scholarly journals MALE RHEUMATOID ARTHRITIS IN ALL MOROCCAN RA UNDERGOING BIOTHERAPY: PREVALENCE, CHARACTERISTICS, AND RESPONSE TO BIOLOGICAL TREATMENTS (NATIONAL REGISTRY)

2021 ◽  
Vol 9 (5) ◽  
pp. 852-859
Author(s):  
Abdelhafid Guich ◽  
◽  
Fatimazahra Haddani ◽  
El Mehdi Boudhar ◽  
Soumia Oulahrir ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Pulmonary Tuberculosis ◽  
Structural Damage ◽  
National Registry ◽  
Pain Patient ◽  
Significant Difference ◽  
Biological Treatments ◽  
One Year ◽  
Male Frequency ◽  
Epidemiological Characteristics

Introduction:This study aims at reporting the RA male frequency while undergoing biotherapy and describing the epidemiological characteristics (clinical, biological and radiological) in relation to female RA. It also evaluates its impact on the response to biological treatments. Materials and methods: There are 224 patients followed for rheumatoid arthritis, responding to ACR/EULAR 2010 criteria during their biotherapy. They were included in the national RBSMR registry. The patients were divided into two groups and were compared at the basis of their gender in terms of the socio-demographic, clinical, biological, radiological parameters, and response to the treatement. Results: The average age of the patients under study is 51.94 ans±11.36 years old [20-80]. The presence of male rheumatoid arthritis under biotherapy is 12.4%. The mean age of RA male is 55.96+9 years old. The estimated duration of progression of male RA is 542 weeks with an average diagnostic deadline of 562.61 weeks. As a description of the case study, 28,6% of men are diagnosed with cormobidities (mainly tuberculosis 21.4%) while 10,7% of men are smokers. There is an average sedimentation rate (1st hour) at 52.6mm. Rheumatoid serology is found to be positive in 96.4% of cases. Radiological abnormalities are observed in 90.5% of the cases. Male rheumatoid arthritis is related to a shorter duration of progression (542 versus 768 weeks in females, p=0.01), liberal profession (p=0.00), study level (p=0.003), duration between diagnosis and the starting of biotherapy (p=0.021), EVA pain patient and physician (p=0.003, p=0.01) Tobacco (p=0.006), and pulmonary tuberculosis (p=0.029). On the other hand, it was not associated with the following parameters: age, duration of diagnosis, disease intensity, rheumatoid serology, structural damage nor with the DAS 28vs response during one year. Conclusion: The male RA rate in RBSMR study is 12.4% in that there is no significant difference between the sexes in clinical presentation, disease activity, disease severity, rheumatoid serology and response to the biotherapy. However, male RA was related to smoking, liberal profession, and history or occurrence of pulmonary tuberculosis.

scholarly journals OP0185 RADIOGRAPHIC PROGRESSION DESPITE PERSISTENT LDA OR REMISSION IS INFLUENCED BY CURRENT SMOKING RATHER THAN THE RESPECTIVE DAS 28 LEVEL, RESULTS OF THE SWISS RHEUMATOID ARTHRITIS REGISTER (SCQM)

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 112.1-112
Author(s):  
L. Brandt ◽  
H. Schulze-Koops ◽  
T. Hügle ◽  
M. J. Nissen ◽  
H. Paul ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Radiographic Progression ◽  
X Rays ◽  
Das28 Score ◽  
Das 28 ◽  
Significant Difference ◽  
Control Disease ◽  
One Year ◽  
Ratingen Score

Background:The therapeutic aim for rheumatoid arthritis (RA) is to control disease activity and prevent radiographic progression. Various clinical scores are utilized to describe disease activity in RA patients. The DAS28 score can define states of low disease activity (LDA) and remission. Despite achieving LDA or remission, radiographic progression may nevertheless occur. However, the rates and frequency of this occurrence have not been analyzed in detail.Objectives:To describe the frequency and rate of radiographic progression in patients with persistent LDA or remission.Methods:Analysis of RA patients from the SCQM cohort. Persistent LDA or remission were defined as DAS 28 ≤3.2 or <2.6 respectively, at two subsequent follow up time points in the database. We included patients with at least two sets of radiographs within these intervals of LDA and/or remission. Radiographic progression was measured with the Ratingen-score (range 0-190), which describes joint erosions numerically. Repair was defined as an improvement in the Ratingen score >5 points/year and progression as >2 or >5 points change in the Ratingen score within one year.Results:Among 10’141 RA patients, 4’342 episodes of remission occurred in 3’927 patients with 1’776 sets of X rays available within these episodes. Similarly, 8’136 episodes of LDA in 6’765 patients and 2’358 sets of X rays were present within these intervals. For patients in LDA or remission, rates of repair were 5.5% and 4.8%, respectively, while for radiographic progression >5 points in the Ratingen score/year were 10.3% in both groups and for >2 points change of Ratingen score/year were 27.7 and 25.4%, respectively).No differences for demographic factors or measures of disease activity, rheumatoid factor or ACPA were found comparing patients with radiographic progression or non-progression despite LDA or remission at the beginning of the episode of LDA and/or remission.Interestingly, 42.9% of patients in LDA with progression of >5 points in the Ratingen score/year were current smokers vs 29.4% among the non-progressors (X2 = 6.55, p = 0.01). This significant difference vanished when the cut-off for radiographic progression was set at >2 points yearly change in Ratingen score or in patients in remission.Conclusion:Radiographic progression despite LDA or remission are more frequent than expected. No differences in radiographic progression were found comparing LDA and remission suggesting that the goal of LDA is appropriate. Smoking seems to be an independent risk factor for radiographic progression despite LDA. Why the effect of smoking could was not demonstrated in patients in remission, remains unclear.Disclosure of Interests:Lena Brandt: None declared, Hendrik Schulze-Koops: None declared, Thomas Hügle Consultant of: GSK, Abbvie, Pfizer, Jansen, Novartis, Eli Lilly., Michael J. Nissen Consultant of: Abbvie, Celgene, Eli-Lilly, Janssen, Novartis and Pfizer, Hasler paul Consultant of: Abbvie, Lilly, Rudiger Muller Consultant of: AbbVie, Novartis, Grant/research support from: Gebro

The Serum Level of Agalactosyl IgG in Rheumatoid Arthritis Patients Treated with Methotrexate

1996 ◽  
Vol 9 (1) ◽  
pp. 19-22
Author(s):  
J. K. Lacki ◽  
U. Mackiewicz ◽  
S. Mackiewicz ◽  
W. Muller
Keyword(s):  
Rheumatoid Arthritis ◽  
Serum Level ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Healthy Controls ◽  
Disease Course ◽  
Antiinflammatory Drugs ◽  
Significant Difference ◽  
One Year ◽  
Agalactosyl Igg

To verify the hypothesis that methotrexate may affect the serum level of agalactosyl IgG (IgG[0]) we followed the changes in IgG galactosylation patterns in a cohort of rheumatoid arthritis patients treated with either methotrexate (MTX) or nonsteroidal antiinflammatory drugs (NSAID). The average values of IgG[0] in RA patients at the beginning of the observation were significantly higher as compared to healthy controls (0.45 ± 0.39 vs. −0.03 ± 0.09, p<0.05). The findings of IgG[0] after one-year follow-up were also higher as compared to healthy controls (0.38 ± 0.39 vs. −0.03 ± 0.09, p<0.05). We did not notice any statistically significant difference in IgG[0] between MTX and NSAID treated patients at the beginning of the study (0.49 ± 0.42 vs. 0.42 ± 0.38, NS). However, during one-year MTX treatment IgG[0] significantly dropped (0.49 ± 0.42 vs. 0.25 ± 0.24, p<0.01). We did not establish any fluctuation in IgG[0] in the group of patients treated with NSAID (0.42 ± 0.38 vs. 0.46 ± 0.45, NS). The data thus far obtained suggest that IgG[0] may serve as an indicator for the disease course in patients with RA. Secondly, the clinical improvement and IgG[0] decrease after methotrexate implies, that the immunoregulatory abnormality in RA may be susceptible to correction by immunotherapy.

scholarly journals POS1417 DO SOCIAL FACTORS IMPACT ON BIOLOGICS COSTS IN RHEUMATOID ARTHRITIS? RESULTS FROM THE MOROCCAN RBSMR REGISTRY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 992.2-992
Author(s):  
S. Farih ◽  
H. Rkain ◽  
S. Fellous ◽  
S. Ahid ◽  
R. Abouqal ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Social Factors ◽  
Economic Status ◽  
Direct Costs ◽  
Medical Assistance ◽  
Biologic Dmards ◽  
Tertiary Structures ◽  
Significant Difference ◽  
One Year ◽  
The Impact

Background:Objectives:The aim of this study was to estimate the annual direct cost of biologics in rheumatoid arthritis and to evaluate the impact of social factors on biological use and costs.Methods:Patients in the Moroccan register of biologicals (RBSMR) with available 1-year data were included. Variables related to socio-economic status, disease and biological were collected. Direct costs included prices of biologics, costs of infusions, and subcutaneous injections. Biological use and costs were compared based on social factors.Results:Our study included 197 patients (female sex of 86.8%, mean age of 52.3 ± 11 years). Patients were on one of the following therapies: Rituximab (n=132), Tocilizumab (n=37) or TNF-blockers (n=28). 44.2% of included patients have the RAMED medical assistance (health insurance scheme for the economically underprivileged). Illiteracy was noted in 45.7% of cases. Median one-year direct costs per patient were €1,665 [€1,472 - €9,879].There was no statistically significant difference in costs between men and women (p>0.05), between illiterate and literate (p>0.05). There was a statistically significant difference in costs between patients with the RAMED medical assistance scheme and other health insurances (p<0.01).Conclusion:This study showed that Moroccan RA patients had equal access to biologics regardless of their gender or level of education. Indeed, the insurance system influence the costs of biologics. Accessibility of those expensive treatments in a developing country seems be explained by efforts of the Moroccan ministry of health who has allocated a substantial budget for biologic DMARDs for patients with RAMED in the tertiary structures in our country.Disclosure of Interests:None declared

scholarly journals Association of TNF-alpha polymorphism (-308 A/G) with high activity of rheumatoid arthritis and therapy response to etanercept

2011 ◽  
Vol 139 (11-12) ◽  
pp. 784-789 ◽  
Author(s):  
Sonja Stojanovic ◽  
Tatjana Jevtovic-Stoimenov ◽  
Aleksandra Stankovic ◽  
Dusica Pavlovic ◽  
Jovan Nedovic ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Therapeutic Response ◽  
Therapy Response ◽  
Response To Treatment ◽  
Control Group ◽  
Clinical Activity ◽  
Significant Difference ◽  
Group A ◽  
One Year

Introduction. Genetic markers are significant predictive factors in the assessment of therapeutic response of rheumatoid arthritis (RA) to biological medication. Objective. The aim of the study was to determinate the association of TNF-? -308 G/A polymorphism with a high RA activity and its predictive value in therapeutic response after 12 months of treatment with Etanercept. Methods. The study enrolled 132 patients with RA treated with Methotrexate (MTX) and 58 control subjects. The -308 TNF polymorphism was examined using the polymerase chain reaction - restriction fragment length polymorphism (PCR- RFLP). The patients were divided into two groups: group A with A/A and A/G genotype and group G with G/G genotype. After 12 months, beside MTX, Etanercept was introduced in 36 patients. We compared clinical activity among the groups at the beginning and after one year of therapy by using DAS28 SE (Disease activity score with sedimentation). Results. There was no significant difference found in the distribution of G and A allele in the RA group compared to the control group. A significantly higher disease activity was noticed in A compared to the G group (DAS28 SE: 6.31 to 5.81; p<0.05). The patients with A allele kept the majority of the disease activity even after a year of study (DAS28 SE: 5.25 to 3.89). After a year of MTX and Etanercept therapy, a significantly larger proportion of patients in the G group displayed a good clinical response to treatment compared to the A group (81.5% to 25%; p<0.05). The average change of DAS28 SE in G group was 2.24, while in the A group DAS 28 reduction was significantly lower (1.17; p=0.005). Conclusion. There was no significant difference in the frequency of A in the patients with RA compared to healthy subjects. The presence of A allele is associated with more serious clinical presentation of the disease and lower therapeutic response to Etanercept.

scholarly journals SAT-345 Etanercept Induced Hypercalcemia

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Bayan Chaker ◽  
Hussam Alim ◽  
Louna S El-Zein
Keyword(s):  
Rheumatoid Arthritis ◽  
Vitamin D ◽  
Calcium Level ◽  
Case Reports ◽  
Whole Body ◽  
Ground Glass ◽  
Mediastinal Lymphadenopathy ◽  
Tnf Alpha ◽  
Pain Patient ◽  
One Year

Abstract Non-PTH mediated hypercalcemia has multiple etiologies including medications. There are some case reports showing TNF-alpha inhibitors causing sarcoidosis or sarcoidosis type presentation involving lungs, skin, lymph nodes, and kidneys. We report here a 69-year-old male with a past medical history of prostate cancer status post prostatectomy (in remission), CKD stage 3, and seronegative rheumatoid arthritis who was sent to the ED from clinic due to hypercalcemia. On admission, patient had a calcium level of 14.2 (8.7–10.4 mg/dL), albumin 4.1 (3.4–4.8 g/dL), magnesium 2.0 (1.3–2.7 mg/dL), creatinine 2.5 (0.7–1.3 mg/dL), iPTH &lt;2 (14–88 pg/mL), PSA 0.13 (0–4 ng/mL), 25-OH vitamin D 45.3 (30–100 ng/mL), 1,25-OH vitamin D 144 (19.9–79.3 pg/mL), alkaline phosphatase 46 (46–116 U/L) along with generalized weakness, nausea, vomiting, poor appetite, decreased oral intake, dizziness, and slight epigastric pain. Patient was given IV fluids and a dose of Reclast 3.3 mg IV was given 2 days after admission. At home for at least the past year before admission, patient was on etanercept for seronegative rheumatoid arthritis which was held on admission. CT thorax was done which showed geographic ground glass worst in the bilateral upper lobes where there is interlobular septal thickening and interstitial consolidation highly suspicious for interstitial pneumonitis and reactive appearing mediastinal lymphadenopathy. During the admission PTH-rP was 2.5 (0–2.3 pmol/L) and angiotensin converting enzyme was 36 (9–67 U/L). Based on previous case reports, etanercept was held. Upon discharge 6 days later, calcium had improved to 10.0 mg/dL, albumin 3.3 g/dL, and creatinine to 1.5 mg/dL. Upon follow up, etanercept was continued to be held. One month later, calcium level improved to 9.2 mg/dL, albumin 4.0 g/dL, iPTH 187 pg/mL, PTH-rP 3.0 pmol/L, and 1,25 OH vitamin D 50.7 pg/mL. Patient’s calcium levels remained within normal range for over one year after admission and 1,25-OH vitamin D remained normal. Moreover, patient had nuclear medicine parathyroid scan which showed no evidence parathyroid adenoma. An ultrasound thyroid was done which was negative for any thyroid/parathyroid mass or nodule. Whole body bone scan was done which showed no evidence of osseous metastatic disease. Given up trending PTH-rP levels, patient was evaluated by oncology and was found to be up to date on age recommended cancer screening and no evidence of current malignancy. Repeat CT thorax done over one year later showed stable to mildly improved bilateral ill-defined centrilobular ground glass nodules in both lungs, greater on the left side, may represent improving infectious/inflammatory process. In conclusion, when in doubt, a good medication review is essential in the evaluation of hypercalcemia because TNF-alpha inhibitors like etanercept may cause a sarcoidosis like presentation.

scholarly journals AB0278 REAL LIFE EXPERIENCE OF DISEASE ACTIVITY AND QUALITY OF LIFE IN PATIENTS TREATED WITH BIOLOGICAL DMARDS VERSUS TOFACITINIB.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1438.2-1438
Author(s):  
V. Boyadzhieva ◽  
N. Stoilov ◽  
E. Kurteva ◽  
R. Stoilov
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Activity Index ◽  
Real Life ◽  
Disease Activity Index ◽  
Significant Difference ◽  
One Year

Background:Assessment of disease activity and quality of life are one of the main indicators for determining the effectiveness of treatment with disease-modifying antirheumatic drugs. In recent years, a new group has entered the market - target synthetic DMARDS, which prove their effectiveness in treating RA comparable to that of biological products.Objectives:The aim of this study is to evaluate the disease activity and quality of life of patients with rheumatoid arthritis (RA) treated with biological agents in comparison with Tofacitinib (real life data from Bulgarian population) and determine whether or not the benefits of different therapies were sustained over a follow up period of 1 year.Methods:164 patients were selected with a mean age 55.34 ± 16SD years, meeting the 1987 ACR and /or ACR/ EULAR (2010) classification criteria for Rheumatoid arthritis (RA). Patients were arranged according to treatment regimens: Tocilizumab (TCL) 30 patients, Certolizumab (CZP) 16, Golimumab (GOL) 22, Etanercept (ETN) 20, Adalimumab (ADA) 20, Rituximab (RTX) 16, Infliximab (INF) 20, Tofacitinib (TOF) 20. Disease activity and quality of life was the primary concern. Independent joint assessor evaluated 28 joints on baseline, 6th and 12th month’s thereafter. CRP was used to measure the inflammatory process.DAS28-CRP, clinical disease activity index (CDAI) and simplified disease activity index (SDAI)were calculated. On baseline all of the patients’ groups had severe disease activity (mean DAS28-CRP > 5.2, mean CDAI > 22, mean SDAI > 26. The quality of life was evaluated via EQ-5D.All of the patients were on stable therapy according to the inclusion criteria, and didn’t interrupt any of the medications including biological or target synthetic treatment.Results:Significant clinical improvement and statistically significant reduction in disease activity were observed in patients treated with bDMARDS and tsDMARDS within 6 months (p <0.005) of treatment and after 12 months of follow-up (p=0.039). The mean value of DAS28-CRP after one year follow up showed an non-inferior effect of Tofacitnib (3.04± 0.81) in comparison to biological treatment (TCL: 3.07 ± 0.73; CZP: 3.06 ± 0.65; GOL: 2.49 ± 0.76; ETN: 2.85 ± 0.55; ADA: 3.15 ± 0.82; RTX: 2.90 ± 0.70; INF: 3.14; ± 0.61; TOF: 3.04± 0.81). An improvement was also observed for the 6 to 12 months of follow-up as we did not detect a significant difference in the activity of the disease assessed by CDAI among the different drug groups.The mean values showing the change of the SDAI over the study period also outline comparable profiles. All of the treatment groups achieved a rapid reduction in disease activity that continued to decrease through the 6 and 12 months period, respectively, as supported by changes in SDAI.The quality of life evaluated with EQ-5D revealed significant improvement on the 6-th month of follow up as well as after 12th month (p<0.005) without significant difference between the observed groups.Conclusion:Real-life data show that patients on biological treatment as well as those on Tofacitinib therapy achieve a significant decrease in disease activity after one year of follow-up. This gives us reason to accept the importance of non-inferior effect of jak-inhibitors and their place in treatment of Rheumatoid arthritis.Disclosure of Interests:Vladimira Boyadzhieva: None declared, Nikolay Stoilov: None declared, Ekaterina Kurteva: None declared, Rumen Stoilov Grant/research support from: R-Pharm

scholarly journals AB0193 ROLE OF DICKKOPF-1 IN RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1396.2-1397
Author(s):  
H. Sadek ◽  
A. Monir ◽  
S. Bahgat ◽  
M. Elwan ◽  
A. Hamed
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Functional Status ◽  
Structural Damage ◽  
Negative Regulator ◽  
Control Group ◽  
Das 28 ◽  
Significant Difference ◽  
Dickkopf 1 ◽  
Laboratory Measures

Background:Rheumatoid arthritis (RA) is characterized by persistent synovitis that leads to structural joint damage causing deformity and disability. Dickkopf-1(DKK-1) was shown to be a major regulator of joint remodeling, which is associated with subchondral bone erosion in RA. Dickkopf-1 is a secreted glycoprotein that also acts as a potent negative regulator of wingless signaling. Current therapies used to treat RA are not able to effectively repair damaged bone. There is a strong relationship between Wnt signaling pathway, RA and DKK-1 so; this relationship may be a therapeutic point of interestObjectives:To assess the correlation between Dickkopf-1 and RA disease activity, disability, severity and functional status.Methods:Fifty patients fulfilled the 2010 ACR -EULAR criteria for RA were included. Twenty five healthy age and sex matched individuals served as a control (for assessment of serum DKK-1 level). Excluded from the study, patients with Paget disease, Multiple myeloma, Breast cancer, Bone metastasis, Diabetes mellitus, Hyperthyroidism, patients on medication that influence bone metabolism as: heparin, anticonvulsant or thyroxin.All patients were subjected to full history and examination. Disease activity measures as disease activity score (DAS 28-ESR), Visual analogue scale (VAS) and Disease disability indices including ACR criteria of functional status in RA and Health assessment questionnaire disability index (HAQ-DI). Erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP), Rheumatoid factor (RF), Anti citrullinated peptide antibody (ACPA) and Serum dickkopf-1 level. Simple erosion narrowing score (SENS) and Ultrasound DAS (US DAS) were done for all patients. Ultrasound DAS included 28 joints, Power Doppler ultrasound (PDUS) examination of 22 joints and gray scale ultrasound (GSUS) examination for Effusion/Hypertrophy (E/H) of 28 joints. Ultrasound erosion count (USEC) and Ultrasound erosion rate (USER) were assessed.Results:Dickkopf-1 level in RA patients ranged from 66 to 453 ng/ml while in the control group ranged from 15 to 87 ng/ml with statistically significant difference. RA patients were grouped in to: group 1 included 15 (30%) patients with normal DKK-1 level and group 2: included 35 (70%) patients with elevated DKK-1. The differences between both groups were highly significant regarding clinical and laboratory measures (duration of morning stiffness, DAS 28, VAS, ESR, CRP, RF and ACPA), and regarding HAQ-DI, SENS and US DAS. We found significant positive correlation between DKK-1 level and laboratory measures (ESR, CRP, RF, ACPA), radiographic parameters (SENS and erosion score), ultrasonographic parameters (US DAS, USEC and USER) and with HAQ-DI and functional status.Conclusion:Serum level of dickkopf-1 was elevated in RA patients and the results demonstrated the relationship between increased dickkopf-1 level and increased disease activity, decreased functional capacity and chronic structural damage suggesting its important role in the pathogenesis of RA.References:[1]Cardona-Rincón A D, Acevedo-Godoy M, Perdomo-Lara S, Chila L, et al. (2018).AB0001 Association of dickkopf1–1 polymorphisms with radiological damage and periodontal disease in patients with early rheumatoid arthritis. Annals of the Rheumatic Diseases; 77(2): 1206.[2]Huang Y, Liu L and Liu A. (2018).Dickkopf-1: Current knowledge and related diseases. Life sciences; 209: 249-54.Disclosure of Interests:None declared

scholarly journals Efficacy, safety and tolerability of using abatacept for the treatment of rheumatoid arthritis

2012 ◽  
Vol 48 (4) ◽  
pp. 781-791 ◽  
Author(s):  
Rafael Venson ◽  
Astrid Wiens ◽  
Cassyano Januário Correr ◽  
Roberto Pontarolo
Keyword(s):  
Rheumatoid Arthritis ◽  
Adverse Events ◽  
Control Group ◽  
Serious Adverse Events ◽  
Randomized Controlled Clinical Trials ◽  
Significant Difference ◽  
Safety Parameters ◽  
Efficacy Parameters ◽  
One Year ◽  
Meta Analyses

The objective is to provide an update on the clinical efficacy, safety and tolerability of the use of abatacept for treating rheumatoid arthritis. A systematic review (up to June 2011) followed by meta-analyses was performed. Randomized controlled clinical trials comparing abatacept at a dose of 10 mg/kg with a placebo, both with concomitant methotrexate, were used. Only high- or moderate-quality studies were included. The efficacy was evaluated based on changes in the ACR, DAS and HAQ; safety was assessed based on serious adverse events, serious infections, malignancies and deaths; tolerability was evaluated based on the withdrawals due to adverse events, serious adverse events and lack of efficacy. All these parameters were evaluated within one year of treatment. Nine studies met the inclusion criteria, comprising 4,219 patients. For all of the efficacy parameters, the abatacept group had better results than the placebo group, except in the case of HAQ improvement >0.3, which presented no statistically significant difference. None of the safety parameters presented a significant difference between the groups. The tolerability parameters were also similar between groups, with the exception of withdrawals due to lack of efficacy. For this criterion, the abatacept group presented favorably compared to the control group. Abatacept showed a higher efficacy compared to placebo without significant differences between the abatacept and control group in terms of safety.

Risk of venous thromboembolism following surgical treatment of superficial venous incompetence

VASA ◽  
2017 ◽  
Vol 46 (6) ◽  
pp. 484-489 ◽  
Author(s):  
Tom Barker ◽  
Felicity Evison ◽  
Ruth Benson ◽  
Alok Tiwari
Keyword(s):  
Venous Thromboembolism ◽  
Varicose Vein ◽  
Lower Incidence ◽  
Varicose Veins ◽  
Secondary Data ◽  
Foam Sclerotherapy ◽  
Increased Risk ◽  
Significant Difference ◽  
Chi Squared ◽  
One Year

Abstract. Background: The invasive management of varicose veins has a known risk of post-operative deep venous thrombosis and subsequent pulmonary embolism. The aim of this study was to evaluate absolute and relative risk of venous thromboembolism (VTE) following commonly used varicose vein procedures. Patients and methods: A retrospective analysis of secondary data using Hospital Episode Statistics database was performed for all varicose vein procedures performed between 2003 and 2013 and all readmissions for VTE in the same patients within 30 days, 90 days, and one year. Comparison of the incidence of VTEs between procedures was performed using a Pearson’s Chi-squared test. Results: In total, 261,169 varicose vein procedures were performed during the period studied. There were 686 VTEs recorded at 30 days (0.26 % incidence), 884 at 90 days (0.34 % incidence), and 1,246 at one year (0.48 % incidence). The VTE incidence for different procedures was between 0.15–0.35 % at 30 days, 0.26–0.50 % at 90 days, and 0.46–0.58 % at one year. At 30 days there was a significantly lower incidence of VTEs for foam sclerotherapy compared to other procedures (p = 0.01). There was no difference in VTE incidence between procedures at 90 days (p = 0.13) or one year (p = 0.16). Conclusions: Patients undergoing varicose vein procedures have a small but appreciable increased risk of VTE compared to the general population, with the effect persisting at one year. Foam sclerotherapy had a lower incidence of VTE compared to other procedures at 30 days, but this effect did not persist at 90 days or at one year. There was no other significant difference in the incidence of VTE between open, endovenous, and foam sclerotherapy treatments.

Clinical Factors Associated with Progression to AIDS in the Italian Cohort of HIV-Positive Hemophiliacs

1994 ◽  
Vol 72 (01) ◽  
pp. 033-038 ◽  
Author(s):  
N Schinaia ◽  
A M G Ghirardini ◽  
M G Mazzucconi ◽  
G Tagariello ◽  
M Morfini ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
National Registry ◽  
Factor Ix ◽  
Clotting Factor ◽  
Coagulation Disorders ◽  
Factors Associated ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Congenital Coagulation Disorders ◽  
Clotting Factor Concentrates

SummaryThis study updates estimates of the cumulative incidence of AIDS among Italian patients with congenital coagulation disorders (mostly hemophiliacs), and elucidates the role of age at seroconversion, type and amount of replacement therapy, and HBV co-infection in progression. Information was collected both retrospectively and prospectively on 767 HIV-1 positive patients enrolled in the on-going national registry of patients with congenital coagulation disorders. The seroconversion date was estimated as the median point of each patient’s seroconversion interval, under a Weibull distribution applied to the overall interval. The independence of factors associated to faster progression was assessed by multivariate analysis. The cumulative incidence of AIDS was estimated using the Kaplan-Meier survival analysis at 17.0% (95% Cl = 14.1-19.9%) over an 8-year period for Italian hemophiliacs. Patients with age greater than or equal to 35 years exhibited the highest cumulative incidence of AIDS over the same time period, 32.5% (95% Cl = 22.2-42.8%). Factor IX recipients (i.e. severe B hemophiliacs) had higher cumulative incidence of AIDS (23.3% vs 14.2%, p = 0.01) than factor VIII recipients (i.e. severe A hemophiliacs), as did severe A hemophiliacs on less-than-20,000 IU/yearly of plasma-derived clotting factor concentrates, as opposed to A hemophiliacs using an average of more than 20,000 IU (18.8% vs 10.9%, p = 0.02). No statistically significant difference in progression was observed between HBsAg-positive vs HBsAg-negative hemophiliacs (10.5% vs 16.4%, p = 0.10). Virological, immunological or both reasons can account for such findings, and should be investigated from the laboratory standpoint.

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