Cost-effectiveness of novel treatment of hepatitis C virus in Lebanese patients

Abstract

Background Limited data is available on Hepatitis C disease prevalence, treatment initiation and its cost-effectiveness in Lebanon and the whole Middle East. Objective The aim of the study is to assess whether initiation of novel Direct Acting Antiviral agents (DAAs) at early stage of hepatitis C is cost-effective in Lebanese patients. Setting Lebanon. Methods This modeling study was conducted from the perspective of Lebanese third party payers, where existing practice is based on international guidelines for the diagnosis and treatment of diseases. The model assessed cost-effectiveness of early versus delayed DAAs treatment in a standard patient upon HCV diagnosis. Medical costs were valued using in-house database. Main outcome measures Incremental Cost-Effectiveness Ratio (ICER) per QALY and per life-year extended. Results Treatment at early HCV disease stage has led to an ICER of 587 euro per QALY gained throughout the course of the disease. Outcomes of early treatment with DAAs upon HCV diagnosis led to an incremental cost of 27,268 euro per QALY gained at first year of treatment, and of 1527 euro per additional life-year extended. Sensitivity analysis showed that a 25% decrease in the cost of dual drug option resulted in a decrease of incremental cost to 16,982 euro per QALY gained at first year of treatment with DAAs upon early HCV diagnosis. Conclusion Decision makers are encouraged to reinforce the need to screen for HCV and initiate novel treatment at early disease stage in the Lebanese healthcare system.

https://ift.tt/2H4ikmW

Epidemiology of drug hypersensitivity reactions using 6-year national health insurance claim data from Korea

Abstract

Background Drug hypersensitivity reactions (DHRs) constitute a large portion of adverse drug reactions (ADRs), but studies for DHR incidence based on national data are scarce. Objective This study aimed to estimate the incidence and patterns of DHRs in a Korean population and the associated utilization of medical resources using the national claims data. Setting The retrospective cohort study performed using the national insurance claim database of the Health Insurance Review and Assessment (HIRA) in Korea. Methods The International Classification of Disease 10th revision code was used to identify DHRs with 20 drug induced DHR codes. The claim data with a diagnosis of DHR in the 2009-2014 periods were analyzed. Main outcome and measure The annual incidence and the 6-year incidence rates were calculated. Incidence rate coefficients were analyzed by sex, age, and year. DHRs following with visits of emergency department (ED) or intensive care unit (ICU) were assessed for utilization of medical resources and risk of ER or ICU visits by sex and age Results A total of 535,049 patients with 1,083,507 claims were assessed in the HIRA database for 6 years. DHR incidence was high in the elderly. The risk of ED and ICU visit with DHR was also higher in the elderly than in the young [highest relative risk, RR of ED 2.59 (1.65–4.07), ICU 5.04 (2.50–10.18)]. DHRs related to blood were high in the young age. Conclusion Incidence of DHRs in the real-world clinical practice was higher in the elderly and female. Clinical consequence was more severe in the elderly.

https://ift.tt/2Gwov1G

Oral health and chemotherapy act as cofactors in malnutrition in the elderly with other cancers than head and neck malignancies

Abstract

Objectives

This study explores whether the chemotherapy regimen has a role in inducing oral health problems and malnutrition in elderly patients with other cancers than head and neck malignancies.

Material and methods

An observational cross-sectional study was designed to compare the relationships between oral health and nutritional status between four groups of elderly differing in cancer or chemotherapy regimen. Data were collected using a questionnaire including the Mini-Nutritional Assessment (MNA), the Geriatric Oral Health Assessment Index (GOHAI) and questions about perception of xerostomia. The oral examinations recorded the number of functional dental units (PFU) and the presence of oral lesions.

Results

The sample comprised 46 patients receiving chemotherapy, 48 patients on a non-chemotherapy regimen, 45 persons in complete remission not under treatment and 53 non-cancer patients. Oral health perception was significantly worse in chemotherapy patients. They reported limiting the kinds of food they consumed, the discomfort felt when eating and took medications for oral pain. Oral lesions were frequent in chemotherapy participants. Nutritional status was related to the cancer treatment regimen (OR = 4.17; p value = 0.017), the presence of oral lesions (OR = 4.51; p value = 0.003), perception of xerostomia (OR = 3.54; p value = 0.012), the number of PFU (OR = 2.51; p value = 0.046) and GOHAI score (OR = 1.617; p value = 0.019).

Conclusion

The presence of oral lesions and the chemotherapeutic regimen were highly associated with nutritional status in older patients with cancer.

Clinical relevance

Dental professionals should be asked to intervene preventively and per-therapy to optimise oral health status in elderly patients with other cancers than head and neck malignancies.

https://ift.tt/2H4DpxB

Morphogenetic diversity of the ectomycorrhizal genus Cortinarius section Calochroi in the Iberian Peninsula

Abstract

The taxonomic and genetic diversity of Cortinarius section Calochroi in one of the most biodiversity-rich regions in Europe, the Iberian Peninsula, was investigated through morphological and phylogenetic methods. This combined methodological approach allowed the identification of 15 known species and one new species, Cortinarius ortegae, which is described here. A dichotomous key is provided for field recognition of Calochroi species inhabiting different Iberian and Balearic Island woodlands. Polymorphism analyses within some studied species showed that the distribution of intraspecific lineages is dependent on geography and, in some cases, tree host. Furthermore, the dating analysis suggested that diversification within Calochroi started in the Pliocene and most of the current genetic diversity originated in the Pleistocene. This temporal scenario supports hypotheses in which climatic oscillations in the Quaternary may have been driving the evolution of this group of ectomycorrhizal fungi.

https://ift.tt/2J7fNcd

Multiple reaction monitoring targeted LC-MS analysis of potential cell death marker proteins for increased bioprocess control

Abstract

The monitoring of protein biomarkers for the early prediction of cell stress and death is a valuable tool for process characterization and efficient biomanufacturing control. A representative set of six proteins, namely GPDH, PRDX1, LGALS1, CFL1, TAGLN2 and MDH, which were identified in a previous CHO-K1 cell death model using discovery LC-MS^E was translated into a targeted liquid chromatography multiple reaction monitoring mass spectrometry (LC-MRM-MS) platform and verified. The universality of the markers was confirmed in a cell growth model for which three Chinese hamster ovary host cell lines (CHO-K1, CHO-S, CHO-DG44) were grown in batch culture in two different types of basal media. LC-MRM-MS was also applied to spent media (n = 39) from four perfusion biomanufacturing series. Stable isotope-labelled peptide analogues and a stable isotope-labelled monoclonal antibody were used for improved protein quantitation and simultaneous monitoring of the workflow reproducibility. Significant increases in protein concentrations were observed for all viability marker proteins upon increased dead cell numbers and allowed for discrimination of spent media with dead cell densities below and above 1 × 10⁶ dead cells/mL which highlights the potential of the selected viability marker proteins in bioprocess control.

Graphical abstract

Overview of the LC-MRM-MS workflow for the determination of proteomic markers in conditioned media from the bioreactor that correlate with CHO cell death

https://ift.tt/2IiVjfq

Pipette-tip solid-phase extraction using polypyrrole as efficient adsorbent for extraction of avermectins and milbemycins in milk

Abstract

In this work, we developed a HPLC method for the multidetermination of avermectins (AVM) (abamectin—ABA 1b and ABA 1a, eprinomectin—EPR, and ivermectin—IVM) and milbemycins (moxidectin—MOX) in milk samples using polypyrrole (PPy) as adsorbent material in pipette-tip solid-phase extraction (PT–PPy–SPE). PPy was characterized by scanning electron microscopy, thermogravimetric analysis, Fourier transform infrared spectroscopy, and X-ray diffraction and the data agreed with the literature. The sample preparation included the clean-up of the milk by protein precipitation (PP) with acetonitrile and extraction of the analytes by PT–PPy–SPE. The chromatographic method was developed in reverse phase and isocratic mode with flow rate at 1.2 mL min⁻¹ and ultraviolet detection at 250 nm. The mobile phase composition was acetonitrile:methanol:water (55:25:20, v/v/v). The studied parameters and the optimized conditions for the sample preparation were washing solvent (300 μL water), volume and type of eluent (500 μL methanol), volume and pH of sample (1 mL and pH 10), amount of adsorbent material (50 mg PPy), and without addition of salt (NaCl). The method was linear over the concentration range from 20 to 3000 ng mL⁻¹ with coefficients of correlation (r) ≥ 0.99 for all analytes and recoveries around 100%. The method developed and validated was used for the analyses of real milk samples from cow treated with Ivomec^® (IVM 3.5%), in which were found 21.51 ± 2.94 ng mL⁻¹ of IVM. Finally, the results proved that PT–PPy–SPE coupled to HPLC–UV was economical, simple, and easy-to-perform technique.

Graphical abstract

Pipette-tip solid phase extraction using polypirrole as adsorbent material for determination of avermectins and milbemycins in milk

https://ift.tt/2J8XGT0

Personalized Axial Spondyloarthritis Care

Abstract

Purpose of review

To discuss the personalized care of patients with axial spondyloarthritis.

Recent findings

Secukinumab, an IL-17A inhibitor, has recently been proven to be effective in treating signs and symptoms of ankylosing spondylitis. The latest update of ASAS/EULAR management recommendations include secukinumab and recommend a personalized medicine approach for the treatment of patients with axial spondyloarthritis.

Summary

Nonsteroidal anti-inflammatory drugs benefit a significant proportion of patients with axial spondyloarthritis. Conventional disease-modifying anti-rheumatic drugs are not effective for axial symptoms. Sulfasalazine may have limited efficacy for peripheral articular symptoms, but not for enthesitis. Local glucocorticoid injections may be helpful for joint and entheseal inflammation. Patients failing to respond to conventional treatments can be treated with biologics inhibiting TNF-α and IL-17A. They all have a similar efficacy for the treatment of axial and peripheral disease but vary in their efficacy on the extra-articular disease manifestations and safety profiles. TNF-α inhibitors are recommended over secukinumab as the initial choice for biologic treatment, due to the availability of larger amount of data, as well as longer and greater clinical experience with these agents. Molecular and genomic biomarkers which are central and crucial to implementation of personalized medicine in its modern context are not yet available for the treatment of axial spondyloarthritis; therefore, personalized care of such patients can currently be practiced mainly on the basis of general patient characteristics, patient preferences, and clinical findings.

https://ift.tt/2GrUDUg