The psoriatic arthritis cost evaluation study: a cost-of-illness study on tumour necrosis factor inhibitors in psoriatic arthritis patients with inadequate response to conventional therapy

OBJECTIVE

To evaluate costs, benefits and cost-effectiveness of anti-TNF agents in PsA patients with inadequate response to conventional treatment.

METHODS

A total of 107 patients, from nine Italian rheumatology centres, with different forms of PsA were given anti-TNF treatment, mainly etanercept (87%). Information on resource use, health-related quality of life, disease activity, function and laboratory values were collected at baseline and through out the 12 months of therapy. Cost (expressed in euro 2007) and utility (measured by EuroQol) before and after anti-TNF therapy initiation were compared in order to estimate the incremental cost per quality-adjusted life year (QALY) gained, and cost-effectiveness acceptability curve was calculated.

RESULTS

At the end of 12 months, there was a significant increase in direct cost due to an increase of drug cost caused by TNF inhibitors that was only partially offset by the decrease in indirect cost. In the last 6 months of therapy, the direct cost increased by euro5052, the cost for the National Health System (NHS) by euro5044 and the social cost by euro4638. However, a gain of 0.12 QALY resulted in a cost per QALY gained of euro40 876 for the NHS and of euro37 591 for the society. The acceptability curve showed that there would be a 97% likelihood that anti-TNF therapy would be considered cost-effective at willingness-to-pay threshold of euro60 000 per QALY gained.

CONCLUSION

Cost-effectiveness ratios are within the commonly accepted willingness-to-pay threshold. These results need to be confirmed in larger samples of patients.

Association of MICA alleles with psoriatic arthritis and its clinical forms. A multicenter Italian study

OBJECTIVE

Analysis of the association between psoriatic arthritis (PsA) clinical forms and MICA gene transmembrane polymorphisms.

METHODS

Patients were classified as having peripheral asymmetric oligoarthritis (AO), peripheral symmetric poly-arthritis (PA) and spondylitis (SP), or disease combinations (PA/SP, OA/SP). Two hundred and twenty-six patients with PsA were typed for MICA exon 5 microsatellite (TM) by heteroduplex analysis and compared with 225 normal controls.

RESULTS

MICA-TM microsatellite typing revealed that, among the different clinical forms of PsA, only the combined PA/SP subset shows a significant positive association with MICA-A9 and a lower frequency of MICA-A4, A5 genotype in PsA patients with a decrease, only in the PA/SP cohort, of all MICA-A5 combinations except MICA-A5, -A9.

CONCLUSION

These results suggest a role for genes within the HLA region in the pathogenesis of PsA, and reinforce the idea that the different forms of PsA may have heterogeneous genetic basis.

Osteopathic manipulative treatment (OMT) effects on mandibular kinetics: kinesiographic study

AIM

The aim of this study was to evaluate the effects of Osteopathic Manipulative Treatment (OMT) on mandibular kinematics in TMD patients.

METHODS

The study was conduced on 28 children with non-specific TMD symptoms, limited mouth opening, history of trauma (delivery trauma, accident trauma). Patients were randomly divided into two groups: an OMT group (study group) and a no-intervention group (control group). All subjects underwent a first kinesiographic recording to evaluate the amplitude and velocity of maximal opening-closing movements. Study group patients underwent a second kinesiographic recording 2 months after OMT. Control group patients were submitted to a control kinesiographic recording six months after the first one. Kinesiographic tracings were acquired using the K7I system.

RESULTS/STATISTICS

The kinesiographic data of the study group showed a moderate statistically significant difference (p<.07) of maximal mouth opening (MO) parameter and a high statistically significant difference (p<.03) of maximal mouth opening velocity (MOV) parameter. No statistically significative difference (null hypothesis confirmed) of kinesiographic parameters in the control group was observed.

CONCLUSION

The results of this study suggest that OMT can induce changes in the stomatognathic dynamics, offering a valid support in the clinical approach to TMD. Multifactorial genesis of chronic disorders is also confirmed.

Prognostic factors of survival in complicated viral and alcoholic cirrhosis without hepatocellular carcinoma. A retrospective study

AIM

In several studies, attention is needed to one specific complication, in particularly to hepatocellular carcinoma, which modifies the natural history of liver cirrhosis. Thus, we performed a retrospective cohort analysis to clarify which complications, alone or in combination, are predictive factors of mortality in patients with viral or alcoholic cirrhosis without hepatocellular carcinoma.

METHODS

Case records of 255 patients with decompensated viral or alcoholic cirrhosis between January 1990 and December 2000 were retrospectively analyzed. Relevant clinical and laboratory parameters, and their relationship to mortality, were studied.

RESULTS

The mean duration of follow-up period was 29 months in which 178 patients (69.8%) died and 77 (31.8%) survived. None of the patients underwent liver transplantation. The cumulative mortality rate of patients with complicated cirrhosis was 38.8% after 1 year, 51.7% after 2 years, 61.1% after 3 years and 65.1% after 8 years. A multivariate Cox's model identified the following variables as significant: age (P=0.001), gastrointestinal bleeding (GB)-ascites combination (P=0.000), encephalopathy-GB-ascites (P=0.028), hepatorenal syndrome (HRS) (P=0.000), GB-spontaneous bacterial peritonitis (SBP) (P=0.001), alkaline phosphatase (ALP) (P=0.004) and the Child-Pugh score (P=0.000).

CONCLUSION

The mortality in a group of patients with alcoholic cirrhosis is longer than in those with viral cirrhosis . Moreover, ascites in combination with other complications, HRS and hemorrage-SBP association are independent predictors of mortality in patients with complicated liver cirrhosis.

[Italian Society of Rheumatology (SIR) recommendations for performing arthrocentesis]

Joint fluid aspiration, or arthrocentesis, is one of the most useful and commonly performed procedures for the diagnosis and treatment of rheumatic diseases, but to date no definite guidelines have been published. For this reason, a group of experts of the Italian Society of Rheumatology (SIR) produced evidence based recommendations for performing arthrocentesis. Among them, the most relevant are: a) arthrocentesis is necessary when synovial effusion of unknown origin is present, especially if septic or crystal arthritis is suspected; b) the patient should be clearly informed of the benefits and risks of the procedure in order to give an informed consent; c) ultrasonography should be used to facilitate arthrocentesis in difficult joints; d) fluid evacuation often has a therapeutic effect and facilitates the success of the following intraarticular injection; e) careful skin disinfection and the use of sterile, disposable material is mandatory for avoiding septic complications. Disposable, non sterile gloves should always be used by the operator, mainly for his own protection; f) contraindications are the presence of skin lesions or infections in the area of the puncture; g) the patient's anticoagulant treatment is not a contraindication, providing the therapeutic range is not exceeded; h) joint rest after arthrocentesis is not indicated. Several of these recommendations were based on experts' opinion rather than on published evidence which is scanty.

Anti-cyclic citrullinated peptide antibody determination in synovial fluid of psoriatic arthritis

OBJECTIVE

To assess the role of anti-CCP antibodies in synovial fluid (SF) of psoriatic arthritis (PsA) patients by analysing their association with different clinical patterns of the disease.

METHODS

Seventy-five patients with a knee-joint effusion were studied, including 31 PsA patients, 29 rheumatoid arthritis (RA) and 15 osteoarthritis (OA) patients. SF and paired serum samples were stored at -70 degrees C until IgG anti-CCP and total IgG determination. The pattern of PsA articular involvement was defined as mono-, oligo-, polyarticular or axial.

RESULTS

Lower levels of IgG anti-CCP antibodies in SF (p < 0.01) and serum (p < 0.005) were found in PsA respect to RA patients without difference with OA. We found a higher SF/serum ratio for anti-CCP compared to the SF/serum ratio for total IgG in PsA (p < 0.0005) as well as in RA and OA. The correction of anti-CCP concentration in SF as IgG anti-CCP (unit) / total IgG revealed lower (p < 0.002) values in PsA patients with respect to RA patients. In PsA group, values of anti-CCP antibodies, SF/serum ratio of anti-CCP and anti-CCP/IgG above the cut-off were found in 5, 6 and 2 SF samples respectively. The presence or absence of anti-CCP antibodies did not discriminate a particular clinical subset.

CONCLUSIONS

In conclusion, strengthening the concept of local production of anti-CCP antibodies within the joint space, our results suggest that anti-CCP antibody detection in SF should take into account corrections such as total amount of corresponding immunoglobulin or SF/serum ratio. In our study, the presence or absence of anti-CCP antibodies did not discriminate a particular clinical subset, but further longitudinal studies are required to clarify the clinical role of anti-CCP in PsA.

Prevalence of atypical swallowing: a kinesiographic study

AIM

The aim of this study was to investigate the prevalence of kinesiographic coincidence between the most cranial position during deglutition of mandible and habitual occlusal position and to evaluate the distribution of clinical diagnosis according to the kinesiographic pattern of deglutition.

MATERIALS AND METHODS

201 random patients in waiting list for dental treatment and classified as orthodontic patients, prosthetic patients, TMD patients and control patients, were evaluated. Kinesiographic records were acquired using K7I and positioning a magnetic sensor frame integral with the head and with the sensory field balanced on an artificial magnet adhering to the mucosa covering the roots of the lower mandibular incisors. The kinesiographic occlusal position was compared to the kinesiographic most cranial position of the mandible during swallowing.

RESULTS

99 patients displayed a discrepancy between the most cranial position during swallowing and the occlusal position. 102 patients did not show any discrepancy. In this group the kinesiographic most cranial position during swallowing coincided with the occlusal position.

CONCLUSION

The finding suggests that computerised kinesiography could be useful to study deglutition, detecting in a reliable way the movement pattern. Atypical deglutition seems to be less atypical than previously though in dental patient population and, despite these data confirm its correlation with malocclusion, we noted an inverse correlation with necessity of prosthetic treatment and no higher prevalence in TMD patients.

[Occupational therapy in rheumatoid arthritis: short term prospective study in patients treated with anti-TNF-alpha drugs]

OBJECTIVE

To assess the effect of occupational therapy (OT) in rheumatoid arthritis (RA) patients treated with anti-TNF-alpha drugs in a short-term open controlled prospective study.

METHODS

31 RA subjects [(M/F=5/26; mean age= 56 (range=28-73) years; mean disease duration= 165 (range =15-432) months], treated with anti- TNF-alpha drugs, were allocated to OT (n=15) or control (n=16) group. We evaluated at entry and 12 weeks the following outcome parameters including Health Assessment Questionnaire (HAQ), Short-Form Health Survey (SF-36), Global Health (GH), Ritchie index, number of swollen or tender joints, pain, patient and physician disease activity, Disease Activity Score (DAS28), erythrocyte sedimentation rate (ESR), C-reactive protein CRP) and the correct adherence to items regarding activity daily living (ADL).

RESULTS

At baseline, OT and control group had similar demographic and clinical features. After 12 weeks, the changes from baseline of main outcome parameters were not significantly different between the two groups. After 12 weeks, in 7 out of 11 items regarding ADL, the percentage of patients showing a correct adherence was significantly increased in OT group only. Moreover at the end of the study, the OT group showed a correct adherence to 8 out of 11 ADL items in an higher percentage of patients respect to the control group.

CONCLUSION

Our study sustains that OT improves self-management but not main parameters of disease activity or functional capacity. Nevertheless educational intervention should be considered as a useful tool in conjunction with pharmacological treatment.

Ocular correction effects on EMG activity of stomatognathic muscles in children with functional mandibular lateral- deviation: a case control study

AIM

This study was conducted in order to determine the ocular correction effects on electromyography activity of anterior temporal, masseter, sternocleidomastoid and anterior digastric muscles in children with functional mandibular lateral-deviation.

METHODS

This study was performed on 32 subjects, aged between 8 and 12 years with functional lateral deviation of mandible and oculo-extrinsic muscular tone disorders. After complete ophthalmologic evaluation and ocular correction prescription, the children were randomly divided into two groups: study and control. In the study group (16 subjects) EMG activity at rest was recorded in the following conditions: with eyes closed; with eyes open; with ocular correction modified through electromyographic control. In the control group (16 subjects) EMG activity at rest was recorded in the following conditions: with eyes closed; with eyes open; with conventional ocular correction. Data were acquired in 15-seconds trial using a SEMG K7, while the subjects maintained rest dental position.

RESULTS/STATISTICS

Both groups presented a significative correlation between value of lateral-deviation and the degree of ocular-extrinsic muscular tone disorders (r=0.69). In addition, a significant statistical increase of EMG activity at rest with eyes open in both groups was observed in the anterior temporal left and right. A significant decrease of EMG activity with open eyes was observed only with ocular correction upon electromyographic control (study group). The findings, expressed as Symmetry Index, showed a significant increase of muscles imbalance right/left with conventional methods of ocular correction (p < 0.0001).

CONCLUSION

The significant worsening in EMG activity, mainly observed with conventional corrective lenses, could have an important consequence in clinical diagnostic and therapeutic behaviour because anterior temporal muscles are important in postural position of the mandible. Instead EMG corrective lenses could improve tonus and balance of stomatognathic muscles and, therefore, support the functionality of orthodontic treatment. Moreover, the data suggest an interesting new tool in order to reach an interdisciplinary approach to complex growth disorders represented by functional lateral deviation of mandible and ocular-extrinsic muscular tone disorders.

Visual input effect on EMG activity of masticatory and postural muscles in healthy and in myopic children

AIM

The purpose of this study was to evaluate the activity of Anterior Temporal, Masseter, Sternocleidomastoid and Anterior Digastric muscles in response to changes in visual input in subjects with defective vision by means surface electromyography.

METHODS

A total of 20 children, aged between 7 and 13 years, were evaluated. In the study group 10 children with myopic defects were enlisted, selected among patients afferent to the paediatric dentistry clinic. Ten subjects with normal vision, the control group, were chosen through the Pair Matching procedures, so that each myopic child had a matching age case control. Both study group and control group patients maintained mandible at rest with teeth apart and were submitted to a 15-sec electromyography (EMG) recording with closed eyes followed by a 15-sec EMG recording with open eyes.

RESULTS/STATISTICS

The Root Mean Square (RMS) values were elaborated to obtain means and standard deviation. Statistical analysis was undertaken using the Student's T-test for independent samples. Analysis of the results demonstrated a marked difference in tonic activity of temporal anterior muscles at open eyes between the myopic and the normal groups.

CONCLUSION

The findings suggest that in the evaluation of masticatory muscles tenderness, such as episodic tension type headaches, attention should be paid to vision defects.

[Soluble P-selectin levels in synovial fluid and serum from patients with psoriatic arthritis]

OBJECTIVE

P-selectin is an adhesion molecule expressed by activated endothelial cells and platelets favouring the leukocyte adherence to microvascular endothelium. A soluble form of this molecule has been described, whose serum levels were found to be elevated and correlate with disease activity in rheumatoid arthritis (RA) patients. Aim of this study was to determine soluble P-selectin levels in synovial fluid (SF) and serum from patients with psoriatic arthritis (PsA), where it has never been investigated, to define its involvement in PsA synovial damage.

METHODS

we analysed, by ELISA, soluble P-selectin serum and SF levels in 100 patients presenting a knee joint effusion: 38 of them presented PsA, 40 RA and 22 osteoarthritis (OA). We examined the main clinical and laboratory parameters of these patients. Soluble P-selectin serum levels were also detected in 15 healthy subjects.

RESULTS

soluble P-selectin SF levels were significantly higher in PsA and RA patients respect to OA subjects. Soluble P-selectin SF levels were lower than those found in serum and the SF/serum ratio was higher in PsA and RA patients respect to OA. Soluble P-selectin serum levels were not significantly different among patients and controls. No correlation was found between SF and serum levels of soluble P-selectin and the main clinical parameters.

CONCLUSIONS

our study of soluble P-selectin in PsA reveals a prominent local role of this molecule, with no differences respect to RA. Histological findings may be of help in understanding the role of this adhesion molecule in PsA.

[Italian consensus on Eular 2003 recommendations for the treatment of knee osteoarthritis]

The recommendations for the management of osteoarthritis (OA) of the knee firstly proposed by the EULAR in 2000, have been updated in 2003. One of the most important objectives of the expert charged to provide these recommendations was their dissemination. Thus, the information generated may be used by each individual country to produce their own set of management guidelines and algorithms for treatment in primary care. The Italian Society of Rheumatology (SIR) and the Italian League against Rheumatism (LIMAR) have organised a Consensus on the EULAR recommendations 2003 with the aim to analyse their acceptability and applicability according to our own experience and local situations in the Italy. The results of this Consensus have demonstrated that a large majority of the EULAR recommendations are endorsed by the Italian experts. Furthermore, the final document of the Italian Consensus clearly indicated the need that specialists involved in the management of knee OA strongly encourage the dissemination of the EULAR 2003 recommendations also in Italy.

[Role for familial and genetic features in the therapeutic response of psoriatic arthritis]

AIM OF THE STUDY

To analyze PsA patients with and without a familiar distribution for Ps and PsA, in order to better evaluate the genetic data, to verify the existence of different expression of the disease and finally to define the susceptibility to treatment in these patients.

MATERIALS AND METHODS

230 PsA patients were selected for familiar or sporadic distribution of the disease and were evaluated for the main clinical, demographic, radiological and laboratory features, as well as for the ongoing treatments. In each patient HLA class I (A,B,C) and II (DRB1, DQB1) antigens were typed with PCR-SSP method while MICA-A exon 5 microsatellite typing was performed by heteroduplex analysis in 122 subjects.

RESULTS

A familiar distribution for Ps and PsA was found in 68 patients (29.6%) although only two patients had familiarity for PsA. In the familiar PsA group the male prevalence was significantly higher respect to the sporadic one (p<0.001) and the more frequently involved relative was the father (28%). Mean age (p<0.006) and age at onset of Ps (p<0.004) and PsA (p<0.014) were significantly lower in familiar respect to sporadic PsA. Between the two groups no difference was found concerning the articular involvement, the radiological findings, the disease activity (including number of painful/swollen joints), the inflammatory laboratory parameters (including ESR and CRP) and genetic aspects, including the frequencies of MICA-A alleles that were analysed in 30 patients with the familiar form and in 92 with the sporadic one. In the follow-up the therapeutic response to any evaluated treatment adopted for PsA did not show any significant difference in the two groups. All these results were confirmed even when the patients in the two groups were matchable for sex, age and disease duration.

CONCLUSION

Our results confirm that familiar PsA is characterized by an early onset of the disease and by a male and fatherly predominance respect to the sporadic form, although the clinical-radiologic findings, the genetic typing and the therapeutic response do not permit us to identify any particular subset.

Synthesis and anti-measles virus activity of new isoquinolin-4-one derivatives

Despite intense efforts to increase vaccine coverage, measles virus (MV) still causes significant morbidity and mortality in the world sometimes as a results of severe, chronic and lethal diseases. In an effort to develop therapies to supplement immunization strategies a number of 1-oxo-2-[[(1E)-phenylmethylene]amino]-1,2-dihydroisoquinoline-4-carboxylic acid derivatives were synthesized and evaluated for anti-measles activity. The substituents on the aromatic ring were chosen in order to evaluate the influence of electron-withdrawing or electron-donating effects on the electronic density of the aromatic moiety. We also evaluated the introduction of a vinyl chain between the exocyclic nitrogen and phenyl moiety. The biological results allow to outline some preliminary considerations on structure-activity relationship.

Natural killer cells and gamma/delta T cells in synovial fluid and in peripheral blood of patients with psoriatic arthritis

OBJECTIVE

NK surface markers and gamma/delta TCR antigen are involved in non-MHC-restricted cytotoxicity, which represents a major effector mechanism of the cell-mediated immune response. We evaluated in PsA patients SF and PB lymphocytes expressing these cellular subsets in order to obtain information on the possible role played by them in the disease.

METHODS

We studied 29 PsA and 27 RA patients, as well as 27 healthy controls. In 17 PsA and 16 RA patients with knee joint effusion, analysis of SF was performed. SF and PB lymphocyte analysis was performed by direct dual immunofluorescence flow cytomettry using anti-CD3, anti-CD4, anti-CD8, anti-CD19, anti-TCR-gamma/delta-1 and anti-CD16 and anti-CD56 monoclonal antibodies.

RESULTS

PsA and RA patients had, with respect to controls, lower values (both as percentages and in absolute numbers) of PB T cells expressing gamma/delta TCR. SF Iymphocytes of PsA and RA patients were characterised, as compared to PB lymphocytes, by lower numbers (both in absolute numbers and in relative terms) of NK and NK-T cells. Considering the absolute numbers of the various lymphocyte subsets, a strong correlation was found in PsA SF between gamma/delta T cells and NK (p < 0.0007) or NK-T cells (p < 0.0003), as well as between NK and NK-T cells (p < 0.0019). There was instead no statistically significant correlation among the different SF or PB lymphocytes and the most relevant clinical or serological parameters.

CONCLUSION

This study, analyzing the impairment of different subsets involved in non-MHC-restricted cytotoxicity, suggests that this component of the cell-mediated immune response seems to play a pivotal role in the development of PsA.

[Immunohistochemical analysis of the expression of main adhesion molecules and tumor necrosis factors in the synovial membrane of psoriatic arthritis]

OBJECTIVE

To define the expression and pattern of the synovial distribution of adhesion molecules such as E-selectin, ICAM-1 and VCAM-1 and of TNFalpha and TNFbeta cytokines in psoriatic arthritis (PsA), according to the synovitis duration.

METHODS

Cryostatic sections of the synovial membrane tissue samples were stained for the different antibodies using a standard three-stage-immunoperoxidase-labeling technique.

RESULTS

E-selectin grade of staining was higher in those patients with a shorter disease duration compared to longstanding synovitic specimens, as well as ICAM-1 expression. On the contrary a higher VCAM-1 positivity was mainly found in longstanding PsA patients. Anti-TNFalpha positivity was found almost in all the specimens with no difference among the two groups, while the intensity of anti-TNFbeta positivity was globally higher in longstanding cases.

CONCLUSIONS

Different adhesion molecules may separately participate to the synovitic process in the different phases of PsA, leading to the hypothesis of their different involvement during the disease evolution. Moreover the upregulation of TNFalpha and TNFbeta gives evidence to their local proinflammatory effect within the synovium and to their role in perpetuating the PsA synovitis.

Interleukin-13 in systemic sclerosis: relationship to nailfold capillaroscopy abnormalities

The aim of this study was to investigate whether interleukin-13 (IL-13) serum levels correlate to different nailfold capillaroscopy (NC) findings in patients with systemic sclerosis (SSc). IL-13 serum levels were measured using an ELISA method. The following NC abnormalities were considered: the presence of giant loops, haemorrhages, loss of capillaries, disorganisation of the vascular array, ramified/bushy capillaries and sludging of blood. A semiquantitative rating scale was adopted to score these changes, as well as a rating system for avascular areas and three morphological NC patterns ('early', 'active' and 'late'). Mean capillary density was determined by counting the total number of capillaries in a 1 mm length, and the arterial and venous diameters of the capillary as well as the total loop diameter were measured. In SSc patients IL-13 serum levels were significantly higher than in controls ( P < 00.1), whereas in patients with ( n=8) and without ( n=24) abnormal IL-13 serum levels (>17 pg/ml) the comparison of the NC features showed significantly relevant differences concerning a more frequent 'active' NC pattern ( P < 0.02), the presence of haemorrhages ( P < 0.0037) and sludging of blood ( P < 0.038), as well as larger total loop ( P < 0.036) and arterial ( P < 0.03) diameters, in those patients with elevated IL-13 serum levels. The study confirmed that IL-13 serum levels are higher in the sera of patients with SSc, and shows for the first time the significant correlations between this serological finding and some of the main relevant SSc capillaroscopic features, leading us to believe that this cytokine not only seems to sustain the immunological and fibrotic process of SSc, but might have a role in determining the more severe microvascular lesions in this disease.

Relationship of interleukin-12 and interleukin-13 imbalance with class-specific rheumatoid factors and anticardiolipin antibodies in systemic lupus erythematosus

The aim of the study was to evaluate whether the imbalance between IL-12 and IL-13 serum levels, reflecting Th1/Th2 activity, is related to class-specific circulating rheumatoid factors (RF) and anticardiolipin (aCL) antibodies in SLE. Using ELISA we measured serum IL-12, IL-13, RF and aCL antibodies in 73 SLE patients and 20 healthy controls. The determination of IL-12/IL-13 ratio showed that IL-12 levels were above (group A), equal to (group B) or below (group C) IL-13 levels in 71.2%, 15.1% and 13.7% of SLE patients, respectively. IgM-RF levels were significantly higher in group C than in groups A ( P < 0.002) and B ( P < 0.019). Group C had also higher IgM-aCL levels than group A ( P < 0.04). No relationship between IL-12/IL-13 ratio and clinical or other laboratory parameters was found. It was concluded that the increased levels of both IgM-RF and IgM-aCL in patients with prevalent Th2 activity suggest that the predominance of Th2 over Th1 could drive autoantibody production in SLE patients.

Retreatment with interferon plus ribavirin of chronic hepatitis C non-responders to interferon monotherapy: a meta-analysis of individual patient data

BACKGROUND AND AIMS

Retreatment with a combination of alpha interferon (IFN) plus ribavirin of patients with chronic hepatitis C who did not respond to IFN monotherapy has not been assessed in large controlled studies.

METHODS

To assess the effectiveness and tolerability of IFN/ribavirin retreatment of non-responders to IFN and to identify predictors of complete (biochemical and virological) sustained response, we performed a meta-analysis of individual data on 581 patients from 10 centres. Retreatment with various IFN schedules (mean total dose 544 mega units) and a fixed ribavirin dose (1000-1200 mg/daily depending on body weight) was given for 24-60 (mean 39.5) weeks.

RESULTS

Biochemical end of treatment and sustained responses were observed in 271/581 (46.6%; 95% confidence interval (CI) 42.6-50.7%) and in 109/581 (18.7%; 95% CI 15.6-22.0%) cases, respectively. Two hundred and six of 532 patients (38.7%; 95% CI 34.6-42.9%) had an end of treatment complete response to retreatment while a complete sustained response occurred in 88 of 559 (15.7%; 95% CI 12.8-18.8%). Fifty four of 581 patients (9.2%; 95% CI 7.0-11.7%) stopped retreatment due to adverse effects. By logistic regression, complete sustained response was predicted independently by age <45 years (p=0.04), by normal pretreatment gamma-glutamyltransferase levels (p=0.01), and by a second course total IFN dose of at least 432 mega units (p=0.008).

CONCLUSIONS

The overall low probability of effectiveness argues against indiscriminate retreatment of all IFN monotherapy non-responders with IFN/ribavirin. Patients less than 45 years old with normal gamma-glutamyltransferase levels who were retreated with high dose long course combination therapy had a complete sustained response rate of 30%.

Determination of undecylenic and sorbic acids in cosmetic preparations by high performance liquid chromatography with electrochemical detection

A highly sensitive and selective method for the determination of sorbic (SA) and undecylenic acid (UA) in cosmetic formulations by a high performance liquid chromatography method with electrochemical detection (ECD) is described. The pre-column derivatizations of SA and UA and the internal standard (cyclohexanoic acid (cHA)) were carried out using 1-(2,5-dihydroxyphenyl)-2-bromoethanone (2,5-DBE) as an electroactive labeling reagent previously synthesized in our lab. The resulting electroactive esters were separated by isocratic elution of a 5 micrometer Hypersil CN column with acetonitrile-acetate buffer eluent. The compounds were detected by a porous graphite electrode set at an oxidation potential of +0.45 V. The analytical method developed in this study is suitable for quality control assays of complex cosmetic formulations containing sorbic and/or UA.