The short-term cost-effectiveness of once-weekly semaglutide versus once-weekly dulaglutide for the treatment of type 2 diabetes mellitus in Colombian adults

Background

Type 2 Diabetes Mellitus (T2DM) is a highly prevalent disease worldwide and in Colombia, representing one of the main causes of death and placing a considerable burden on healthcare systems. 13 classes of drugs are approved for the treatment of T2DM, with Glucagon-like Peptide-1 (GLP-1) receptor agonists being a first-line treatment option for patients with or at high risk of certain cardiovascular diseases and chronic kidney disease. The objective of this study is to conduct a short-term cost-effectiveness analysis of once-weekly semaglutide versus once-weekly dulaglutide in Colombian adults with T2DM, from a third-party payer perspective.

Methods

Numbers needed to treat were calculated for different single and composite endpoints of the SUSTAIN 7 trial, annual costs for once weekly semaglutide 1.0 mg and dulaglutide 1.5 mg were extracted from the public SISMED database. With these inputs a cost of control model was developed, to obtain the annual cost of bringing one T2DM patient to relevant clinical outcomes by using semaglutide or dulaglutide.

Results

Semaglutide was considered cost-effective compared to dulaglutide across all pre-specified endpoints, even in the different scenarios evaluated in the sensitivity analyses, and in a particularly pronounced manner for weight loss outcomes. Semaglutide at a dose of 1.0 mg once-weekly was cost-effective compared to dulaglutide 1.5 mg across all outcomes in the short-term, making it an appropriate first-line choice in the treatment of T2DM when deciding between these two GLP-1 receptor agonists.

Conclusions

This is the first short-term cost-effectiveness study of semaglutide and dulaglutide in T2DM Colombian patients. Our modeled results suggest that once-weekly semaglutide represents a cost-effective option for treating individuals with T2DM in Colombia who are not achieving glycaemia control with metformin, and it would be expected to improve HbA1C, promote greater weight loss and reduce costs from a third-payer perspective compared with treatment with dulaglutide.

Mesenchymal Stromal Cells from Perinatal Tissues as an Alternative for Ex Vivo Expansion of Hematopoietic Progenitor and Stem Cells from Umbilical Cord Blood

Umbilical cord blood (UCB) serves as a source of hematopoietic stem and progenitor cells (HSPCs) utilized in the regeneration of hematopoietic and immune systems, forming a crucial part of the treatment for various benign and malignant hematological diseases. UCB has been utilized as an alternative HSPC source to bone marrow (BM). Although the use of UCB has extended transplantation access to many individuals, it still encounters significant challenges in selecting a histocompatible UCB unit with an adequate cell dose for a substantial proportion of adults with malignant hematological diseases. Consequently, recent research has focused on developing ex vivo expansion strategies for UCB HSPCs. Our results demonstrate that co-cultures with the investigated mesenchymal stromal cells (MSCs) enable a 10- to 15-fold increase in the cellular dose of UCB HSPCs while partially regulating the proliferation capacity when compared to HSPCs expanded with early acting cytokines. Furthermore, the secretory profile of UCB-derived MSCs closely resembles that of BM-derived MSCs. Moreover, both co-cultures exhibit alterations in cytokine secretion, which could potentially impact HSPC proliferation during the expansion process. This study underscores the fact that UCB-derived MSCs possess a remarkably similar supportive capacity to BM-derived MSCs, implying their potential use as feeder layers in the ex vivo expansion process of HSPCs.

Comparative evaluation of healing biomarkers in skin wound exudates using a nanobiosensor and histological analysis of full-thickness skin wounds grafted with multidirectional or unidirectional artificial dermis

Analysis of factors that play a role on the healing process in exudates from skin wounds might shed light on the effect that grafted artificial tissue has in wound regeneration and repair. The first objective of this work was to standardize an optic surface plasmon resonance method based on self-assembled monolayers to quantify healing mediator factors (angiopoietin-2, epidermal growth factor, tumour necrosis factor-α, transforming growth factor-β1, and vascular endothelial growth factor) in wound exudates. Optimal conditions for self-assembling of alkanethiol monolayers, immobilization of antibodies antifactors, and regeneration of sensor surfaces were established. A second objective was to compare healing of wounds grafted with artificial dermis with wounds left to heal by secondary intention (control) in a lagomorph model of full-thickness skin wound. Each animal included in this study had a control wound and an identical contralateral wound grafted with artificial dermis that was made by seeding autologous skin fibroblasts into unidirectional or multidirectional collagen type I scaffolds. Histological and histomorphometric analyses were carried out when animals were sacrificed, in addition to quantifying the factors in the exudates of wounds sampled 3 days after surgery. There were significant differences between the concentrations of evaluated factors in the exudates from grafted and control wounds. This finding coincides with differences observed in the histological and histomorphometric analyses of repaired tissue formed in treated and control wounds.

Approaches of the Transcriptomic Analysis in Astrocytes: Potential Pharmacological Targets

Astrocytes are important glial cells involved in the ionic regulation of the extracellular fluid in the Central Nervous System (CNS), the formation of the blood brain barrier (BBB) and the support to neurons for the maintenance of the Krebs cycle intermediaries. Even though these cells are known to be important for the brain functioning, several of their functions and their development have not been fully elucidated. In this context, identifying the algorithms used for their analysis plays a pivotal role in the development of new strategies in the study of astrocytes. The main objective of this review is to summarize the techniques that have helped to obtain transcriptomic data in astrocytes and the new algorithms that were used to perform the analysis of experimental data, elucidating new studies in which these had been used. We also highlight the current transcriptomics approaches targeting astrocytes function as a possible target for pharmacological interventions.

Real-time quantification of proteins secreted by artificial connective tissue made from uni- or multidirectional collagen I scaffolds and oral mucosa fibroblasts

Previously, we found that oral autologous artificial connective tissue (AACT) had a different protein secretion profile to that of clot-embedded AACT. Other oral mucosa substitutes, having different cell types and scaffolds, had dissimilar secretion profiles of proteins (including that for AACT) that influence healing outcome; thus, to ascertain the profiles of factors secreted by artificial tissue and whether they are influenced by their microstructure might help in understanding their bioactivity. An important component of tissue microstructure is the fiber orientation of the scaffold used for manufacturing it. This work developed a surface plasmon resonance (SPR) methodology to quantify factors secreted by oral artificial connective tissue (ACT) in culture medium, and a method to manufacture unidirectional laminar collagen I scaffolds. The SPR methodology was used for assessing differences in the protein secretion profile of ACT made with collagen scaffolds having different fiber orientation (unidirectional vs multidirectional). Oral fibroblasts seeded onto unidirectional scaffolds increased the secretion of six factors involved in modulating healing compared to those seeded onto multidirectional scaffolds. Histological analysis of uni- and multidirectional ACT showed that cells differ in their alignment and morphology. This SPR-methodology led to nanoscale detection of paracrine factors and might be useful to study biomarkers of three-dimensional cell growth, cell differentiation, and wound-healing progression.