging from 0.375 mg for infants to 0.8 mg for adults may be taken up. Also the recommended daily intakes of the Deutsche Gesellschaft für Ernährung can be exceeded.--The carry-over effect of daily vitamin A consumption of pigs and their liver vitamin A was investigated by parallel determination of the retinol content in the liver after slaughtering and the vitamin A content in the pig-feed during the fattening period. A clear correlation between their daily vitamin A intake and the resulting retinol content in the livers was found.