Persistence of denosumab in Slovak patients with bone metastases - a prospective observational study.

BACKGROUND: An integrated analysis of phase III trials in patients with advanced solid tumors demonstrated superiority of denosumab over zoledronic acid in preventing skeletal-related events. A drug's clinical efficacy, however, depends on regular and continued administration (persistence); persistence in Slovak real-life is yet undetermined for denosumab in the oncology indication. PATIENTS AND METHODS: This was a single-arm, prospective, observational, non-interventional study in patients with bone metastases from solid tumors treated with denosumab every 4 weeks in real-world clinical practice in 5 European countries. The results of the 54 patients from Slovakia are presented here. Persistence was defined as denosumab administration at ≤ 35-day intervals over 24 or 48 weeks, respectively. RESULTS: Previous skeletal-related events were found in 5.6% of patients. 84.8% were persistent over 24 weeks and 61.4 % over 48 weeks. The median (95% confidence interval (CI)) time to non-persistence was 306.5 days (Q1 = 151.0; Q3 = 315.0). The most frequent reason for non-persistence was delayed administration of denosumab. There was a trend towards weaker analgesics over time, with > 70% of patients not requiring any analgesics. Serum calcium remained within the normal range throughout the whole study. Adjudicated osteonecrosis of the jaw was not documented in any Slovak patient. CONCLUSION: Most patients received denosumab regularly once every 4 weeks over 24 weeks of treatment. Non-persistence was mainly due to delayed administration. The incidence of adverse drug reactions was in line with expectations from previous studies, osteonecrosis of the jaw did not occur in any of the patients involved in the study.

[Central serous choroidopathy as rare complication of the corticosteroid treatment]. / Centrálna serózna chorioretinopatia ako zriedkavá komplikácia kortikosteroidnej liecby.

The secondary glaucoma and complicated cataract are known and frequent complications of the corticosteroid treatment. The central serous choroidopathy (CSCH) is rare complication of corticotherapy in which occurs the focal serous ablation of the neurosensoric retina in the macular region caused by means of the leakage of the fluid trough the damaged retinal pigment epithelium. The authors present 5 cases of the CSCH during the corticosteroid treatment period, or the worsening of the already existing disease after the corticosteroid treatment. Despite the generally recognized fact the corticosteroids may precipitate the CSCH and they are contraindicated in its treatment, we repeatedly meet patients with this diagnosis, who are treated by means of systemic or parabulbar corticosteroids.

[Vasculitis of retinal vessels in lung tuberculosis--a case report]. / Vaskulitída sietnicových ciev pri pl'úcnej tuberkulóze--kazuistika.

The authors examined during the period 2003-2004 in an eye practice 652 patients who were hospitalized due to active lung tuberculosis. All patients were treated with combination of 3-4 antituberculotic drugs and the examination was performed to observe the possible side effects of ethambutol to the optic nerve. The most interesting was the ocular finding in a young man treated due to acute lung tuberculosis in whom during the antituberculotic therapy with combination of 4 antituberculotics, the acute retinal vasculitis developed. This type of vasculitis is rare demonstration of ocular tuberculosis. The ocular finding resolved after starting the systemic corticoid therapy.

[Sarcoidosis--a case report]. / Sarkoidóza--kazuistika.

We refer about a 47 years old woman patient with polymorphous complaints, in which the ophthalmologic examination with the findings of bilateral choroiditis and papilitis in the right eye helped to establish the diagnosis of sarcoidosis. According to the ophthalmic finding only, the treatment with Prednisone was started. With this treatment, the ocular findings improved, and polymorphous symptoms subsided. We stress the importance of good interdisciplinary cooperation.

[Anterior chronic uveitis in chronic juvenile arthritis]. / Predná chronická uveitída pri juvenilnej chronickej artritíde.

BACKGROUND: Anterior uveitis (iridocyclitis) in association with juvenile chronic arthritis has two different clinical units: the acute and chronic form. They differ as to the clinical picture, course, complications, relation to antinuclear antibodies and HLA B 27 antigen, response to treatment and prognosis of optic functions. OBJECTIVE: To investigate the development of complications in patients with the chronic form of juvenile chronic arthritis in relation to the duration of uveitis. To focus attention on the treatment and prognosis of the disease. PATIENTS: The authors evaluated retrospectively 18 patients with anterior chronic uveitis and diagnosed juvenile chronic arthritis. The group comprised 13 girls and 5 boys, mean age 14.3 years (6-25 years) with a mean duration of uveitis of 7.5 years (2-21 years). RESULTS: Complications and deterioration of vision are frequent and serious in patients with the chronic form of uveitis. With the duration of the disease progression of complications occurs, their number increases and vision deteriorates. The adverse prognosis in some patients is promoted by an inadequate response to treatment. Six patients (8 eyes) were subjected to surgical treatment of complications. The postoperative results are not encouraging. CONCLUSION: The authors wish to draw attention to the need of close collaboration with a rheumatologist, paediatrician, ophthalmologist and the necessity to devote special care to children with juvenile chronic arthritis and uveitis.

[Central serous chorioretinopathy--treatment with beta blockers]. / Centrálna serózna chorioretinopatia--liecba betablokátormi.

The authors present an account on their first experience with treatment of central serous chorioretinopathy (CSCHR) by beta-blocking agents. In 21 patients with CSCHR Trimepranol (metipranololum) a beta non-selective blocker, 2 x 10 mg/day for two to three months was used. In 30 patients with CSCHR Vasocardin (Metoprololi tartas) was used i.e. a beta-1 selective blocking agent, 2 x 50 mg/day for two to three months. In all patients remission of the disease occurred, on average 4.5 to 4.8 weeks after the onset of treatment. During treatment of CSCHR by beta-blocking agents no significant difference was found in the action of beta selective and non-selective blockers regardless of the duration of the disease before onset of treatment and the number of relapses.

[Climate therapy of uveitis in a mountain environment]. / Klimatoterapia uveitíd vo vysokohorskom prostredí.

Climatotherapy as part of treatment of intraocular inflammatory diseases has a worldwide renaissance due to recent research. The stimulating climate in high mountains leads to induction of defence mechanisms in the organism. In these mechanisms participates in particular the neurovegetative, cardiovascular, thermoregulating and immune system. An important effect of climatotherapy is marked vascularization of tissues and increased ACTH and glucocorticoid secretion, and this along with the immunosuppressive action of light during heliotherapy leads to physiological immunosuppression. This fact is significant in particular in the treatment of uveitis and raises hope of reduced doses of corticoids and immunosuppressive drugs which reduces the risk of undesirable side-effects of this treatment. The results of climatotherapy is in many instances a reduced number of relapses of inflammatory diseases, shortening of the period of the acute attack and a milder course of the attack.

[Intermediate uveitis]. / K problematike intermediárnej uveitídy.

In a group of 50 patients with intermediary uveitis (IU) the authors evaluated the clinical finding, diagnosis with which the patients were referred to the institute and considered the problem of corticotherapy. The majority of patients was referred with a vague and inaccurate diagnosis: uveitis chronica (34%) and uveitis posterior (20%). 96% patients were treated by locally applied corticosteroids which are justified only in case of marked participation of the anterior segment of the eye. The development of posterior subcapsular cataract in 20% of the patients is according to the authors associated with overdosage of local corticotherapy. They recommend general and parabulbar corticotherapy only if cystoid oedema of the macula and oedema of the papilla develops, or in case of massive formation of an exudate on the pars plana. In patients with IU corticosteroid treatment should be indicated with great care, as complications may develop which are more serious than the disease.

[Ophthalmic complications in general corticoid therapy]. / Ocné komplikácie celkovej kortikoterapie.

The authors investigated in a group of 850 patients the influence of long-term general corticotherapy on the transparency of the lens and intraocular pressure in relation to the length of therapy, dosage, age and sex of the patient. The presence of posterior subcapsular cataract was revealed in 5.2% of the patient, a raised intraocular pressure in 12.8%. The authors reached the conclusion that the duration of corticotherapy did not influence in a substantial way the development of posterior subcapsular cataract nor of cortisone glaucoma. A dose of 10-15 mg per day may be considered marginal for the development of cataract; dosage has no basic effect on the development of glaucoma. The maximum incidence of complications was in advanced age groups. No predisposition as regards sex was observed. A significant role in the development of cortisone cataract and cortisone glaucoma is played by individual sensitivity to corticoids.