Eficiencia de diferentes dosis de rituximab en la artritis reumatoide / Eficiency of different doses of rituximab in rheumatoid arthritis

OBJETIVO: Evaluar la efectividad, seguridad y coste de rituximab en pacientes con artritis reumatoide (AR) dependiendo de la dosis utilizada. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo. Se incluyó a 52 pacientes con AR tratados al menos con una dosis de rituximab durante 135,3 pacientes-año. Se obtuvieron 3 grupos de tratamiento: G1, primer curso y siguientes de 2 infusiones de 1g separadas 15 días; G2, primer curso de 2 infusiones de 1g seguido por cursos de 2 infusiones de 500mg, y G3, primer curso y siguientes de 2 infusiones de 500mg separadas por 15 días. Los retratamientos fueron a demanda según la clínica. Se analizaron por grupos: el tiempo retención (Log-Rank), las tasas de retratamientos y de eventos adversos (razón de tasas de incidencia) y los costes del tratamiento por paciente-mes de rituximab. RESULTADOS: El grupo 2 mostró una mejor relación coste-efectividad que el grupo 1 ya que se asoció a una mayor retención de rituximab (media [IC del 95%] 65,7 [60,8-70,7] meses vs. 33,5 [22,7-44,3]; p < 0,001) y una menor tasa de eventos adversos graves, con solo un ligero incremento de la tasa de retratamientos (cursos/paciente-año [IC del 95%] 1,66 [1,39-1,93] vs. 1,01 [0,69.-1,34]; p = 0,005) y del coste (mediana/paciente-mes, 484,89 € vs. 473,45 €). Aunque el grupo 3 fue 41,20 €/paciente-mes más económico que el grupo 2, se asoció a una mayor tasa de retratamientos y una menor retención de rituximab (p < 0,001). CONCLUSIONES: El uso de rituximab a dosis completa al inicio seguido de dosis reducida en los sucesivos cursos administrados a demanda parece la opción más coste-efectiva

OBJECTIVE: Evaluate the effectiveness, cost and safety of rituximab in patients with rheumatoid arthritis (RA) depending on the dose used. MATERIAL AND METHODS: Retrospective observational study conducted on 52 patients with RA treated with at least one dose of rituximab for 135.3 patient-years were included. Three treatment groups were obtained: (G1) First course and following two 1g infusions separated by 15 days; (G2) First course 2 infusions of 1g followed by 2 infusions of 500mg; (G3) First course and followed by 2 infusions of 500mg separated by 15 days. Re-treatments were administered on-demand according to the clinical activity. The retention time (Log-Rank), retreats and adverse events rates (incidence rate ratio) and treatment costs per patient-month of rituximab were analysed by groups. RESULTS: Group 2 showed a better cost-effectiveness ratio than group 1, as it was associated with a longer retention of rituximab (mean [95% CI] 65.7 [60.8 to 70.7] months vs 33.5 [22.7 to 44.3]; P<.001) and a lower rate of severe adverse events with only a slight increase in the rate of retreatment (courses/patient-year [95% CI] 1.66 [1.39 to 1.93] vs. 1.01 [0.69 to 1.34]; P=.005), and in the costs (median/patient-month, €484.89 vs. €473.45). Although group 3 was €41.20/patient-month cheaper than group 2, it was associated with a higher rate of re-treatments and shorter retention of rituximab (P<.001). CONCLUSIONS: The use of full-dose rituximab at onset, followed by reduced doses in successive courses administered on-demand retreatment may be the most cost-effective option

Eficiency of different doses of rituximab in rheumatoid arthritis. / Eficiencia de diferentes dosis de rituximab en la artritis reumatoide.

OBJECTIVE: Evaluate the effectiveness, cost and safety of rituximab in patients with rheumatoid arthritis (RA) depending on the dose used. MATERIAL AND METHODS: Retrospective observational study conducted on 52 patients with RA treated with at least one dose of rituximab for 135.3 patient-years were included. Three treatment groups were obtained: (G1) First course and following two 1g infusions separated by 15 days; (G2) First course 2 infusions of 1g followed by 2 infusions of 500mg; (G3) First course and followed by 2 infusions of 500mg separated by 15 days. Re-treatments were administered on-demand according to the clinical activity. The retention time (Log-Rank), retreats and adverse events rates (incidence rate ratio) and treatment costs per patient-month of rituximab were analysed by groups. RESULTS: Group 2 showed a better cost-effectiveness ratio than group 1, as it was associated with a longer retention of rituximab (mean [95% CI] 65.7 [60.8 to 70.7] months vs 33.5 [22.7 to 44.3]; P<.001) and a lower rate of severe adverse events with only a slight increase in the rate of retreatment (courses/patient-year [95% CI] 1.66 [1.39 to 1.93] vs. 1.01 [0.69 to 1.34]; P=.005), and in the costs (median/patient-month, €484.89 vs. €473.45). Although group 3 was €41.20/patient-month cheaper than group 2, it was associated with a higher rate of re-treatments and shorter retention of rituximab (P<.001). CONCLUSIONS: The use of full-dose rituximab at onset, followed by reduced doses in successive courses administered on-demand retreatment may be the most cost-effective option.

Marcadores bioquímicos en osteoporosis. Utilidad en la práctica clínica / Biochemical markers in osteoporosis: usefulness in clinical practice

En la actualidad, la determinación de marcadores bioquímicos de remodelado óseo supone una propuesta novedosa en la evaluación clínica de los pacientes con osteoporosis. El uso de estos biomarcadores podría permitir la identificación de pacientes con mayor riesgo de fractura y monitorizar la respuesta terapéutica. Al tratarse de mediciones no invasivas y relativamente económicas, debería extenderse su empleo, ya que posibilitaría una medición seriada y en intervalos cortos de las variaciones en el recambio óseo. Sin embargo, su variabilidad analítica y biológica limita en la actualidad su aplicabilidad clínica (AU)

Currently, the measurement of bone remodeling biomarkers is an innovate proposal in clinical evaluation of patients with osteoporosis. Its use may identify patients at increased risk of fracture as well as monitoring therapeutic efficacy. Because they constitute a relatively inexpensive non-invasive measurement, its use should be widespread for serial and frequent measurements of bone turnover. However, their analytical and biological variability limits their clinical applicability (AU)

Biochemical markers in osteoporosis: usefulness in clinical practice.

Currently, the measurement of bone remodeling biomarkers is an innovate proposal in clinical evaluation of patients with osteoporosis. Its use may identify patients at increased risk of fracture as well as monitoring therapeutic efficacy. Because they constitute a relatively inexpensive non-invasive measurement, its use should be widespread for serial and frequent measurements of bone turnover. However, their analytical and biological variability limits their clinical applicability.

Tendencia anual de las artroplastias de rodilla y cadera en artritis reumatoide entre 1998-2007 / Annual trends in knee and hip arthroplasty in rheumatoid arthritis 1998-2007

Objetivo. Conocer el número anual y la tendencia de las prótesis implantadas en nuestro hospital a los pacientes con artritis reumatoide (AR) durante la última década. Material y métodos. Estudio observacional retrospectivo. Los pacientes fueron localizados mediante búsqueda exhaustiva en la base de datos del servicio de documentación clínica entre 1998 y 2007. Los datos se extrajeron de las historias clínicas siguiendo un cuestionario prediseñado. El análisis estadístico longitudinal de las prótesis colocadas se efectuó mediante la Q de Cochrane y las curvas de Kaplan-Meier. Resultado. Sesenta y un pacientes con AR fueron intervenidos con 78 prótesis como consecuencia directa de su enfermedad en nuestro hospital entre 1998 y 2007. La mayoría eran mujeres (80%) con factor reumatoide positivo (84%). La media de edad fue de 58 años y el tiempo de evolución medio de la AR fue de 13 años. Todos excepto uno habían recibido previamente fármacos antirreumáticos (88% metotrexato), pero sólo el 11% había accedido a una terapia biológica. No se observaron cambios en el número de artroplastias a lo largo de toda la década, aunque sí hubo una tendencia a la reducción en el número de pacientes que precisaron por primera vez una prótesis de rodilla (Q Cochrane; p=0,05). Conclusión. No hemos observado cambios significativos en la colocación de prótesis articulares en su conjunto en la última década en nuestro hospital, aunque podría estar produciéndose un descenso del número de pacientes que acceden por primera vez a una prótesis de rodilla (AU)

Objective. To determine the annual number and trend of prostheses implanted in patients with rheumatoid arthritis (RA) at our hospital during the past decade. Materials and methods. Retrospective observational study. Patients were collected through an extensive search of the database of the Clinical Documentation Service between 1998 and 2007. The data was extracted from medical records using a predesigned questionnaire. Statistical analysis of longitudinal prostheses was made by Cochrane's Q test and the Kaplan-Meier method. Results. Sixty-one RA patients were operated on with 78 prostheses as a direct result of their disease at our hospital between 1998 and 2007. Most were women (80%) with positive rheumatoid factor (84%). The mean age was 58 years, and the average time since onset of RA was 13 years. All but one had previously received antirheumatic drugs (88% methotrexate), but only 11% had biological therapy. No changes were observed in the number of arthroplasties as a whole over a decade, although there was a trend towards reduction in the number of patients that required a knee replacement for the first time (Cochrane Q, P=0.05). Conclusion. We observed no significant changes in trends in the number of new joint replacement procedures as a whole in the past decade at our hospital, although the number of patients that required knee replacement for the first time as a direct result of their underlying disease seems to have declined in the last decade (AU)

[Annual trends in knee and hip arthroplasty in rheumatoid arthritis 1998-2007]. / Tendencia anual de las artroplastias de rodilla y cadera en artritis reumatoide entre 1998-2007.

OBJECTIVE: To determine the annual number and trend of prostheses implanted in patients with rheumatoid arthritis (RA) at our hospital during the past decade. MATERIALS AND METHODS: Retrospective observational study. Patients were collected through an extensive search of the database of the Clinical Documentation Service between 1998 and 2007. The data was extracted from medical records using a predesigned questionnaire. Statistical analysis of longitudinal prostheses was made by Cochrane's Q test and the Kaplan-Meier method. RESULTS: Sixty-one RA patients were operated on with 78 prostheses as a direct result of their disease at our hospital between 1998 and 2007. Most were women (80%) with positive rheumatoid factor (84%). The mean age was 58 years, and the average time since onset of RA was 13 years. All but one had previously received antirheumatic drugs (88% methotrexate), but only 11% had biological therapy. No changes were observed in the number of arthroplasties as a whole over a decade, although there was a trend towards reduction in the number of patients that required a knee replacement for the first time (Cochrane Q, P=0.05). CONCLUSION: We observed no significant changes in trends in the number of new joint replacement procedures as a whole in the past decade at our hospital, although the number of patients that required knee replacement for the first time as a direct result of their underlying disease seems to have declined in the last decade.