Objectiv e: To evaluate clinical,Quality of Life (QoL) and medical cost outcomes in pati ents with symptomatic reflux esophagitis (RE) receiving different ″triple c ombin ation therapy″ . Methods: A multicent...Objectiv e: To evaluate clinical,Quality of Life (QoL) and medical cost outcomes in pati ents with symptomatic reflux esophagitis (RE) receiving different ″triple c ombin ation therapy″ . Methods: A multicenter medical effectiveness trial conducte d in 10 hospitals of 5 regions in Zhejiang Province. 248 patient-volunteers were ass ig ned to 8 weeks of ″ triple combination therapy″ with Lansoprazole plus Cisapri de and Sucralfate or Ranitidine plus Cisapride and Sucralfate. Main outcomes asses sment included symptoms scale scores,RE severity,QoL at baseline and 8 weeks. Medical cost data were collected with cost analysis questionnaire. Results: (1)M ore Lansoprazole group patients noted RE symptoms resolution than Ranitidine gro up(92.3% vs 78.4%,P<0.01). There was no striking difference between two gro ups in RE healing rate (90.8% vs 82.9%, P>0.05). (2)RE significantly impaire d QoL of patients(P<0.001).Compared with Ranitidine group,QoL in Lansoprazole group had significant improvement (rate of ″good″ QoL 64.5% vs 45.6%,P<0.01). (3)T here w as close correlation between symptomic effectiveness and QoL rating scale in bot h the Lansoprazole and Ranitidine group(P<0.01,r=0.235 and 0.353 respec tively). There were no statistical difference of medical cost between the two groups ( P> 0.05). Conclusion: RE significantly impaired QoL of patients. ″Triple combinati o n therapies″ can significantly improve RE symptoms and QoL. Lansoprazole combin ation therapy was more cost-effective than Ranitidine combination group.展开更多
AIM:To evaluate the effectiveness of the biological disease-modifying antirheumatic drugs(b DMARD) in the treatment of rheumatoid arthritis through a systematic review of observational studies.METHODS:The studies were...AIM:To evaluate the effectiveness of the biological disease-modifying antirheumatic drugs(b DMARD) in the treatment of rheumatoid arthritis through a systematic review of observational studies.METHODS:The studies were searched in the Pub Med,EMBASE,Cochrane Controlled Trials Register and LILACS databases(until August 2014),in the grey literature and conducted a manual search.The assessed criteria of effectiveness included the EULAR,the disease activity score(DAS),the Clinical Disease Activity Index,the Simplified Disease Activity Index,the American College of Rheumatology and the Health Assessment Questionnaire.The meta-analysis was performed with Review Manager 5.2 software using a random effects model.A total of 35 studies were included in this review.RESULTS:The participants anti-tumor necrosis factor inhibitors(TNF) nave,who used adalimumab(P = 0.0002) and etanercept(P = 0.0006) exhibited greater good EULAR response compared to the participants who used infliximab.No difference was detected between adalimumab and etanercept(P = 0.05).The participants who used etanercept exhibited greater remission according to DAS28 compared to the participants who used infliximab(P = 0.01).No differences were detected between adalimumab and infliximab(P = 0.12) or etanercept(P = 0.79).Better results were obtained with b DMARD associated with methotrexate than with b DMARD alone.The good EULAR response and DAS 28 was better for combination with methotrexate than b DMARD monotherapy(P = 0.03 e P < 0.00001).In cases of therapeutic failure,the participants who used rituximab exhibited greater DAS28 reduction compared to those who used anti-TNF agents(P = 0.0002).The participants who used etanercept achieved greater good EULAR response compared to those who did not use that drug(P = 0.007).Studies that assessed reduction of the CDAI score indicated the superiority of abatacept over rituximab(12.4 vs +1.7) and anti-TNF agents(7.6 vs 8.3).The present systematic review with meta-analysis found that relative to anti-TNF treatmentnave patients,adalimumab and etanercept were more effective when combined with methotrexate than when used alone.Furthermore,in case of therapeutic failure with anti-TNF agents;rituximab and abatacept(non anti-TNF) and etanercept(as second anti-TNF) were more effective.However,more studies of effectiveness were found for the rituximab.CONCLUSION:The best treatment for treatment-nave patients is adalimumab or etanercept combined with methotrexate.For anti-TNF therapeutic failure,the best choice is rituximab,abatacept or etanercept.展开更多
文摘Objectiv e: To evaluate clinical,Quality of Life (QoL) and medical cost outcomes in pati ents with symptomatic reflux esophagitis (RE) receiving different ″triple c ombin ation therapy″ . Methods: A multicenter medical effectiveness trial conducte d in 10 hospitals of 5 regions in Zhejiang Province. 248 patient-volunteers were ass ig ned to 8 weeks of ″ triple combination therapy″ with Lansoprazole plus Cisapri de and Sucralfate or Ranitidine plus Cisapride and Sucralfate. Main outcomes asses sment included symptoms scale scores,RE severity,QoL at baseline and 8 weeks. Medical cost data were collected with cost analysis questionnaire. Results: (1)M ore Lansoprazole group patients noted RE symptoms resolution than Ranitidine gro up(92.3% vs 78.4%,P<0.01). There was no striking difference between two gro ups in RE healing rate (90.8% vs 82.9%, P>0.05). (2)RE significantly impaire d QoL of patients(P<0.001).Compared with Ranitidine group,QoL in Lansoprazole group had significant improvement (rate of ″good″ QoL 64.5% vs 45.6%,P<0.01). (3)T here w as close correlation between symptomic effectiveness and QoL rating scale in bot h the Lansoprazole and Ranitidine group(P<0.01,r=0.235 and 0.353 respec tively). There were no statistical difference of medical cost between the two groups ( P> 0.05). Conclusion: RE significantly impaired QoL of patients. ″Triple combinati o n therapies″ can significantly improve RE symptoms and QoL. Lansoprazole combin ation therapy was more cost-effective than Ranitidine combination group.
基金Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico,Brazil
文摘AIM:To evaluate the effectiveness of the biological disease-modifying antirheumatic drugs(b DMARD) in the treatment of rheumatoid arthritis through a systematic review of observational studies.METHODS:The studies were searched in the Pub Med,EMBASE,Cochrane Controlled Trials Register and LILACS databases(until August 2014),in the grey literature and conducted a manual search.The assessed criteria of effectiveness included the EULAR,the disease activity score(DAS),the Clinical Disease Activity Index,the Simplified Disease Activity Index,the American College of Rheumatology and the Health Assessment Questionnaire.The meta-analysis was performed with Review Manager 5.2 software using a random effects model.A total of 35 studies were included in this review.RESULTS:The participants anti-tumor necrosis factor inhibitors(TNF) nave,who used adalimumab(P = 0.0002) and etanercept(P = 0.0006) exhibited greater good EULAR response compared to the participants who used infliximab.No difference was detected between adalimumab and etanercept(P = 0.05).The participants who used etanercept exhibited greater remission according to DAS28 compared to the participants who used infliximab(P = 0.01).No differences were detected between adalimumab and infliximab(P = 0.12) or etanercept(P = 0.79).Better results were obtained with b DMARD associated with methotrexate than with b DMARD alone.The good EULAR response and DAS 28 was better for combination with methotrexate than b DMARD monotherapy(P = 0.03 e P < 0.00001).In cases of therapeutic failure,the participants who used rituximab exhibited greater DAS28 reduction compared to those who used anti-TNF agents(P = 0.0002).The participants who used etanercept achieved greater good EULAR response compared to those who did not use that drug(P = 0.007).Studies that assessed reduction of the CDAI score indicated the superiority of abatacept over rituximab(12.4 vs +1.7) and anti-TNF agents(7.6 vs 8.3).The present systematic review with meta-analysis found that relative to anti-TNF treatmentnave patients,adalimumab and etanercept were more effective when combined with methotrexate than when used alone.Furthermore,in case of therapeutic failure with anti-TNF agents;rituximab and abatacept(non anti-TNF) and etanercept(as second anti-TNF) were more effective.However,more studies of effectiveness were found for the rituximab.CONCLUSION:The best treatment for treatment-nave patients is adalimumab or etanercept combined with methotrexate.For anti-TNF therapeutic failure,the best choice is rituximab,abatacept or etanercept.
