Registry of the Spanish Network for Systemic Sclerosis: Survival, Prognostic Factors, and Causes of Death.

Systemic sclerosis (SSc) is a rare, multisystem disease showing a large individual variability in disease progression and prognosis. In the present study, we assess survival, causes of death, and risk factors of mortality in a large series of Spanish SSc patients. Consecutive SSc patients fulfilling criteria of the classification by LeRoy were recruited in the survey. Kaplan-Meier and Cox proportional-hazards models were used to analyze survival and to identify predictors of mortality. Among 879 consecutive patients, 138 (15.7%) deaths were registered. Seventy-six out of 138 (55%) deceased patients were due to causes attributed to SSc, and pulmonary hypertension (PH) was the leading cause in 23 (16.6%) patients. Survival rates were 96%, 93%, 83%, and 73% at 5, 10, 20, and 30 years after the first symptom, respectively. Survival rates for diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc were 91%, 86%, 64%, and 39%; and 97%, 95%, 85%, and 81% at 5, 10, 20, and 30 years, respectively (log-rank: 67.63, P < 0.0001). The dcSSc subset, male sex, age at disease onset older than 65 years, digital ulcers, interstitial lung disease (ILD), PH, heart involvement, scleroderma renal crisis (SRC), presence of antitopoisomerase I and absence of anticentromere antibodies, and active capillaroscopic pattern showed reduced survival rate. In a multivariate analysis, older age at disease onset, dcSSc, ILD, PH, and SRC were independent risk factors for mortality. In the present study involving a large cohort of SSc patients, a high prevalence of disease-related causes of death was demonstrated. Older age at disease onset, dcSSc, ILD, PH, and SRC were identified as independent prognostic factors.

[Program for the substitution of therapeutic equivalents in the hospital setting]. / Programa para la sustitución de equivalentes terapéuticos en el medio hospitalario.

BACKGROUND: A Program of Therapeutic Equivalents (TEP) is here reported which was elaborated and is currently in force at a third level university teaching hospital. MATERIALS AND METHODS: Therapeutic equivalents were selected within the same pharmacologic group on the basis of approved indications and both efficiency and safety data. RESULTS: TEP considers: a) the substitution of drugs which are considered therapeutic equivalents; b) withdrawal of drugs which have not proved efficiency or are of no interest for inpatients; c) continuation of therapies when changes are not advisable, and d) indistinct use of homologous drugs. From August 1998 up to April 1999, TEP was applied in 505 occasions; it was accepted in 499 (99%) and rejected in 6 (1%). DISCUSSIONS: The substitution of therapeutic equivalents should be viewed in the context of selecting the most appropriate drugs to be used in the hospital setting. TEP should be a consensus document and supervised by the Pharmacy and Therapeutics Commission.

Programa para la sustitución de equivalentes terapéuticos en el medio hospitalario / Programme for the substitution of therapeutic equivalents in the hospital setting

Se presenta un Programa de Equivalentes Terapéuticos (PET) elaborado e implantado en un hospital universitario de tercer nivel. Material y métodos. Los equivalentes terapéuticos se seleccionaron dentro del mismo grupo farmacológico en función de las indicaciones aprobadas y los datos de eficacia y seguridad. Resultados. El PET contempla: a) sustitución de fármacos considerados equivalentes terapéuticos; b) suspensión de fármacos que no han mostrado eficacia o sin interés en pacientes hospitalizados; c) continuación de tratamientos que no es aconsejable modificar, y d) utilización indistinta de fármacos homólogos. Desde agosto de 1998 hasta abril de 1999 se aplicó el PET en 505 ocasiones, fue aceptado en 499 (99 por ciento) y rechazado en 6 (1 por ciento). Discusión. La sustitución de equivalentes terapéuticos debe englobarse en el contexto de la selección de medicamentos más adecuados para su utilización en el medio hospitalario. El PET debe ser un documento consensuado y supervisado por la Comisión de Farmacia y Terapéutica (AU)