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Cotia A, Oliveira Junior HA, Matuoka JY, Boszczowski Í. Clinical Equivalence between Generic Versus Branded Antibiotics: Systematic Review and Meta-Analysis. Antibiotics (Basel) 2023; 12:antibiotics12050935. [PMID: 37237838 DOI: 10.3390/antibiotics12050935] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/05/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Regulatory authorities authorize the clinical use of generic drugs (GD) based on bioequivalence studies, which consist of the evaluation of pharmacokinetics after a single dose in vitro or in healthy individuals. There are few data on clinical equivalence between generic and branded antibiotics. Our aim was to synthesize and analyze the available evidence on the clinical efficacy and safety of generic antibiotics compared to their original formulations. A systematic review was performed on Medline (PubMed) and Embase and validated through Epistemonikos and Google Scholar. The last search was conducted on 30 June 2022. Meta-analyses of clinical cure and mortality outcomes were performed. One randomized clinical trial (RCT) and 10 non-randomized intervention studies were included. No differences in clinical cure were observed between groups in the meta-analysis (OR = 0.89, 95% CI [0.61-1.28]; I2 = 70%, p = 0.005). No difference was observed between groups when considering the use of carbapenems for overall mortality (OR = 0.99, 95% CI [0.63-1.55]; I2 = 78%) or death associated with infections (OR = 0.79, 95% CI [0.48-1.29], I2 = 67%). Most of the studies were observational, and the duration of follow-up, the characteristics of the participants, and the sites of infections were heterogeneous. Due to the uncertainty of the evidence, it is not possible to contraindicate the use of generics, which is an important strategy to expand access.
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Affiliation(s)
- André Cotia
- MBA Program in Prevention of Healthcare Acquired Infections, Infectious Diseases Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | | | - Jessica Y Matuoka
- Health Technology Assessment Unit, Hospital Alemão Oswaldo Cruz, São Paulo 01323-903, Brazil
| | - Ícaro Boszczowski
- Infection Control Department, Hospital Alemão Oswaldo Cruz, São Paulo 01323-020, Brazil
- Infection Control Department, Central Institute, Clinics Hospital, Medicine Faculty, Universidade de São Paulo, São Paulo 05403-010, Brazil
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Lucchetta R, Matuoka JY, de Oliveira HA, Oliveira G, Cavalcanti AB, Azevedo L, Berwanger O, Lopes RD, Rosa RG, Veiga VC, Avezum Á. Hydroxychloroquine for Non-Hospitalized COVID-19 Patients: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Arq Bras Cardiol 2023; 120:e20220380. [PMID: 37042856 PMCID: PMC10263429 DOI: 10.36660/abc.20220380] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Previous systematic reviews have identified no benefit of hydroxychloroquine and chloroquine in non-hospitalized COVID-19 patients. After publication of these reviews, the results of COPE, the largest randomized trial conducted to date, became available. OBJECTIVES To conduct a systematic review and meta-analyses of randomized clinical trials (RCTs) to synthesize the evidence on the efficacy and safety of hydroxychloroquine and chloroquine for non-hospitalized COVID-19 patients compared to placebo or standard of care. METHODS Searches were conducted in PubMed, Embase, The Cochrane Library, and ClinicalTrials.gov complemented by manual search. Pairwise meta-analyses, risk of bias, and evidence certainty assessments were conducted, including optimal information size analysis (OIS). A level of significance of 0.05 was adopted in the meta-analysis. PROSPERO: CRD42021265427. RESULTS Eight RCTs with 3,219 participants were included. COVID-19 hospitalization and any adverse events rates were not significantly different between hydroxychloroquine (5.6% and 35.1%) and control (7.4% and 20.4%) (risk ratio, RR, 0.77, 95% confidence interval, CI, 0.57-1.04, I2: 0%; RR 1.78, 95%-CI 0.90; 3.52, I2: 93%, respectively). The OIS (7,880) was not reached for COVID-19 hospitalization, independently of the simulation for anticipated event rate and RR reduction estimate. CONCLUSION Evidence of very low certainty showed lack of benefit with hydroxychloroquine in preventing COVID-19 hospitalizations. Despite being the systematic review with the largest number of participants included, the OIS, considering pre-vaccination response to infection, has not yet been reached.
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Affiliation(s)
- Rosa Lucchetta
- Hospital Alemão Oswaldo CruzSão PauloSPBrasilHospital Alemão Oswaldo Cruz, São Paulo, SP – Brasil
| | - Jessica Y. Matuoka
- Hospital Alemão Oswaldo CruzSão PauloSPBrasilHospital Alemão Oswaldo Cruz, São Paulo, SP – Brasil
| | | | - Gustavo Oliveira
- Hospital Alemão Oswaldo CruzSão PauloSPBrasilHospital Alemão Oswaldo Cruz, São Paulo, SP – Brasil
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia, São Paulo, SP – Brasil
| | | | - Luciano Azevedo
- Hospital Sírio-LibanêsSão PauloSPBrasilHospital Sírio-Libanês, São Paulo, SP – Brasil
| | - Otavio Berwanger
- Hospital Israelita Albert EinsteinSão PauloSPBrasilHospital Israelita Albert Einstein, São Paulo, SP – Brasil
| | - Renato Delascio Lopes
- Duke University HospitalDurhamNorth CarolinaEUADuke University Hospital, Durham, North Carolina – EUA
| | - Regis Goulart Rosa
- Hospital Moinhos de VentoPorto AlegreRSBrasilHospital Moinhos de Vento, Porto Alegre, RS – Brasil
| | - Viviane Cordeiro Veiga
- Beneficência Portuguesa de São PauloSão PauloSPBrasilBeneficência Portuguesa de São Paulo, São Paulo, SP – Brasil
| | - Álvaro Avezum
- Hospital Alemão Oswaldo CruzSão PauloSPBrasilHospital Alemão Oswaldo Cruz, São Paulo, SP – Brasil
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Avezum Á, Oliveira GBF, Oliveira H, Lucchetta RC, Pereira VFA, Dabarian AL, D O Vieira R, Silva DV, Kormann APM, Tognon AP, De Gasperi R, Hernandes ME, Feitosa ADM, Piscopo A, Souza AS, Miguel CH, Nogueira VO, Minelli C, Magalhães CC, Morejon KML, Bicudo LS, Souza GEC, Gomes MAM, Fo JJFR, Schwarzbold AV, Zilli A, Amazonas RB, Moreira FR, Alves LBO, Assis SRL, Neves PDMM, Matuoka JY, Boszczowski I, Catarino DGM, Veiga VC, Azevedo LCP, Rosa RG, Lopes RD, Cavalcanti AB, Berwanger O. Hydroxychloroquine versus placebo in the treatment of non-hospitalised patients with COVID-19 (COPE - Coalition V): A double-blind, multicentre, randomised, controlled trial. Lancet Reg Health Am 2022; 11:100243. [PMID: 35378952 PMCID: PMC8968238 DOI: 10.1016/j.lana.2022.100243] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Previous Randomised controlled trials (RCT) evaluating chloroquine and hydroxychloroquine in non-hospitalised COVID-19 patients have found no significant difference in hospitalisation rates. However, low statistical power precluded definitive answers. Methods We conducted a multicenter, double-blind, RCT in 56 Brazilian sites. Adults with suspected or confirmed COVID-19 presenting with mild or moderate symptoms with ≤ 07 days prior to enrollment and at least one risk factor for clinical deterioration were randomised (1:1) to receive hydroxychloroquine 400 mg twice a day (BID) in the first day, 400 mg once daily (OD) thereafter for a total of seven days, or matching placebo. The primary outcome was hospitalisation due to COVID-19 at 30 days, which was assessed by an adjudication committee masked to treatment allocation and following the intention-to-treat (ITT) principle. An additional analysis was performed only in participants with SARS-CoV-2 infection confirmed by molecular or serology testing (modified ITT [mITT] analysis). This trial was registered at ClinicalTrials.gov, NCT04466540. Findings From May 12, 2020 to July 07, 2021, 1372 patients were randomly allocated to hydroxychloroquine or placebo. There was no significant difference in the risk of hospitalisation between hydroxychloroquine and placebo groups (44/689 [6·4%] and 57/683 [8·3%], RR 0·77 [95% CI 0·52–1·12], respectively, p=0·16), and similar results were found in the mITT analysis with 43/478 [9·0%] and 55/471 [11·7%] events, RR 0·77 [95% CI 0·53–1·12)], respectively, p=0·17. To further complement our data, we conducted a meta-analysis which suggested no significant benefit of hydroxychloroquine in reducing hospitalisation among patients with positive testing (69/1222 [5·6%], and 88/1186 [7·4%]; RR 0·77 [95% CI 0·57–1·04]). Interpretation In outpatients with mild or moderate forms of COVID-19, the use of hydroxychloroquine did not reduce the risk of hospitalisation compared to the placebo control. Our findings do not support the routine use of hydroxychloroquine for treatment of COVID-19 in the outpatient setting. Funding COALITION COVID-19 Brazil and EMS.
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Affiliation(s)
- Álvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815; Bloco A, 1o SS, São Paulo, SP 01327-001, Brazil
| | - Gustavo B F Oliveira
- International Research Center, Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815; Bloco A, 1o SS, São Paulo, SP 01327-001, Brazil
| | - Haliton Oliveira
- International Research Center, Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815; Bloco A, 1o SS, São Paulo, SP 01327-001, Brazil
| | - Rosa C Lucchetta
- International Research Center, Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815; Bloco A, 1o SS, São Paulo, SP 01327-001, Brazil
| | | | | | | | | | | | | | | | | | - Audes D M Feitosa
- Pronto Socorro Cardiológico Universitário - Prof. Luiz Tavares (PROCAPE), Recife, PE, Brazil
| | | | | | - Carlos H Miguel
- Estratégia Saúde da Família Dr. João Paccola Primo. Prefeitura Municipal, Lençois Paulista, SP, Brazil
| | - Vinicius O Nogueira
- Centro de Pesquisa em Medicina Tropical de Rondônia. Porto Velho, RO, Brazil
| | | | | | | | - Letícia S Bicudo
- Irmandade de Misericórdia do Hospital da Santa Casa de Monte Alto, SP, Brazil
| | | | - Marco A M Gomes
- Centro de Pesquisas Clínicas Dr. Marco Mota, Maceió, AL, Brazil
| | | | | | | | | | - Frederico R Moreira
- International Research Center, Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815; Bloco A, 1o SS, São Paulo, SP 01327-001, Brazil
| | - Lucas B O Alves
- International Research Center, Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815; Bloco A, 1o SS, São Paulo, SP 01327-001, Brazil
| | - Silvia R L Assis
- Academic Research Organization - Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Precil D M M Neves
- International Research Center, Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815; Bloco A, 1o SS, São Paulo, SP 01327-001, Brazil
| | - Jessica Y Matuoka
- International Research Center, Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815; Bloco A, 1o SS, São Paulo, SP 01327-001, Brazil
| | - Icaro Boszczowski
- International Research Center, Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815; Bloco A, 1o SS, São Paulo, SP 01327-001, Brazil
| | - Daniela G M Catarino
- International Research Center, Hospital Alemão Oswaldo Cruz, Rua Treze de Maio, 1815; Bloco A, 1o SS, São Paulo, SP 01327-001, Brazil
| | - Viviane C Veiga
- Intensive Care Unit, BP - A Beneficência Portuguesa de São Paulo, SP, Brazil
| | - Luciano C P Azevedo
- Research and Education Institute, Hospital Sírio Libanês, São Paulo, SP, Brazil
| | - Regis G Rosa
- Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.,Brazilian Clinical Research Institute, São Paulo, SP, Brazil
| | | | - Otavio Berwanger
- Academic Research Organization - Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Matuoka JY, Kahn JG, Secoli SR. Denosumab versus bisphosphonates for the treatment of bone metastases from solid tumors: a systematic review. Eur J Health Econ 2019; 20:487-499. [PMID: 30382484 DOI: 10.1007/s10198-018-1011-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/25/2017] [Accepted: 10/23/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Bone metastases are highly prevalent in breast, prostate, lung and colon cancers. Their symptoms negatively affect quality of life and functionality and optimal management can mitigate these problems. There are two different targeted agents to treat them: bisphosphonates (pamidronate and zoledronic acid) and the monoclonal antibody denosumab. Estimates of cost-effectiveness are still mixed. OBJECTIVE To conduct a systematic review of economic studies that compares these two options. METHOD Literature search comprised eight databases and keywords for bone metastases, bisphosphonates, denosumab, and economic studies were used. Data were extracted regarding their methodologic characteristics and cost-effectiveness analyses. All studies were evaluated regarding to its methodological quality. RESULTS A total of 263 unique studies were retrieved and six met inclusion criteria. All studies were based on clinical trials and other existing literature data, and they had high methodological quality. Most found unfavorable cost-effectiveness for denosumab compared with zoledronic acid, with adjusted ICERS that ranged from $4638-87,354 per SRE avoided and from US$57,274-4.81 M. per QALY gained, which varied widely according to type of tumor, time horizon, among others. Results were sensitive to drug costs, time to first skeletal-related event (SRE), time horizon, and utility. CONCLUSIONS Denosumab had unfavorable cost-effectiveness compared with zoledronic acid in most of the included studies. New economic studies based on real-world data and longer time horizons comparing these therapeutic options are needed.
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Affiliation(s)
- Jessica Y Matuoka
- School of Nursing of the University of Sao Paulo, 419, Eneas de Carvalho Aguiar Avenue, Sao Paulo, 05403-000, Brazil.
- Hospital Universitario of the University of Sao Paulo, Sao Paulo, Brazil.
| | - James G Kahn
- University of California San Francisco, San Francisco, United States
| | - Silvia R Secoli
- School of Nursing of the University of Sao Paulo, 419, Eneas de Carvalho Aguiar Avenue, Sao Paulo, 05403-000, Brazil
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Matuoka JY, Kurita GP, Nordly M, Sjøgren P, de Mattos-Pimenta CA. Validation of a Battery of Neuropsychological Tests for Patients With Metastatic Cancer. Clin Nurs Res 2019; 29:607-615. [PMID: 30793636 DOI: 10.1177/1054773819831210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the psychometric properties of Trail Making Test (TMT), Continuous Reaction Time (CRT), Finger Tapping Test (FTT), Digit Span Test (DST), and Mini-Mental State Examination (MMSE) in Brazilian patients with metastatic cancer. Cognitive performance of 178 patients with metastatic cancer and 79 controls was assessed using the TMT, CRT, FTT, DST, and MMSE. Discriminant validity, concurrent validity, and reliability (39 patients were retested after 3-7 days) were investigated. Discriminant validity between groups was observed in TMT, DST, and MMSE. Measures of concurrent validity and cognitive performance were positively correlated with physical performance, education level, and better performance on MMSE. Negative correlations were observed between cognitive function, pain, anxiety, and depression. All tests but FTT demonstrated very good reliability. Thus, all neuropsychological tests but FTT showed psychometric properties that permit their use in clinical and research purposes in patients with metastatic cancer.
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Affiliation(s)
| | | | - Mie Nordly
- Rigshospitalet Copenhagen University Hospital, Denmark
| | - Per Sjøgren
- Rigshospitalet Copenhagen University Hospital, Denmark.,University of Copenhagen, Denmark
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