A comparison of leflunomide and subcutaneous methotrexate in the treatment of rheumatoid arthritis: an approximation based on the number needed to treat

ObjectiveTo compare, in the Spanish setting, two drugs for adults with rheumatoid artritis (RA): leflunomide and subcutaneous methotrexate (SC). The high price of methotrexate SC compared with traditional presentations of methotrexate justifies conducting an economic evaluation comparing it with leflunomide.MethodsThe analysis considered the annual costs of the drugs and their effectiveness, measured with a Number Needed to Treat (NNT) approach, considering both the ACR20 and ACR50 criteria for effectiveness. Data about efficacy and dosage were derived from the clinical trial US310, a randomized, doble-blinded controlled trial, which compared efficacy and safety of leflunomide (20 mg/daily) vs placebo vs methotrexate (7.5–15 mg/weekly) in 482 patients with active RA. Data about use of medical resources for drug monitoring (visits to rheumatologists and diagnostic procedures) were derived from the manufacturers’ summary of product characteristics. Direct costs (drugs and monitoring) were obtained from two Spanish databases. The analysis has been performed under the Spanish National Health System perspective.ResultsUsing the ACR20 criteria, the NNT with leflunomide and methotrexate are 4 (95% CI, 2.56–7.71) and 5 (95% CI, 3.03–14.3) respectively. Using the ACR50 criteria, NNT are 4 (95% CI, 2.72–6.54) and 7 (95% CI, 4.03–19.3). In the case of leflunomide, annual treatment costs per patient-year equals 1,793.30€; in the case of methotrexate total treatment costs amounts to 2,149.20€.ConclusionsCombining these results the cost of a controlled patient according to ACR20 would amount 7,173€ for leflunomide and 10,746€ for methotrexate SC. Results considering ACR50 are 7,173€ and 15,044€ for leflunomide and methotrexate respectively.     

Fragment length analysis screening for detection of CEBPA mutations in intermediate-risk karyotype acute myeloid leukemia

During last years, molecular markers have been increased as prognostic factors routinely screened in acute myeloid leukemia (AML). Recently, an increasing interest has been reported in introducing to clinical practice screening for mutations in the CCAAT/enhancer-binding protein ?? (CEBPA) gene in AML, as it seems to be a good prognostic factor. However, there is no reliable established method for assessing CEBPA mutations during the diagnostic work-up of AMLs. We describe here a straightforward and reliable fragment analysis method based in PCR capillary electrophoresis (PCR-CE) for screening of CEBPA mutations; moreover, we present the results obtained in 151 intermediate-risk karyotype AML patients (aged 16?C80?years). The method gave a specificity of 100% and sensitivity of 93% with a lower detection limit of 1?C5% for CEBPA mutations. The series found 19 mutations and four polymorphisms in 12 patients, seven of whom (58%) presented two mutations. The overall frequency of CEBPA mutations in AML was 8% (n?=?12). CEBPA mutations showed no coincidence with FLT3-ITD or NPM1 mutations. CEBPA mutation predicted better disease-free survival in the group of patients without FLT3-ITD, NPM, or both genes mutated (HR 3.6, IC 95%; 1.0?C13.2, p?=?0.05) and better overall survival in patients younger than 65 of this group without molecular markers (HR 4.0, IC 95%; 1.0?C17.4, p?=?0.05). In conclusion, the fragment analysis method based in PCR-CE is a rapid, specific, and sensitive method for CEBPA mutation screening and our results confirm that CEBPA mutations can identify a subgroup of patients with favorable prognosis in AML with intermediate-risk karyotype.     

Simple classification of renal calculi closely related to their micromorphology and etiology

BACKGROUND: Classification of renal calculi with clear correlation with the main urinary etiological conditions has been previously established. However, such information is complex and difficult to adapt to clinical routine practice. METHODS: A simple classification of renal calculi based on their structure and composition is proposed and applied to 2500 renal calculi to achieve the percentage of each category. The urines of 700 individuals chosen randomly have been analyzed and the results compared with those obtained with 51 healthy subjects. RESULTS: 12.9% calculi corresponded to calcium oxalate monohydrate papillary calculi, 16.4% to calcium oxalate monohydrate unattached calculi, 33.8% to calcium oxalate dihydrate calculi, 11.2% calcium oxalate dihydrate/hydroxyapatite mixed calculi, 7.1% hydroxyapatite calculi, 4.1% struvite calculi, 0.6% brushite calculi, 8.2% uric acid calculi, 2.6% calcium oxalate/uric acid mixed calculi, 1.1% cystine calculi and 1.9% various infrequent calculi. Based on the corresponding urinary analytical studies, each kind of calculus is related with the more frequently associated urinary alterations. CONCLUSIONS: An important aspect of this classification is the possibility to establish, by means of the correct study of the calculus, some of the main possible etiologic factors closely related to its formation.     

Risk-adapted treatment of acute promyelocytic leukemia with all-trans retinoic acid and anthracycline monochemotherapy: long-term outcome of the LPA 99 multicenter study by the PETHEMA Group

A previous report of the Programa de Estudio y Tratamiento de las Hemopatías Malignas (PETHEMA) Group showed that a risk-adapted strategy combining all-trans retinoic acid (ATRA) and anthracycline monochemotherapy for induction and consolidation in newly diagnosed acute promyelocytic leukemia results in an improved outcome. Here we analyze treatment outcome of an enlarged series of patients who have been followed up for a median of 65 months. From November 1999 through July 2005 (LPA99 trial), 560 patients received induction therapy with ATRA plus idarubicin. Patients achieving complete remission received 3 courses of consolidation followed by maintenance with ATRA and low-dose chemotherapy. The 5-year cumulative incidence of relapse and disease-free survival were 11% and 84%, respectively. These results compare favorably with those obtained in the previous LPA96 study (P = .019 and P = .04, respectively). This updated analysis confirms the high antileukemic efficacy, low toxicity, and high degree of compliance of a risk-adapted strategy combining ATRA and anthracycline monochemotherapy for consolidation therapy.     

Is the fasting calcium/creatinine a bone resorption marker in patients with calcium renal stones?

Osteoporosis and osteopenia are an important endocrine-metabolic disease that affect women and men from a certain age and it has a high risk and health cost. The aim of this short communication is to show that fasting calcium/creatinine ratio in patients with calcium stones is a marker of bone resorption.We studied 180 patients with renal stones with calcium composition and the relationship of them between the calcium/creatinine in urine after 8 h of fasting with bone densitometry (T-score) and values of bone resorption marker β-crosslaps (ng/ml). The Pearson correlation test was applied for the analysis of linear correlations between quantitative variables.We have observed a statistically significant positive linear correlation between the fasting calcium/creatinine and serum and β-crosslaps (R = 0.534, p < 0.0001) and a statistically significant negative linear correlation between fasting calcium/creatinine and T-score of bone densitometry in hip (R = -0.237, p = 0.002), femoral neck (R = -0.217, p = 0.009) and lumbar spine (R = 0.292, p = 0.001).The fasting ratio calcium/creatinine in urine is associated with increased levels of β-crosslaps marker and therefore may be useful as a marker of bone resorption in these patients.     

Feasibility of Clinical Hypnosis For The Treatment of Parkinson's Disease: A Case Study

Parkinson's disease is a severe neurodegenerative disorder with a prevalence rate of approximately 1.6% in elderly Americans. This case study reports on a 51-year-old male Parkinson's patient who received 3 weekly sessions of a hypnosis intervention, as well as instruction in self-hypnosis. Actigraphy was used to assess rest-tremor severity. Results revealed a 94% reduction in rest tremors following treatment. Self-reported levels of anxiety, depression, sleep quality, pain, stiffness, libido, and quality of life also showed improvements. The patient reported a high level of satisfaction with treatment. These findings suggest clinical hypnosis is potentially feasible and beneficial treatment for some Parkinson's symptoms. Further investigation with diverse samples and an ambulatory monitoring device is warranted.     

New perspectives in B-1 B cell development and function

In contrast to the predominant population of B-2 B cells produced in the bone marrow, B-1 B cells are a minor population of B lymphocytes that are found in multiple tissues, including the pleural and peritoneal cavities in mice. Although the role of B-1 B cells as effectors of innate-like immunity is widely accepted, their developmental origin has been controversial. This review highlights recent experimental data from murine studies supporting the hypothesis that B-1 B cells belong to a developmental lineage distinct from B-2 B cells, and draws attention to recent studies that have defined new roles for the B-1a and B-1b B-cell subsets in the response to bacteria and self-antigens.