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Cosentino VL, Casado G, Gobbi C, Secco A, Romanini F, Citera G, Rosemffet M, Papasidero S, Medina MA, Bande JM, Roberts K, Brigante A, Pons Estel G, de la Vega MC, Sequeira G, Kerzberg EM. Speciality training in rheumatology: Promotion, repetition and dropout rates in the city of Buenos Aires. Reumatol Clin (Engl Ed) 2024; 20:92-95. [PMID: 38290954 DOI: 10.1016/j.reumae.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/17/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVES To evaluate the trajectory of students enrolled in the specialty training in rheumatology. METHODS Retrospective analysis (2009-2016). Promotion, repetition, and dropout rates were determined. Analysis was performed to define variables associated with academic success. RESULTS Out of 119 students, the actual promotion rate was 66.4%, 11.8% failed an exam (at least) and completed the course after the stipulated time, and the dropout rate was 7.6%. Among residents, the promotion rate was 82.5% vs. 48.2% among the rest (p < 0.001), the lagging students' repetition rate was 3.2% vs. 21.4% among the rest (p 0.005), and the dropout rate was 3.2% vs. 12.5% among the rest (p = 0.06). A higher average score in medical school increased the chances of success in the postgraduate programme (OR 3.41 CI 95% 2.0-6.4; p < 0.001). CONCLUSIONS The residency was associated with higher rates of academic success in postgraduate studies. The average score in medical school can help identify students at risk of failure.
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Affiliation(s)
- Vanesa Laura Cosentino
- Servicio de Reumatología, Hospital J. M. Ramos Mejía, Ciudad Autónoma de Buenos Aires. Argentina.
| | - Gustavo Casado
- Servicio de Reumatología, Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich, Ciudad Autónoma de Buenos Aires. Argentina
| | - Carla Gobbi
- Cátedra de Clínica Medica 1. Hospital de Córdoba, Córdoba. Argentina
| | - Anastasia Secco
- Servicio de Reumatología, Hospital Bernardino Rivadavia, Ciudad Autónoma de Buenos Aires. Argentina
| | - Félix Romanini
- Servicio de Reumatología, Hospital Bernardino Rivadavia, Ciudad Autónoma de Buenos Aires. Argentina
| | - Gustavo Citera
- Instituto de Rehabilitación Psicofísica (IREP), Ciudad Autónoma de Buenos Aires. Argentina
| | - Marcos Rosemffet
- Instituto de Rehabilitación Psicofísica (IREP), Ciudad Autónoma de Buenos Aires. Argentina
| | - Silvia Papasidero
- Servicio de Reumatología, Hospital General de Agudos Dr. E. Tornú, Ciudad Autónoma de Buenos Aires, Argentina
| | - María Alejandra Medina
- Servicio de Reumatología, Hospital General de Agudos Dr. E. Tornú, Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan Manuel Bande
- Servicio de Reumatología, Hospital General de Agudos Dr. E. Tornú, Ciudad Autónoma de Buenos Aires, Argentina
| | - Karen Roberts
- Unidad de Investigación Clínica de la Sociedad Argentina de Reumatología (UNISAR), Argentina
| | - Alejandro Brigante
- Unidad de Investigación Clínica de la Sociedad Argentina de Reumatología (UNISAR), Argentina
| | - Guillermo Pons Estel
- Unidad de Investigación Clínica de la Sociedad Argentina de Reumatología (UNISAR), Argentina
| | - María Celina de la Vega
- Servicio de Reumatología, Hospital General de Agudos Dr. Cosme Argerich, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gabriel Sequeira
- Servicio de Reumatología, Hospital J. M. Ramos Mejía, Ciudad Autónoma de Buenos Aires. Argentina
| | - Eduardo Mario Kerzberg
- Servicio de Reumatología, Hospital J. M. Ramos Mejía, Ciudad Autónoma de Buenos Aires. Argentina
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Brigante A, Isnardi CA, Gómez G, Quintana R, Haye M, Roberts K, García M, Gomez G, Gobbi C, Casado G, Rebak J, Dapeña JM, Berbotto G, Viola M, Saurit V, Petkovic IE, Bertoli A, Giorgis P, Diaz MP, Catay E, Exeni IE, Pons-Estel B, Paira S, Bovea Castelblanco G, De La Sota ME, Larroude MS, Pereira DA, Granel AB, Medina G, Pisoni C, Alvarez A, Aguero SE, Fernandez L, Sacnun M, Soares de Souza S, Velozo E, Aste N, Castro C, Lazaro A, Kerzberg E, Gallardo MDLÁ, Savio V, Gamba J, Secco A, Citera G, Soriano E, Graf C, Pons-Estel G, Delavega M. POS0655 SURVIVAL AND SAFETY OF BIOLOGICAL AND TARGETED SYNTHETIC THERAPIES AS REGARDS TO AGE GROUPS. BIOBADASAR 3.0 REGISTRY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAdvances in rheumatology and new therapeutic options have certainly impacted patient survival, changing the age range, from youth to seniors. The differences between the age groups could influence the evolution of the disease and the adverse events (AEs) related to the treatments. There are few real-world data on the safety and efficacy of treatments in different age groups.ObjectivesTo evaluate the frequency of AEs and the survival of treatments according to the age in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS).MethodsRetrospective, observational, multicenter study of real-life data of patients included in the BIOBADASAR 3.0 registry; exposed and not exposed to original biological treatments (b-DMARDs), biosimilars, targeted synthetic drugs (ts-DMARDs). The unexposed group received treatment with conventional disease-modifying drugs (cDMARDs). A Kaplan-Meier and Log Rank Test analysis was performed to study AEs-free survival and treatment in different age groups (young people <25; young adults 25-34; mature adults 34-65; old adults >65). Factors related to treatment survival were evaluated using Cox regression models.Results5,297 patients were included, 80.3% female, mean age 43.7 years (SD 15.6) and median disease progression 14.3 [IQR 11.5]. RA 4658 (87.9%); APs 490 (9.25%) and EA 149 (2.8%). The main reason for treatment discontinuation was ineffectiveness, in 624 patients in the exposed group and in 53 (2.5%) patients in control group, followed by the presence of AEs in 352 (11.2%) and 83 (3.9%), respectively (p=0.001).A mean Charlson Score of 0.268 (SD 0.6) in the exposed group and 0.306 (SD 0.7) in the control group (p=0.095). Median EAs-free survival in the exposed group was 12.5 years [IQR 16.6] while in controls was 28 years [IQR 11], p<0.0001. Median AEs-free survival was 12 years (IQR 11) in young people, 11.5 years [IQR: 4.9] in young adults, 10 years [IQR: 3.25] in mature adults and 7.6 years [IQR: 6] in old adults with a difference statistically significant (p>0.017). The exposed group presented a median treatment survival in years of 11.25 years [IQR: 10] in young people; 12.5 years [IQR: 4.7] in young adults, 7.5 years [IQR: 12.1] in mature adults and 4.5 years [IQR: 1.14] in old adults (p>0.0001). Considering only the first line of treatment, a median survival of 11.5 years [IQR: 10] was evidenced in the age group <25; 12 years [IQR: 2.6] between 25-34 years old, 10 years [IQR: 12] in the group between 34-65 years old and 5.5 years [IQR: 1.14] in the group > 65 years old (p>0.004). (Figure 1). Considering the second line of treatment, the differences between the groups were not statistically significant (p=0.57). In the multivariate regression model for patients with RA, the factors with the greatest impact on treatment survival were female sex (HR 1.3, 95% CI 1.2-1.4), old age (HR 1.01, 95% CI 1.008-1.01), treatment with steroids (HR 1.19, 95% CI1.1-1.2) and longer disease duration (HR 1.01, 95% CI1.01 – 1.02).ConclusionIn the present study we were able to demonstrate a greater occurrence of AEs in old adults and mature adults compared to young people and young adults. Conversely, survival for b-DMARDs and ts-DMARDs were greater in youth and young adults. In patients with RA, female sex, corticosteroid therapy, old aged and longer disease duration were associated with treatment discontinuation.References[1]Souto A, et al. Rate of discontinuation and drug survival of biologic therapies in rheumatoid arthritis: a systematic review and meta-analysis of drug registries and health care databases. Rheumatology (Oxford). 2016;55(3):523–34.[2]Ray D, et al. Immune senescence, epigenetics and autoimmunity. Clin Immunol. 2018 Nov;196:59-63. doi: 10.1016/j.clim.2018.04.002. Epub 2018 Apr 11.[3]Vela P, et al. Influence of age on the occurrence of adverse events in rheumatic patients at the onset of biological treatment: data from the BIOBADASER III register. Arthritis Res Ther. 2020 Jun 15;22(1):143. doi: 10.1186/s13075-020-02231-x.Disclosure of InterestsNone declared
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Smichowski AM, Caputo VD, Romeo C, Rivero E, Morales NS, Casado G. Ocular cicatricial pemphigoid: Methotrexate as an initial treatment? Reumatol Clin (Engl Ed) 2022; 18:30-32. [PMID: 34088654 DOI: 10.1016/j.reumae.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To analyse the clinical/epidemiological data, the management and the treatments established in patients with Ocular Cicatricial Pemphigoid (OCP) in a Rheumatology Service. MATERIAL AND METHODS Review of clinical histories of patients with OCP referred by ophthalmology between 2008 and 2019. RESULTS In our series of 27 patients, 67% were diagnosed and referred in the last 2 years. Most in Foster stage 1. Of the patients, 18.5% presented associated Sjogren's syndrome, with poor progression: 88.8% received Methotrexate, 74% used it as monotherapy and 66% continued with said treatment up to the end. Eighteen point five percent had to combine or rotate therapies, the drugs used were mycophenolate, azathioprine, cyclophosphamide, sirolimus, etanercept, rituximab: 29% used steroids. Only in 2 eyes was stage progression observed. There were no serious adverse events, and 37% had mild adverse events. CONCLUSION Starting immunosuppressive therapy early is essential, methotrexate being a good initial alternative in our experience, and treatment must be escalated in line with disease progression.
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Affiliation(s)
- Andrea María Smichowski
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina.
| | - Victor Daniel Caputo
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
| | - Cecilia Romeo
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
| | - Estela Rivero
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
| | - Natalia Soledad Morales
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
| | - Gustavo Casado
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
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4
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Smichowski AM, Caputo VD, Romeo C, Rivero E, Morales NS, Casado G. Ocular Cicatricial Pemphigoid: Methotrexate as an Initial Treatment? Reumatol Clin (Engl Ed) 2021; 18:S1699-258X(20)30242-4. [PMID: 33454207 DOI: 10.1016/j.reuma.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/21/2020] [Accepted: 10/15/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyse the clinical / epidemiological data, the management and the treatments established in patients with ocular cicatricial pemphigoid in a Rheumatology Service. MATERIAL AND METHODS Review of clinical histories of patients with ocular cicatricial pemphigoid referred by ophthalmology between 2008 and 2019. RESULTS In our series of 27 patients, 67% were diagnosed and referred in the last 2 years. Most in Foster stage 1. Of the patients, 18.5% presented associated Sjogren's syndrome, with poor progression: 88.8% received Methotrexate, 74% used it as monotherapy and 66% continued with said treatment up to the end. Eighteen point five percent had to combine or rotate therapies, the drugs used were mycophenolate, azathioprine, cyclophosphamide, sirolimus, etanercept, rituximab: 29% used steroids. Only in 2 eyes was stage progression observed. There were no serious adverse events, and 37% had mild adverse events. CONCLUSION Starting immunosuppressive therapy early is essential, methotrexate being a good initial alternative in our experience, and treatment must be escalated in line with disease progression.
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Affiliation(s)
- Andrea María Smichowski
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina.
| | - Victor Daniel Caputo
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
| | - Cecilia Romeo
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
| | - Estela Rivero
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
| | - Natalia Soledad Morales
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
| | - Gustavo Casado
- Servicio de Reumatología, Hospital Militar Central 601 Cirujano Mayor Doctor Cosme Argerich, Buenos Aires, Argentina
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Echazarreta DF, Perna ER, Coronel ML, Diez M, Lescano AJ, Atamañuk AN, Mazzei JA, Cáneva JO, Svelitza GN, Nitsche A, Babini A, Casado G, Haag DF, Cazalas M, Stepffer C. Collaborative registry of pulmonary hypertension in Argentina (RECOPILAR). Final analysis. Medicina (B Aires) 2021; 81:180-190. [PMID: 33906136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
The epidemiology of pulmonary hypertension (PH), especially pulmonary arterial hypertension (PAH), has not been evaluated in our country, therefore there is no reference parameter to establishing the representativeness of this information in the national order. This registry represents the first collaborative effort to provide a knowledge base of this disease, including 5 scientific societies that represent different specialties (pediatrics, rheumatology, pulmonology and cardiology) with data from 23 Argentine provinces. These efforts involved five societies of various adult (cardiology, rheumatology, and pulmonology) and pediatric (cardiology) specialties. Subjects were grouped (1-5) in accord with the 2013 Nice classification. A total of 627 patients (mean age, 50.8 ± 18 years; women, 69.2%) were recruited. Incident cases accounted for 53%. Functional class III-IV accounted for 69% at time of diagnosis and 33.4% at time of inclusion. Distributions in groups 1-5 were 63.6%, 15.9%, 8.3%, 9.7%, and 2.4%, respectively. Treatment consisted of diuretics (51.2%), mineralocorticoid receptor antagonists (44.7%), digoxin (16.6%), anticoagulants (39.2%), renin-angiotensin antagonists (15.5%), beta blockers (15.6%), and calcium channel blockers (8%). Rates of specific therapies usage in PAH vs. non-PAH group were 80.5% vs. 40.8% (phosphodiesterase-5 inhibitors: 71% vs. 38.6%; endothelin receptor antagonists: 54.4% vs. 14.5%; prostanoids: 14.3 vs. 3.1%; all p < 0.001). Three-year survival in PAH and non-PAH differed significantly (82.8% vs. 73.3%; p = 0.001). In the Argentine RECOPILAR registry, the clinic-epidemiologic profile was that of advanced-stage disease. Diagnostic workups and therapeutics interventions, including use of specific therapy for PAH, were consistent with current recommendations. Despite delays in diagnosis, survival was aligned with other contemporary registries.
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Affiliation(s)
| | | | | | - Mirta Diez
- Sociedad Argentina de Cardiología (SAC), Argentina
| | | | | | - Juan A Mazzei
- Asociación Argentina de Medicina Respiratoria (AAMR), Argentina
| | - Jorge O Cáneva
- Asociación Argentina de Medicina Respiratoria (AAMR), Argentina
| | | | | | | | | | - Dora F Haag
- Sociedad Argentina de Pediatría (SAP), Pulmonary Hypertension Registry
| | - Mariana Cazalas
- Sociedad Argentina de Cardiología (SAC), Argentina
- Sociedad Argentina de Pediatría (SAP), Pulmonary Hypertension Registry
| | - Carolina Stepffer
- Asociación Argentina de Medicina Respiratoria (AAMR), Argentina
- Sociedad Argentina de Pediatría (SAP), Pulmonary Hypertension Registry
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Babini A, Cappuccio AM, Caprarulo C, Casado G, Eimon A, Figueredo H, García MA, Magri S, Mannucci P, Perez Rodriguez S, Pons-Estel BA, Velozo EJ, Iglesias-Rodriguez M, Streger G. Evaluation of belimumab treatment in patients with systemic lupus erythematosus in a clinical practice setting: Results from a 24-month OBSErve study in Argentina. Lupus 2020; 29:1385-1396. [PMID: 32791930 PMCID: PMC7536527 DOI: 10.1177/0961203320947814] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To describe clinical effectiveness of belimumab for systemic lupus
erythematosus (SLE) in real-world practice in Argentina. Methods This retrospective, observational study analysed medical record data of
patients with SLE treated with belimumab in 15 centres in Argentina. Primary
endpoint: overall clinical response (assessed on a scale similar to the
6-point Physician Global Assessment) at months 6, 12, 18 and 24, all versus
index (belimumab initiation). Secondary endpoints: improvement in disease
activity (SELENA-SLEDAI), SLE manifestations, and corticosteroid dose
change. Results Records for 81 patients (91% female) were analysed. Clinical improvements
were reported for 95%, 95%, 98% and 100% patients at 6, 12, 18, and
24 months post index, respectively. Mean SELENA-SLEDAI score decreased from
11.21 at index to 4.76, 3.77, 3.86 and 2.17 at 6, 12, 18, and 24 months post
index, respectively. Number of flares decreased from 1.05 at index to 0.21,
0.09, 0.22 and 0.30 at 6, 12, 18, and 24 months post index, respectively.
Mean corticosteroid dose was 14.59 mg/day at index, and 6.45, 5.18, 5.17 and
4.78 mg/day at 6, 12, 18, and 24 months post index, respectively. Conclusions Real-world patients with SLE treated with belimumab in Argentina demonstrated
clinical improvements and reductions in corticosteroid dose.
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Affiliation(s)
- A Babini
- Hospital Italiano de Córdoba, Córdoba, Argentina
| | | | - C Caprarulo
- Consultorio Privado, Concordia, Entre Rios, Argentina
| | - G Casado
- Servicio de Reumatología, Hospital Militar Central, Buenos Aires, Argentina
| | - A Eimon
- CEMIC, Buenos Aires, Argentina
| | - H Figueredo
- Hospital de Alta Complejidad 'Pte. Juan Domingo Perón', Formosa, Argentina
| | - M A García
- Hospital Interzonal General de Agudos José de San Martín, La Plata, Argentina
| | - S Magri
- Hospital Italiano de La Plata, Buenos Aires, Argentina
| | - P Mannucci
- Aprillus Asistencia e Investigación de Arcis Salud SRL, Buenos Aires, Argentina
| | | | - B A Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Grupo Oroño, Sanatorio Parque, Rosario, Santa Fé, Argentina
| | - E J Velozo
- Unidad de Reumatologia, Universidad y Sanatorio Adventista del Plata, Entre Rios, Argentina
| | | | - G Streger
- Immunology & Specialty Medicine, GSK, Buenos Aires, Argentina
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Gallego A, Ramon-Patino J, Brenes J, Mendiola M, Berjon A, Casado G, Castelo B, Espinosa E, Hernandez A, Hardisson D, Feliu J, Redondo A. Bevacizumab in recurrent ovarian cancer: could it be particularly effective in patients with clear cell carcinoma? Clin Transl Oncol 2020; 23:536-542. [PMID: 32651885 DOI: 10.1007/s12094-020-02446-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/27/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Treatment of recurrent ovarian carcinoma is a challenge, particularly for the clear cell (CCC) subtype. However, there is a preclinical rationale that these patients could achieve a benefit from antiangiogenic therapy. To assess this hypothesis, we used the growth modulation index (GMI), which represents an intrapatient comparison of two successive progression-free survival (PFS). METHODS We conducted a retrospective real-world study performed on 34 patients with recurrent ovarian cancer, treated with bevacizumab-containing regimens from January 2009 to December 2017. The primary endpoint was GMI. An established cut-off > 1.33 was defined as a sign of drug activity. RESULTS 73.5% of patients had high-grade serous ovarian carcinoma (HGSOC), and 17.7% had CCC; 70.6% of patients received carboplatin/gemcitabine/bevacizumab, and 29.4% received weekly paclitaxel/bevacizumab. According to histological subtype, the overall response rate and median PFS were 52% and 14 months for HGSOC and 83.3% and 20 months for CCC, respectively. The overall population median GMI was 0.99; it was 0.95 and 2.36 for HGSOC and CCC, respectively. CCC subtype was significantly correlated with GMI > 1.33 (odds ratio 41.67; 95% confidence interval 3.6-486.94; p = .03). CONCLUSION Adding bevacizumab to chemotherapy in recurrent CCC is associated with a remarkable benefit in this cohort. The efficacy of antiangiogenic drugs in CCC warrants further prospective evaluation.
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Affiliation(s)
- A Gallego
- Department of Medical Oncology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.,Translational Oncology Research Laboratory, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - J Ramon-Patino
- Translational Oncology Research Laboratory, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - J Brenes
- Department of Medical Oncology, Instituto Catalán de Oncología, Hospitalet de Llobregat, Barcelona, Spain
| | - M Mendiola
- Molecular Pathology and Therapeutic Targets Group, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.,Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, Madrid, Spain
| | - A Berjon
- Molecular Pathology and Therapeutic Targets Group, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.,Department of Pathology, Hospital Universitario La Paz, Madrid, Spain
| | - G Casado
- Department of Pharmacy, Hospital Universitario La Paz, Madrid, Spain
| | - B Castelo
- Department of Medical Oncology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.,Translational Oncology Research Laboratory, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.,Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain.,Cátedra Universidad Autónoma de Madrid UAM-Amgen, Madrid, Spain
| | - E Espinosa
- Department of Medical Oncology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.,Translational Oncology Research Laboratory, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.,Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, Madrid, Spain.,Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain.,Cátedra Universidad Autónoma de Madrid UAM-Amgen, Madrid, Spain
| | - A Hernandez
- Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain.,Department of Gynecology, Hospital Universitario La Paz, Madrid, Spain
| | - D Hardisson
- Molecular Pathology and Therapeutic Targets Group, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.,Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, Madrid, Spain.,Department of Pathology, Hospital Universitario La Paz, Madrid, Spain.,Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - J Feliu
- Department of Medical Oncology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.,Translational Oncology Research Laboratory, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.,Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, Madrid, Spain.,Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain.,Cátedra Universidad Autónoma de Madrid UAM-Amgen, Madrid, Spain
| | - A Redondo
- Department of Medical Oncology, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain. .,Translational Oncology Research Laboratory, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain. .,Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain. .,Cátedra Universidad Autónoma de Madrid UAM-Amgen, Madrid, Spain.
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Haraoui B, Casado G, Czirják L, Taylor A, Dong L, Button P, Luder Y, Caporali R. Tocilizumab Patterns of Use, Effectiveness, and Safety in Patients with Rheumatoid Arthritis: Final Results from a Set of Multi-National Non-Interventional Studies. Rheumatol Ther 2019; 6:231-243. [PMID: 30859494 PMCID: PMC6513939 DOI: 10.1007/s40744-019-0150-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION The objective of this study was to observe the patterns of usage, efficacy, and safety of tocilizumab (TCZ) in clinical practice in patients with rheumatoid arthritis. METHODS Data on the real-world usage, efficacy, and safety of TCZ were collected from patients during routine follow-up visits conducted over a 6-month period. Patients were grouped by previous exposure to biologic therapies (biologic exposed vs. biologic naive). RESULTS Of 1912 patients enrolled from 16 countries, 639 (33.4%) received TCZ monotherapy and 1273 (66.6%) received TCZ combination therapy. At baseline, 1073 patients (56.1%) were biologic naive and 839 (43.9%) were biologic exposed. At 6 months, 1504 patients (78.7%) continued to receive TCZ treatment, with no descriptive differences in retention rates between biologic-exposed and biologic-naive patients and between patients receiving TCZ monotherapy or combination therapy. Dose and use of methotrexate and prednisone were reduced at 6 months. Efficacy at 6 months, including patient-reported outcomes, was demonstrated in both biologic-naive and biologic-exposed groups. Adverse events (AEs) occurred in 817 patients [42.7%; incidence rate: 179 events per 100 patient-years (PY)], and serious AEs (SAEs) occurred in 118 patients (6.2%; 17 events per 100 PY), with comparable rates of AEs and SAEs between subgroups. CONCLUSION In routine clinical practice, TCZ discontinuation rates were low and unaffected by prior use of biologics. Effectiveness was similar between groups, and no new safety signals were identified. FUNDING F. Hoffmann-La Roche.
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Affiliation(s)
| | - Gustavo Casado
- Department of Rheumatology, Hospital Militar Central, Buenos Aires, Argentina
| | - László Czirják
- Rheumatology and Immunology Clinic, Medical Center, University of Pécs, Pécs, Hungary
| | - Andrew Taylor
- Medicine and Pharmacology RPH Unit, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Lingli Dong
- Department of Rheumatology and Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | - Yves Luder
- F. Hoffmann-La Roche, Ltd, Basel, Switzerland
| | - Roberto Caporali
- Department of Rheumatology, University of Pavia, IRCCS S. Matteo Foundation, Pavia, Italy
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9
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Ranza R, de la Vega MC, Laurindo IMM, Gómez MG, Titton DC, Kakehasi AM, Brigante A, Benitez A, Ranzolin A, Granel A, Cappuccio AM, Quinteros A, Hayata ALS, Smichowski A, Duarte ÂLBP, Kahlow BS, Andia CS, Brenol CV, Velozo E, Mussano E, Soriano ER, Christopoulos GB, da Rocha Castelar Pinheiro G, de Castro GRW, Casado G, da Silveira Carvalho HM, Exeni IE, da Silveira IG, Petkovic I, Pereira IA, da Costa IP, Rosa JE, Miranda JRS, de Moraes JCB, Bertolo MB, Buhl M, Lázaro MA, da Sauma MDFLC, de Medeiros Pinheiro M, Díaz M, de Vechi MVSS, Cerda OL, Astesana P, Curi PF, Louzada-Jr P, Teodoro RB, Toledo RA, Papasidero S, Valim V, Fernandes V, Saurit V, Bianchi WA, de Melo Costa Pinto R, Descalzo MA, Gomez-Reino JJ. Changing rate of serious infections in biologic-exposed rheumatoid arthritis patients. Data from South American registries BIOBADABRASIL and BIOBADASAR. Clin Rheumatol 2019; 38:2129-2139. [DOI: 10.1007/s10067-019-04516-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/02/2019] [Accepted: 03/13/2019] [Indexed: 12/21/2022]
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10
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Haraoui B, Casado G, Czirják L, Taylor A, Bernasconi C, Reiss W, Caporali R. Patterns of tocilizumab use, effectiveness and safety in patients with rheumatoid arthritis: core data results from a set of multinational observational studies. Clin Exp Rheumatol 2017; 35:899-906. [PMID: 28516886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 03/06/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To observe patients with rheumatoid arthritis (RA) treated with the interleukin-6 receptor-alpha inhibitor tocilizumab (TCZ) in routine clinical practice. METHODS Data on concomitant medications, effectiveness and safety were pooled from independent, multinational studies in patients with RA initiating intravenous TCZ according to local label recommendations observed in routine practice for 6 months. Patients were grouped by TCZ monotherapy or combination therapy with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). The primary endpoint was the proportion of patients receiving TCZ after 6 months. RESULTS Of 1336 patients enrolled, 506 (37.9%) received TCZ monotherapy and 830 (62.1%) received combination therapy. Kaplan-Meier analysis estimated that 80% (95% CI, 76%-83%) of monotherapy and 87% (95% CI, 84%-89%) of combination therapy patients continued to receive TCZ at 6 months (log-rank p<0.001). During the observation period, TCZ was discontinued by 113 (22.3%) monotherapy patients and 116 (14.0%) patients on combination therapy. The mean prednisone-equivalent oral corticosteroid dose was 8.4 mg/day for monotherapy and combination therapy patients at baseline and 7.7 and 7.6 mg/day, respectively, at month 6. Adverse events or laboratory abnormalities requiring TCZ dose modification were reported for 66 (13.0%) monotherapy and 130 (15.7%) combination therapy patients. Effectiveness at 6 months was similar between groups; mean (SD) change from baseline in Clinical Disease Activity Index (CDAI) was -20.3 (14.18) for monotherapy and -22.3 (16.09) for combination therapy (p=0.7347). CONCLUSIONS In routine clinical practice, 38% of patients received TCZ as monotherapy. Persistence on monotherapy or in combination therapy with csDMARDs was high, with a slight trend towards a higher rate with combination therapy, and effectiveness was similar between groups.
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Affiliation(s)
| | - Gustavo Casado
- Department of Rheumatology, Hospital Militar Central, Buenos Aires, Argentina
| | - Laszlo Czirják
- Rheumatology and Immunology Clinic, University of Pécs, Medical Center, Pécs, Hungary
| | - Andrew Taylor
- Medicine and Pharmacology RPH Unit, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | | | | | - Roberto Caporali
- Department of Rheumatology, University of Pavia, IRCCS S. Matteo Foundation, Pavia, Italy
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11
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Benzaquén N, Haye Salinas M, Pirola J, Retamozo S, Caeiro F, Alvarellos A, De la Vega M, Casado G, Gomez G, Citera G, Gallardo M, Quinteros A, Exeni I, Medina M, Astesana P, Sanchez Andia C, Sarano J, Granel A, Peluzzon A, Cappucciona A, Eimon A, Quintana R, Pons Estel B, Mussano E, Scarafia S, Tamaño F, Costi C, De la Sota M, Kirmayr K, Velozo E, Ortiz A, Larroudé M, Bertoli A, Aguero S, Battagliotti C, Soares de Souza S, Cavillon E, Perez Dávila A, Barreira J, Roberti J, Saurit V. SAT0488 Tuberculosis in A Registry of Rheumatic Patients Treated with Biological Drugs. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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12
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Casado G, Rueda C, Sierra A, Sobrino C, Varela H, Martinez L, Ruiz M, Freire M, Herrero A. PS-064 Chemotherapy administration safety in the outpatient oncology setting. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Casado G, Rueda C, Sierra A, Sobrino C, Varela H, Martinez L, Ruiz M, Freire M, Herrero A. PS-064 Chemotherapy administration safety in the outpatient oncology setting. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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14
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Carmona L, de la Vega M, Ranza R, Casado G, Titton DC, Descalzo MÁ, Gómez-Reino J. BIOBADASER, BIOBADAMERICA, and BIOBADADERM: safety registers sharing commonalities across diseases and countries. Clin Exp Rheumatol 2014; 32:S-163-7. [PMID: 25365109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 09/29/2014] [Indexed: 06/04/2023]
Abstract
Registers facilitate the collection and communication of safety concerns. There are as many different register structures as registers, making the merging of rare data and comparison between registers difficult. BIOBADASER, the Safety Register of the Spanish Society of Rheumatology has served as template for other registers within the specialty, BIOBADAMERICA, and outside rheumatology, BIOBADADERM. Here we present the limitations and strengths of such template registers.
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Affiliation(s)
- L Carmona
- Instituto de Salud Musculoesquelética, Madrid, Spain.
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Gomez M, de la Vega M, Casado G, Exeni I, Gobbi C, Quintana R, Pons Estel B, Bertoli A, Miretti E, Saurit V, Paira S, Mussano E, Vidal D, Quinteros A, Cappuccio A, de la Sota M, Larroudé M, Granel A, Rillo O, Quiroz C, Dubinsky D, Oliver M, Eimon A, Alvarez A, Gόmez G, Agüero S, Smichowski A, Battagliotti C, Sacnun M, Garcia M, Soares de Souza S, Velozo E, Caprarulo C, Díaz M, Schneeberger E, Soriano E, Citera G. AB1075 Argentinian Register of BIOLOGICS Treatments (BIOBADASAR). Results. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Haraoui B, Casado G, Theander E, Czirják L, Taylor A, Button P, Hinsch Gylvin L, Caporali R. FRI0300 Baseline Characteristics and Pattern of TOCILIZUMAB Use in Patients with Rheumatoid Arthritis: Interim Results from the Multinational, Observational ACT-UP Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Dougados M, Soubrier M, Antunez A, Balint P, Balsa A, Buch MH, Casado G, Detert J, El-Zorkany B, Emery P, Hajjaj-Hassouni N, Harigai M, Luo SF, Kurucz R, Maciel G, Mola EM, Montecucco CM, McInnes I, Radner H, Smolen JS, Song YW, Vonkeman HE, Winthrop K, Kay J. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis 2013; 73:62-8. [PMID: 24095940 PMCID: PMC3888623 DOI: 10.1136/annrheumdis-2013-204223] [Citation(s) in RCA: 512] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Patients with rheumatoid arthritis (RA) are at increased risk of developing comorbid conditions. Objectives To evaluate the prevalence of comorbidities and compare their management in RA patients from different countries worldwide. Methods Study design: international, cross-sectional. Patients: consecutive RA patients. Data collected: demographics, disease characteristics (activity, severity, treatment), comorbidities (cardiovascular, infections, cancer, gastrointestinal, pulmonary, osteoporosis and psychiatric disorders). Results Of 4586 patients recruited in 17 participating countries, 3920 were analysed (age, 56±13 years; disease duration, 10±9 years (mean±SD); female gender, 82%; DAS28 (Disease Activity Score using 28 joints)–erythrocyte sedimentation rate, 3.7±1.6 (mean±SD); Health Assessment Questionnaire, 1.0±0.7 (mean±SD); past or current methotrexate use, 89%; past or current use of biological agents, 39%. The most frequently associated diseases (past or current) were: depression, 15%; asthma, 6.6%; cardiovascular events (myocardial infarction, stroke), 6%; solid malignancies (excluding basal cell carcinoma), 4.5%; chronic obstructive pulmonary disease, 3.5%. High intercountry variability was observed for both the prevalence of comorbidities and the proportion of subjects complying with recommendations for preventing and managing comorbidities. The systematic evaluation of comorbidities in this study detected abnormalities in vital signs, such as elevated blood pressure in 11.2%, and identified conditions that manifest as laboratory test abnormalities, such as hyperglycaemia in 3.3% and hyperlipidaemia in 8.3%. Conclusions Among RA patients, there is a high prevalence of comorbidities and their risk factors. In this multinational sample, variability among countries was wide, not only in prevalence but also in compliance with recommendations for preventing and managing these comorbidities. Systematic measurement of vital signs and laboratory testing detects otherwise unrecognised comorbid conditions.
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Affiliation(s)
- Maxime Dougados
- Medicine Faculty, Paris-Descartes University, , Paris, France
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Saurit V, De La Vega MC, Citera G, Catay E, Quinteros A, Rillo O, Gomez G, Gobbi C, Capuccio A, Exeni I, Eimon A, Mussano E, Alvarez A, Dubinsky D, Magri S, Pereira D, Quintana R, de la Sota M, Gomez G, Agüero S, Larroude M, Ortiz A, Scheines E, Bertoli A, Seleme G, Apaz M, Risueño F, Battagliotti C, Garrone N, Barreira J, Martinez L, Casado G. FRI0560 Argentinian register of biologics treatments (biobadasar). results. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dougados M, Soubrier M, Antunez A, Balint P, Balsa A, Buch M, Casado G, Detert J, El-Zorkany B, Emery P, Hajjaj-Hassouni N, Harigai M, Kay J, Luo SF, Kurucz R, Maciel G, Martin Mola E, Montecucco CM, Mc Innes I, Radner H, Smolen J, Song YW, Van de Laar M, Winthrop K. SAT0061 Prevalence of Co-Morbidities in Rheumatoid Arthritis (RA) and Evaluation of their Monitoring: Results of an International, Cross-Sectional Study (Comora). Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Benitez B, Capilla E, Gonzalez L, de Miguel MG, Rueda C, Casado G, Varela H, Roldan T, Bravo M, Herrero A. Carboxypeptidase rescue after high-dose methotrexate. Eur J Hosp Pharm 2012. [DOI: 10.1136/ejhpharm-2012-000074.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Casado G, Alba P. [Treat to target in rheumatoid arthritis]. Rev Fac Cien Med Univ Nac Cordoba 2010; 67:133-134. [PMID: 21843436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
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22
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Vázquez de Parga E, Rakhmanova A, Pérez-Alvarez L, Vinogradova A, Delgado E, Thomson MM, Casado G, Sierra M, Muñoz M, Carmona R, Vega Y, Contreras G, Medrano L, Osmanov S, Nájera R. Analysis of drug resistance-associated mutations in treatment-naïve individuals infected with different genetic forms of HIV-1 circulating in countries of the former Soviet Union. J Med Virol 2005; 77:337-44. [PMID: 16173024 DOI: 10.1002/jmv.20461] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There are few data on drug resistance-associated mutations in the former Soviet Union since, studies have usually been focused on the env or gag genes for subtype information. This study examines the prevalence and patterns of resistance-associated mutations to reverse transcriptase and protease inhibitors (RTI, PRI) in 278 HIV-1-infected treatment-naïve subjects from countries of Eastern Europe, and defines characteristic polymorphisms of RT and PR sequences in HIV-1 subtype A viruses. Blood samples were collected between 1997 and 2004. Plasma RNA was used for PR-RT amplification by reverse transcription coupled with nested PCR and sequencing. Phylogenetic analysis was done with neighbor-joining trees and bootscanning. Analysis of drug resistance mutations, with Stanford University HIV Drug Resistance Database's algorithm, resulted in an overall prevalence of 12.9% resistance to RTI and 3.9% to PRI. The most frequent substitutions in the RT region were at positions 62 and 236. V77I substitution in PR was found in 47.8% of samples. Polymorphisms in subtype A sequences were identified. This is the first study reporting the prevalence and patterns of both PRI and RTI resistance-associated mutations in naïve HIV-1 infected patients from the former Soviet Union. These data underline the importance of genotypic resistance testing of chronically HIV-1-infected patients before initiating treatment, in order to select the most suitable drug regimen.
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Carmona R, Pérez-Alvarez L, Muñoz M, Casado G, Delgado E, Sierra M, Thomson M, Vega Y, Vázquez de Parga E, Contreras G, Medrano L, Nájera R. Natural resistance-associated mutations to Enfuvirtide (T20) and polymorphisms in the gp41 region of different HIV-1 genetic forms from T20 naive patients. J Clin Virol 2005; 32:248-53. [PMID: 15722032 DOI: 10.1016/j.jcv.2004.11.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The natural occurrence of primary resistance mutations in reverse transcriptase (RT) and protease (PR) genes of HIV-1 isolates from untreated patients has been reported and it may have important implications for the response to drug treatment. It is predictable that the same occurs in the HR1 region of gp41 sequence from patients who have never received T20 therapy, and in this regard it would be important to know not only the mutation frequencies at HR1 region but also the natural polymorphisms at resistance-associated positions present in the absence of this drug. OBJECTIVES The objectives of this study are to investigate the existence of natural resistance-associated mutations to T20 in HR1 gp41 region corresponding to different HIV-1 genetic forms from T20 naive patients and to determine their prevalence. STUDY DESIGN Two hundred HIV-1 gp41 sequences were included: subtype B: 164 (81.3%); subtype A: 15 (8.2%); subtype G: 10 (4.6%); subtype F: 6 (3.5%); subtype C: 3 (1.8%); subtype K: 1 (0.6%); and subtype D: 1 (0.6%). We analyzed the resistance-associated mutations previously described: Q32H/R, G36D/S, I37V, V38A/M, Q39R/H, Q40H, N42T/D/Q/H, N43D/S/K/Q, L44M, L45M, R46M and V69I. RESULTS Natural resistance mutations to T20 were found at a high frequency: 10.5%, corresponding to 9.1% in subtype B and 16.7% in non-B subtype samples. Polymorphisms were more frequent in non-B and recombinant forms than in subtype B (p<0.001). Different substitutions were related to subtypes: N42S in subtypes A, B, G and C, but not in F, Q56R in subtype A from CRF02_AG, and L54M in subtype B from CRF14_BG. CONCLUSIONS To our knowledge this is the first study describing natural-resistance to T20 among different HIV-1 subtypes, warranting a study of the biological significance of this mutations and their clinical relevance. The detection of differences between subtypes may have an influence on the rate and patterns of resistance in patients undergoing T20 treatment.
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Affiliation(s)
- R Carmona
- Area de Patogenia Viral, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain
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