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OBJECTIVE: To describe the efficacy and safety of adalimumab for the treatment of non-infectious uveitis (NIU) in four Uveitis Units from tertiary Spanish hospitals. METHODS: Multicenter and retrospective clinical cohort study including all patients with NIU treated with adalimumab from January 2012 to October 2022 in four uveitis units was performed. Efficacy was measured with the number of relapses, ocular inflammation and reduction in immunosuppression and corticosteroid dosage before and after adalimumab use. We collected data regarding adverse effects and examined the immunogenicity of adalimumab. RESULTS: One hundred and twenty-two patients (59% females), with a mean age of 48.6 years (SD = 14.8) accounting for 217 eyes were included. The majority (92.6%) were Caucasian. Uveitis analyzed were predominantly panuveitis (34.7%), bilateral (77.9%), acute (41.5%), and non-granulomatous (90%). Most of them were immune mediated (42.6%), and the main reason to initiate adalimumab was refractory disease (96.7%). The analysis was statistically significant due to the reduction in the number of immunosuppressive drugs as well as the dose of oral corticosteroids and the number of relapses during follow-up (p < 0.001). The decrease in ocular inflammation parameters and the improvement in visual acuity (p < 0.05) were also significant. There were no deaths due to the drug and only one reported case of serious infection. In total, 10.9% of 73 patients tested developed anti-adalimumab antibodies and 4.1% lupus-like. CONCLUSIONS: We consider adalimumab as a leading drug in the treatment of NIU with high safety and efficacy.
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BACKGROUND: Sacubitril/valsartan (an Angiotensin receptor-neprilysin inhibitor-ARNI) is one of the cornerstones in the management of patients with heart failure with reduced ejection fraction (HFrEF) having demonstrated significant reductions in both mortality and hospitalisations as compared with enalapril. It proved to be a cost-effective treatment in many countries with stable economies. In Argentina, a country with chronic financial instability and a fragmented health care system, the estimation of its cost-effectiveness requires to consider local financial data. OBJECTIVES: To estimate the cost-effectiveness of sacubitril/valsartan in HFrEF in Argentina. METHODS: We populated an Excel-based cost-effectiveness model, previously validated, using inputs from the pivotal phase-3 PARADIGM-HF trial and from local sources. As the main problem to consider was the financial instability, we adopted a differential approach to cost discounting based on the opportunity cost of capital. Thus, a discount rate for costs were set at 31.6%, using the BADLAR rate published by the Central Bank of Argentina. Discount for effects were set at 5% as is the current practice. Costs were expressed in Argentinian pesos (ARS). We used the perspective for both the social security and private payers at a 30-year horizon. The primary analysis was the incremental cost-effectiveness ratio (ICER) versus enalapril, the previous standard of care. Alternative scenarios performed included a 5% cost discount rate and 3 a 5-year horizon (as is usually used). RESULTS: In Argentina the cost-per quality adjusted life-year (QALY) gained for sacubitril/valsartan versus enalapril was 391,158 ARS and 376,665 ARS for a social security and a private payer, respectively, at a 30- year horizon. These ICERs were under the cost- effectiveness threshold of 520,405.79 ARS (1 Gross domestic product (GDP) per capita) suggested by Argentinian health technology assessment bodies. Probabilistic sensitivity analysis showed an acceptability of sacubitril/valsartan as a cost-effective alternative of 86.40% and 88.25% for social security and private payers, respectively. CONCLUSION: Sacubitril/valsartan is a cost-effective treatment in HFrEF using local inputs that considered the financial instability. For both payers considered the cost per QALY gained are under the cost-effectiveness threshold considered.
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Introducción: La relevancia del estudio de las enfermedades crónicas no transmisibles se explica principalmente por la cantidad de muertes que generan en la población mundial, incluida la Argentina. El presente artículo pretende brindar una perspectiva desde el Programa RemediAR + Redes de la Hipertensión Arterial Primaria (HTA) en la provincia de Buenos Aires, a partir del tratamiento farmacológico de la enfermedad indicado a los usuarios de los centros de salud. Material y método: Las principales fuentes de información fueron los formularios diseñados por RemediAR + Redes para su utilización en los centros de salud, y fuentes secundarias tales como el CENSO 2010 y la Encuesta Nacional de Factores de Riesgo del año 2009. Resultados: En el período abril de 2007 a marzo de 2008, el 13.4% de las recetas tuvieron como diagnóstico HTA, con la indicación de enalapril en casi tres de cada cuatro de esta recetas. En promedio, los usuarios de RemediAR + Redes con HTA recibieron 6 tratamientos anuales, con algunas diferencias significativas al realizar comparaciones por región. Conclusiones: El avance en términos de provisión de medicamentos para garantizar el acceso a quienes lo necesitan, requiere actualmenteun nuevo estadio basado principalmente en el seguimiento de la población con HTA.
Introduction: The relevance of the study of non-communicable chronic diseases is mainly explained by the number of deaths they cause in the global population, including Argentina. This article aims to provide an insight into Primary Hypertension (HT) in the province of Buenos Aires. The analy-sis was based on the drug treatment indicated for the pathology to users of health centers under the RemediAR + Redes Program. Methods: The main sources of information were the forms designed by RemediAR + Redes, which are used in health centers. Other sources were the 2010 Census and the 2009 Encuesta Nacional de Factores de Riesgo (National Survey of Risk Factors). Results: In the period April 2007 to March 2008, the diagnosis in 13.4% of prescriptions was hypertension, with Enalapril being indicated in nearly 3 out of 4 of these prescriptions. On average, RemediAR + Redes users with hypertension received 6 treatments per year, with some significant differences by region. Conclusions:Progress in terms of provision of drugs mainly requires monitoring of the population with hypertension.
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Humanos , Anti-Hipertensivos/uso terapêutico , HipertensãoRESUMO
El presente estudio evaluó el impacto redistributivo del Programa Remediar sobre el gasto en medicamentos en Argentina. A partir del análisis de los resultados obtenidos, se verificó que lastransferencias del programa generan una mejora en el índice de concentración entre los quintiles demenores ingresos. Remediar, junto con otros programas redistributivos, han promovido el bienestar general de la población durante la última década.
