Comorbidity in real clinical practice - the patient with gout, cardiovascular disease and kidney damage

In real clinical practice more and more often doctors treat comorbid patients. The high prevalence of cardiovascular diseases with various comorbid conditions contributes to the progressive increase in the number of patients with a concurrence of several diseases. A comorbid patient is a serious problem for any clinician, since in this case it is necessary to take into account several components of therapy, which makes it difficult to control treatment efficiency, contributes to an increase in polypharmacy, the risk of local and systemic side effects of drugs, and reduces adherence to therapy. A comorbid patient is a serious problem for any clinician. The paper describes and discusses the clinical case of a comorbid patient, who admitted to the cardiological department initially but he had also rheumatological problems (gout), kidney affection.

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Effectiveness of inhaled corticosteroids and long-acting β-agonists combinations in real clinical practice: results of a multicenter cross-sectional study in Russian patients with asthma

Russian Pulmonology ◽

10.18093/0869-0189-2021-31-5-613-626 ◽

2021 ◽

Vol 31 (5) ◽

pp. 613-626

Author(s):

Vladimir V. Arkhipov ◽

Zaurbek R. Aisanov ◽

Sergey N. Avdeev

Keyword(s):

Clinical Practice ◽

Adverse Events ◽

Asthma Control ◽

Inhalation Technique ◽

Adherence To Treatment ◽

Uncontrolled Asthma ◽

Cross Sectional ◽

Long Acting ◽

Adherence To Therapy ◽

Real Clinical Practice

Asthma management approaches are improving yearly, but the problem of asthma control is still acute. Combinations of inhaled glucocorticosteroids (ICS) and long-acting β2-agonists (LABA) play a crucial role in asthma therapy, but their effectiveness in real practice can be insufficient, and asthma control level in the population remains low. Optimizing the use of these drugs, changing the usual therapy regimens, and implementing upgraded inhalers can improve adherence to treatment and inhalation technique, which affects the effectiveness of the therapy.The study aimed to describe the key characteristics of the patient population getting asthma treatment in real clinical practice and assess factors influencing asthma control, including adherence to therapy.Methods. A single-stage cross-sectional observational study in 124 primary health care centers in 22 cities of the Russian Federation included 3,214 patients > 18 years old, with a clinical diagnosis of asthma for at least 1 year, who were able to perform a spirometry test and fill out the ACQ-5 and TAI-12 questionnaires.Results. Assessment of asthma control with the ACQ-5 questionnaire showed that most patients had uncontrolled asthma (56%). Controlled and partially controlled asthma was diagnosed in 21 and 19% of patients, respectively. 4% of patients had severe uncontrolled asthma. The TAI questionnaire revealed low adherence to therapy in more than half of the patients (53.6%). The rate of patients with controlled asthma and the average annual frequency of exacerbations were significantly lower in subgroups of patients who received therapy with extrafine ICS/LABA and ICS/formoterol in single inhaler regimen, compared with controller therapy using fixed and free combinations of ICS and LABA.Conclusion. The main causes of insufficient asthma control are low adherence to treatment, inhalation errors, monotherapy with ICS, asthma with small airways dysfunction, and adverse events associated with ICS. Prescribing the combinations of ICS/LABA in the form of extra-fine aerosol and using it in the Maintenance and Reliever Therapy (MART) regimen can significantly increase asthma control, reduce the risk of adverse events, and increase patient adherence to treatment. A potential alternative to improve asthma control is administering ICS-LABA combinations once daily.

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AB0639 TREATMENT EFFICACY WITH SECUKINUMAB IN A COHORT OF SPONDYLOARTHRITIS PATIENTS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.5400 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1614.2-1614

Author(s):

A. Castilla ◽

Á. García Martos ◽

L. Sala Icardo ◽

A. Prada-Ojeda ◽

L. Barrio Nogal ◽

...

Keyword(s):

New York ◽

Clinical Practice ◽

Clinical Manifestations ◽

Previous Treatment ◽

Response To Treatment ◽

Das 28 ◽

Number Of Patients ◽

Symptoms And Signs ◽

Real Clinical Practice

Background:Spondyloarthropathies are a heterogeneous group of similar diseases, with interrelated clinical manifestations, such as Psoriasis Arthritis (APs) and Ankylosing Spondylitis (EA). There are different treatments for this group of pathologies.Objectives:It is very important to differentiate between those that present predominantly axial (spine and/or sacroiliac) or peripheral involvement, since the response to treatment is very different.In some clinical trials, secukinumab significantly improved versus placebo, the symptoms and signs, physical function and quality of life, however, at present, we do not have enough data from secukinumab in real clinical practice.This is the real reason of this study: the use of secukinumab in clinical practice.Methods:Multicentric longitudinal observational study of 5 Hospitals in Madrid.Patients are over 18 years old and meet the following inclusion criteria: New York criteria for AS, ASAS for EA, CASPAR for APs, and all of them are with secukinumab or have received it.We will evaluate the effectiveness rate as well as its confidence interval at 95%. In addition, the effectiveness of secukinumab will be compared in the different pathologies by using χ2.Results:72 patients were collected, 41 of them were women (57,75%).12 patients (16,90%) had not received FAME before secukinumab and 22 patients (33,99%) were naive to biological treatment.In 4 patients, the reason for starting secukinumab was the patient’s comorbidities, in 2 the adverse effects of previous treatment and in the rest, was the lack of efficacy of the previous treatment.The patients were divided into 4 categories according to the level of DAS-28 or BASDAI, at the beginning of the treatment and the last recorded value, in: Absence of activity, mild, moderate and severe activity. Of the patients with data, they managed to improve the DAS-28 score (change category) by 30,95%, while only 4,76% worsened their score. With respect to BASDAI, of the total number of patients, only 3,03% worsened, while his score improved 27,27%.According to baseline diagnosis, a greater improvement of the disease activity in peripheral APs(66,67%) and mixed APs(61,54%) is achieved.Conclusion:In real clinical practice, treatment with secukinumab was effective in patients with spondyloarthritis, achieving improvement in previous activity rates. In this study, the most significant improvement was obtained in peripheral and mixed APs.Disclosure of Interests:None declared

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Evaluation of the efficacy and safety of injectable glycosaminoglycan-peptide complex (GPC) in patients with osteoarthritis: a multicenter observational study GLADIOLUS (GPC in the treatment of osteoarthritis: a follow-up study of pain relief and local symptom reduction)

Modern Rheumatology Journal ◽

10.14412/1996-7012-2020-2-76-83 ◽

2020 ◽

Vol 14 (2) ◽

pp. 76-83

Author(s):

L. I. Alekseeva ◽

A. E. Karateev ◽

E. Yu. Pogozheva ◽

V. N. Amirdzanova ◽

E. S. Filatova ◽

...

Keyword(s):

Clinical Practice ◽

Large Scale ◽

Rating Scale ◽

Response To Therapy ◽

Efficacy And Safety ◽

Functional Disorders ◽

Peptide Complex ◽

Number Of Patients ◽

Pain At Rest ◽

Real Clinical Practice

Glycosaminoglycan-peptide complex (GPC) is a popular injectable extended-release symptomatic agent (ERSA) in Russia for the treatment of osteoarthritis (OA). To date, no large-scale studies of GPC used in real clinical practice have been conducted in our country.Objective: to evaluate the efficacy and safety of GPC in the treatment of OA in real clinical practice.Patients and methods. A multicenter observational non-interventional study was performed to evaluate the efficacy of GPC (Rumalon® , a cycle of intramuscular injections thrice weekly; a total of 25 injections). A study group consisted of 2,955 patients (75.4% female) aged 61.4±11.8 years) with knee and hip OA, and generalized OA (GOA) with the previous inefficacy of oral ERSAs, moderate/severe pain, and the need for regular use of nonsteroidal anti-inflammatory drugs (NSAIDs). 414 (14%) patients received a GPC and diacerein combination 100 mg/day. The investigators assessed the dynamics of pain during movement and at rest, functional disorders (on a numeric rating scale (NRS) of 0–10), as well as the need for NSAIDs at 12 weeks after starting the GPC cycle.Results and discussion. 98.5% of the patients completed their GPC treatment cycle. The therapy decreased the intensity of pain at rest from 4 [3; 5] to 1 [0; 2] and during movement from 6 [5; 7] to 2 [1; 3] and reduced the severity of functional disorders from 5 [4; 6] to 1 [0; 3]. The number of patients with a good response to therapy (a≥50% decrease in symptom severity) for pain at rest and during movement was 55.6 and 53.5%, respectively; and for functional disorders was 50.8%. 68.1% of patients stopped taking NSAIDs. The GPC and diacerein combination was more effective than GPC monotherapy: the number of patients with a ≥50% decrease in movement pain was 62.8 and 54.3%, respectively (p <0.001). GPC was well tolerated. During treatment, there were skin allergic reactions (0.3%), moderate injection-site pain (0.37%), and adverse reactions (ARs) related to the gastrointestinal tract (8%) and cardiovascular system (6%) (which were likely to be caused by NSAIDs). There were no serious ARs that were life-threatening and required hospitalization.Conclusion. GPC allows successful control of the main symptoms of knee and hip OA and GOA, by reducing pain, and those of functional disorders, and the need for NSAIDs. The GPC and diacerein combination is more effective than GPC monotherapy. GPC therapy is well tolerated and very rarely causes ARs.

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Comparative efficacy of tofacitinib and adalimumab in patients with psoriatic arthritis in real clinical practice. Data from the Russian nationwide register of patients with psoriatic arthritis

Modern Rheumatology Journal ◽

10.14412/1996-7012-2021-3-35-42 ◽

2021 ◽

Vol 15 (3) ◽

pp. 35-42

Author(s):

E. Yu. Loginova ◽

T. V. Korotaeva ◽

E. E. Gubar ◽

Yu. L. Korsakova ◽

S. I. Glukhova ◽

...

Keyword(s):

Clinical Practice ◽

Psoriatic Arthritis ◽

Disease Activity ◽

Median Duration ◽

Comparable Efficacy ◽

Number Of Patients ◽

Group 2 ◽

Low Activity ◽

Real Clinical Practice ◽

Group 1

Objective: to compare the clinical efficacy in real clinical practice of the targeted synthetic disease-modifying antirheumatic drug (sDMARD) tofacitinib (TOFA) and the biologic DMARD (bDMARD), an inhibitor of tumor necrosis factor alpha (TNFα), adalimumab (ADA) in patients with psoriatic arthritis (PsA), included in the Russian nationwide register of patients with PsA.Patients and methods. The study included 77 patients with PsA (43 men and 34 women) who met the CASPAR criteria and were observed in the Russian nationwide register. Patients were divided into two groups depending on the treatment. Group 1, in which oral TOFA was prescribed, 5 mg 2 times a day, included 41 patients: 24 (58.5%) men and 17 (41.5%) women, the median age was 41 [34; 50] years, the median duration of PsA was 72 [35; 120] months. Group 2, in which subcutaneous ADA was used, 40 mg every 2 weeks, included 36 patients: 19 (52.8%) men and 17 (47.2%) women, the median age was 44 [34; 51] years, the median duration of PsA was 59 [22; 102] months. Combination therapy, including methotrexate (MT), received 80.5% of patients in the TOFA group and 52.8% of patients in the ADA group. At the beginning of the study and every 6 months further, the activity and efficacy of PsA therapy were assessed in all patients according to DAPSA and criteria for minimal disease activity – MDA (number of painful joints ≤1, number of swollen joints ≤1, PASI ≤1 or BSA ≤3 , pain score ≤15, patient's general assessment of disease activity ≤20 mm on a visual analogue scale, HAQ ≤0.5, enthesitis ≤1), dynamics of BASDAI and BSA were also assessed. The number of patients who achieved remission (DAPSA ≤4) or MDA (5 criteria out of 7) during therapy with TOFA and ADA was determined.Results and discussion. Before the start of the therapy in the 1st group, the median DAPSA was 44.2 [37.8; 55.3]: moderate PsA activity was in 5 (12.2%) patients, high in 36 (87.8%) patients. In group 2, the median DAPSA was 35.8 [21.1; 52]: low activity was detected in 3 (8.6%), moderate – in 11 (31.4%), high – in 21 (60%) patients (data from 35 patients was available). 6 months after the start of treatment in patients of the 1st and the 2nd group, there was a significant decrease in all indicators of PsA activity compared to the baseline. The median DAPSA was 11 [4.3; 17.3] and 9.1 [6; 19.6]; remissions according to DAPSA reached 11 (26.8%) and 6 (20.8%) patients, respectively, low activity – 15 (36.6%) and 13 (44.8%), MDA – 16 (40%) and 9 (30%). The number of patients with dactylitis in the 1st and in the 2nd group significantly decreased: from 22 (53.7%) to 5 (13.2%) and from 13 (36.1%) to 6 (20%), respectively. Median HAQ decreased from 1 [0.625; 1.5] to 0.5 [0; 0.875] and from 0.875 [0.5; 1.38] to 0.5 [0; 0.875]; median BASDAI – from 6 [4.2; 7] to 1.4 [0.6; 3.2] and from 4.4 [1.9; 5.8] to 3 [0.8; 4.5], respectively. In group 1, the number of patients with BSA> 3% decreased from 16 (39%) to 8 (26.7%; p<0.225), and in group 2, due to insufficient data (5 patients), we failed to evaluate BSA dynamics.Conclusion. In real clinical practice TOFA and ADA both had comparable efficacy on all clinical manifestations of PsA: after 6 months of therapy, most patients with PsA achieved MDA, low disease activity and remission according to DAPSA and BASDAI.

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The impact of duration of the period of home blood pressure assessment on antihypertensive treatment efficiency in real clinical practice

ScienceRise Medical Science ◽

10.15587/2519-4798.2016.80467 ◽

2016 ◽

Vol 0 (10 (6)) ◽

pp. 45-52

Author(s):

Катерина Миколаївна Амосова ◽

Юлія Володимирівна Руденко

Keyword(s):

Blood Pressure ◽

Clinical Practice ◽

Antihypertensive Treatment ◽

Home Blood Pressure ◽

Treatment Efficiency ◽

The Impact ◽

Real Clinical Practice

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ANALYSIS OF THE RESULTS OF TOFACITINIB THERAPY IN REAL CLINICAL PRACTICE ACCORDING TO THE ALL-RUSSIAN ARTHRITIS REGISTRY (OREL)

Rheumatology Science and Practice ◽

10.14412/1995-4484-2020-262-267 ◽

2020 ◽

Vol 58 (3) ◽

pp. 262-267

Author(s):

A. S. Avdeeva ◽

A. S. Misiyuk ◽

A. M. Satybaldyev ◽

G. V. Lukina ◽

V. N. Sorotskaya ◽

...

Keyword(s):

Clinical Practice ◽

Age At Onset ◽

Similar Efficacy ◽

Moderate Activity ◽

Second Line Therapy ◽

Line Therapy ◽

Number Of Patients ◽

Low Activity ◽

Necrosis Factor ◽

Real Clinical Practice

Objective: to analyze the results of tofacitinib (TOFA) therapy in real clinical practice according to the All-Russian Arthritis Registry (OREL). Subjects and methods. The OREL Registry included 347 patients (286 (82%) women and 61 (18%) men) with rheumatoid arthritis (RA) who initiated TOFA therapy. The male:female ratio was 1:4.7. The patients’ median age at onset of the disease was 42 years; its duration was 8 years. Most of the patients included in the registry had extended- (n=171 (52%)) or late- (n=148 (45%)) stage of RA. Results and discussion. Prior to initiation of TOFA therapy, RA activity according to DAS28 was high and moderate in 91 (64.5%) and 40 (28.4%) patients, respectively; the median DAS28 value was 5.5 [4.6; 6.2]; SDAI – 30.5 [21.4; 42.9], and CDAI – 28.2 [20.0; 37.1]. The use of TOFA was accompanied by significant decrease of disease activity. After 12 weeks, high RA activity was persistent in 32 (22.7%) patients; the number of patients with moderate activity increased to 77 (54.6%), that of those with low activity rose to 15 (10.6%); remission was observed in 17 (12.1%) patients. 216 (62.6%) and 76 (22%) patients received TOFA as first- and second-line therapy, respectively. TOFA was most frequently prescribed when tumor necrosis factor-á inhibitors (19.6%), rituximab (7.8%), tocilizumab (4.3%), and abatacept (5.2%) were insufficiently effective or poorly tolerated. Conclusion. The results of using TOFA in real clinical practice may suggest that the drug has high efficacy in patients with RA. TOFA can be used at a dose of 5 or 10 mg twice daily as both alone and in combination with disease-modifying anti-rheumatic drugs. TOFA showed similar efficacy in patients who had earlier taken biological agents and in those who had not.

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Anticoagulant therapy in patients with nonvalvular atrial fibrillation in real clinical practice: the problem of therapy safety and treatment adherence

Bukovinian Medical Herald ◽

10.24061/2413-0737.xxv.2.98.2021.24 ◽

2021 ◽

Vol 25 (2(98)) ◽

pp. 148-153

Author(s):

O. Khaniukov ◽

O. Smolianova

Keyword(s):

Atrial Fibrillation ◽

Clinical Practice ◽

Side Effects ◽

Treatment Adherence ◽

Adult Population ◽

Main Body ◽

Risk Of Bleeding ◽

Risk Increase ◽

Number Of Patients ◽

Real Clinical Practice

Atrial fibrillation (AF) is the most common arrhythmia in the adult population, and the number of patients with this arrhythmia will increase in the future. As a result, the number of patients taking anticoagulants (ACs), which are considered "high alert medication" is constantly increasing. The aim. To highlight the problems of ACs use in patients with non-valvular AF in real clinical practice, to consider the therapy safety and treatment adherence. The main body. Approval of new oral ACs has provided more options to clinicians and patients, but even with their use, errors are possible that increase the risk of bleeding. Mistakes can be made by both patients and doctors. The introduction of training as a mandatory element in the complex therapy of AF helps to reduce the number of errors that the patient could make. The clinical condition, the availability of monitoring and the patient's wishes for treatment may change over time, and this may lead to the need to switch the AC, which is potentially dangerous in terms of side effects. The risk of bleeding increases regardless of the direction of change of AC - the very fact of transition is important. Doctor`s errors play a significant role in the risk increase at this stage, and it is important to raise their awareness of the rules for the ACs switch to avoid bleeding. The article presents the rules of transition from one oral AC to another, following which doctors will minimize the risk of side effects in clinical practice. Conclusion. The use of AC for patients with AF is life-saving, but if used improperly, life-threatening side effects can occur. According to research, in many cases, the development of the latter could be prevented primarily through patient education and the proper doctor training.

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