No abstract

Low levels of plasma vitamin E concentrations were found in canine atopic dermatitis (CAD). The present study was aimed at determining the effect of an eight-week vitamin E supplementation on clinical response (Canine Atopic Dermatitis Extent and Severity Index (CADESI-03) scores and pruritus intensity) in dogs with atopic dermatitis. Levels of oxidative stress markers (plasma malondialdehyde and total antioxidant capacity (TAC), blood glutathione peroxidase and erythrocyte superoxide dismutase, plasma and skin vitamin E concentrations) were also determined. Twenty-nine dogs with CAD were included in the study. Fourteen received vitamin E (8.1 IU/kg once daily, orally) and 15 received mineral oil as placebo (orally). All dogs were treated with antihistamine fexofenadine. Levels of oxidative stress markers (with the exception of skin vitamin E), CADESI-03 and pruritus intensity were determined at the beginning, then every two weeks. Skin vitamin E was determined at the beginning and at the end of the treatment. Significantly higher plasma levels of vitamin E and TAC were observed in the vitamin E group than in the placebo group. CADESI-03 scores determined throughout the treatment in the vitamin E group were significantly lower than in the placebo group. The findings of this study support the supplementation of vitamin E in dogs with atopic dermatitis.

Background: Altered homeostasis of vitamin E has been demonstrated in human atopic dermatitis. Data on plasma and skin vitamin E concentrations in canine atopic dermatitis (CAD) are not available. Objective: To determine vitamin E concentrations in plasma and skin of atopic dogs. Animals and Methods: Vitamin E concentrations in plasma and full-thickness skin biopsies of 15 atopic dogs were related to CAD extent and severity index (CADESI-03) scores and compared to the equivalent concentrations in 17 healthy dogs. Statistically significant differences of measured parameters between the two groups were determined by the nonparametric Mann Whitney U test and correlations between CADESI-03 scores and vitamin E concentrations were evaluated by the Spearman rank test. A value of P < 0.05 was considered significant. Results: Plasma concentrations of vitamin E were significantly lower in atopic dogs than in healthy dogs, with median values of 29.8 and 52.9 mmol/L, respectively. Skin vitamin E values did not differ significantly between patients and healthy controls. The median concentration of skin vitamin E in atopic dogs was higher than that in healthy dogs. No significant correlations were found between CADESI-03 score and plasma vitamin E or skin vitamin E concentrations. Conclusions: Significantly lower plasma vitamin E concentrations in atopic dogs than in healthy controls indicate altered homeostasis of vitamin E in CAD. Clinical importance: Further investigation into vitamin E supplementation in CAD is warranted.

OBJECTIVES:The 90-90-90 target set for 2020 is fast approaching and guidelines recommend antiretroviral therapy (ART) for HIV-positive people (HPP), regardless of CD4 count, aiming to improve long-term patient health and to prevent HIV transmission. The objective of this study was to compare the delay between HIV diagnosis and ART initiation across the EU5. METHODS: Data from Ipsos' EU5 HIV Therapy Monitor Scope Study (Scope) were used. Scope is a medical chart review of HPPs conducted at 3-month intervals (N¼206 physicians reporting on patients January, February, and March). Physicians are requested to abstract data on consecutive 7-8 HPPs initiating therapy and 7-8 HPPs switching therapy (i.e., no untreated or stable patients). Data includes demographics, disease history, and treatment patterns. Descriptive analysis was conducted using appropriate statistical tests. RESULTS: The Scope data set had a total of N¼206 physicians and Y¼1,516 initiating patients with a mean age of 36 (standard deviation ¼ 10.8). 75% of patients were male and 24% female. The delay between diagnosis and ART initiation is significantly lower (p<0.05) in Germany (3.8 months) than in Italy (11.4 months) the UK (10.2 months), and Spain (9 months). Across the EU5, 51% of HPPs were diagnosed in physician offices (PO) and 15.7% in sexual health/family planning clinics (SH/FP). POs were the primary location of diagnosis in France (38.1%), Germany (94.1%), Italy (36.8%), and Spain (62.7%). In the UK, significantly more HPPs (p<0.05) were diagnosed in SH/FPs (47.9%). HPPs diagnosed in POs have significantly shorter delays in treatment initiation (6.3 months) (p<0.05) compared to those diagnosed at non-POs (9.2 months). CONCLUSIONS: HPPs in Italy, the UK, and Spain had the greatest delay in ART initiation compared to Germany. Delay in diagnosis to initiation could lead to higher transmission risk, impacting outcomes and targets set for 2020.

No abstract

OBJECTIVES: In Europe, meningococcal serogroup B is the most common cause of invasive meningococcal disease. The disease incidence is the highest among infants, young children and adolescents, while adolescents are considered the key transmitters of meningococci in the population. The disease is rare, but deadly and can cause permanent sequelae. The two new vaccines (4CMenB and rLP2086) were licensed in 2013 and 2017, respectively. Although the cost-effectiveness of vaccination with the vaccine 4CMenB has been assessed, only Ireland, Italy and England introduced this vaccine in the publicly funded national immunization programme (NIP), while Austria and the Czech Republic recommended it but without funding. The aim of the review is to summarise lessons learned from the cost-effectiveness studies and according to that contribute to decision-making for introducing the vaccine in the NIP in the remaining European countries. METHODS: The databases of PubMed and NHS EED were searched systematically to identify contributions (up to April 15, 2018) on the cost-effectiveness of vaccination with the new vaccines versus no vaccination. Keywords like meningococcal, serogroup B, 4CMenB, rLP2086 and cost-effectiveness were used. The quality of these studies was assessed according to the CHEERS checklist, they were only in English, performed for European countries and included different age groups. The main characteristics of the included studies were extracted. RESULTS: A total of nine cost-effectiveness studies were analysed. According to these analyses, vaccination is likely not costeffective due to low incidence of the disease. CONCLUSIONS: Infant vaccination is a relevant strategy to public health in the short run, while adolescent vaccination may be a more effective strategy in the long run, if herd effects are taken into account.OBJECTIVES: Two MenB vaccines are licensed in the US since 2015: MenB-FHbp and MenB-4C, with a category B recommendation for vaccination at ages 16-23. Both vaccines were approved based on immune responses after series completion, but different dosing schedules and recommendations apply: MenB-4C, 2 doses at least 1 month apart; MenB-FHbp: initially 3 doses (at 0, 1-2, and 6 months), now 2 doses 6 months apart. This study evaluated completion and compliance for MenB-4C or MenB-FHbp vaccination (considering both 2-or 3-dose schedules) in individuals aged 16-23. METHODS: This was a retrospective analysis based on claims data from MarketScan Commercial Claims and Encounters through 2/28/2018. The study population included individuals who initiated MenB-4C or MenB-FHbp between 7/1/2015 and 11/30/2016, with continuous health plan enrollment for 6 months prior and 15 months after series initiation. Series completion was defined as individual receipt of the recommended number of doses within the follow-up period, while compliance was based on adherence to recommended dosing schedule for each vaccine. Current recommendations for MenB-FHbp were applied retroactively. RESULTS: 36,118 individuals met the in...

Objectives: The ACTG 5257 clinical trial showed that raltegravir (RAL) was superior to atazanavir/ritonavir (ATV/r) and darunavir/ritonavir (DRV/r), when used in combination with tenofovir DF/emtricitabine (TDF/FTC), in a 96-week composite endpoint combining virologic efficacy and tolerability for treatment-naive adults with HIV-1 infection. This study aimed to estimate costs and efficiency associated with these three regimens in Spain. MethOds: An economic model was developed to estimate costs for antiretroviral drugs, adverse event management, and HIV care for individuals initiating first-line therapy. Head-to-head efficacy and safety data (discontinuation rates based on the trial's composite endpoint, mean CD4+ cell-count changes, adverse event incidence) up to 96 weeks for RAL, ATV/r, and DRV/r were obtained from the ACTG 5257 clinical trial. Antiretroviral drug costs were based on hospital costs with additional mandatory discounts applied. Adverse event management costs and HIV care costs, stratified by CD4+ cell-count range, were obtained from published sources and inflated to 2015 euros. Costs per successfully treated patient (i.e., remaining on first-line therapy for 96 weeks) were estimated for the three regimens and tested in sensitivity and scenario analyses. All outcomes were discounted at 3.0% per year. Results: At 96 weeks, RAL was associated with higher antiretroviral drug costs, lower adverse event costs, and similar HIV care costs when compared with either ATV/r or DRV/r. Total costs per successfully treated patient were € 22,377 for RAL, € 26,629 for ATV/r, and € 23,928 for DRV/r. These results were found to be robust in probabilistic sensitivity and scenario analyses. cOnclusiOns: RAL has the lowest cost per successfully treated patient when compared with two other common first-line regimens, DRV/r and ATV/r, each used in combination with TDF/FTC, for treatment-naive adults with HIV-1 infection in Spain. This economic evidence further complements the known clinical benefits of RAL as reported in the ACTG 5257 clinical trial.