No abstract

Over the past few years, there has been an undiminished interest on lipoprotein(a) [Lp(a)]. High Lp(a) levels have been proposed as an independent causal risk factor for atherosclerotic cardiovascular disease (CVD). The main question that remains to be answered, however, is the potential clinical benefit of Lp(a) reduction. This will contribute to the enrichment of our knowledge on the exact pathophysiological role of this lipoprotein. This narrative review aims to summarize currently available data on the structure, metabolism, and pathogenicity of Lp(a).

Objectives: Study aims were to describe the impact of Tumour Necrosis Factor-α (TNF-α ) inhibitor golimumab on UK real-world healthcare resource use (HRU) and evaluate the clinical effectiveness of golimumab in the treatment of Ankylosing Spondylitis (AS). This abstract presents HRU data for the 6 months pre-and postgolimumab initiation as well as effectiveness data at 6 months post-golimumab initiation compared with the closest observation pre-golimumab initiation. MethOds: This multicentre observational study of consenting adult patients was carried out via retrospective medical chart review in six UK NHS hospital rheumatology departments between November 2015 and October 2016. Inclusion criteria included AS diagnosis, anti-TNF-α -naïve, received minimum three doses of golimumab for AS, and first dose at least 12 months before data collection. Effectiveness was measured using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Spinal Pain Visual Analogue Scale (VAS) and Bath Ankylosing Spondylitis Functional Index (BASFI). Patients with missing data are excluded from the effectiveness analysis. Results: The study enrolled 47 eligible patients, 74% male, mean age of 46.4 years, mean golimumab treatment duration of 2.3 years. A significant reduction of 30.4% (Mann-Whitney p< 0.005) in mean number of rheumatology clinic visits (from 2.3 to 1.6) and a 27.3% reduction in mean number of clinical investigations (from 13.4 to 9.7) over the 12-month period was observed (Mann-Whitney p< 0.05). 74% (32/43) of patients achieved a clinically meaningful change (BASDAI score reduced by 2 or more), and overall mean BASDAI score reduced by 3.9 points [n= 43] (Mann-Whitney p< 0.001). 75% (18/24) of patients achieved a reduction in spinal pain VAS by 2cm or more indicating a treatment response. Overall mean BASFI score improved by 4.1 points [n= 26] (Mann-Whitney p< 0.001). cOnclusiOns: Golimumab was associated with statistically significant reductions in HRU and clinically meaningful improvements in UK patients with AS during the first 6 months of treatment.

IntroductionThere is conflicting evidence regarding the actual incidence of statin-associated side effects in clinical practice. We aimed to record the incidence of statin-associated side effects in the setting of a lipid clinic. We focused on clinically relevant liver enzyme increase and statin-associated muscle symptoms (SAMS).Material and methodsThis was a retrospective study including adult patients with dyslipidemia followed up for ≥ 3 years in a university hospital lipid clinic in Greece. We recorded the incidence of clinically relevant liver enzyme increase (> 3 × upper limit of normal (ULN) on 2 occasions) and SAMS (muscle crumps, creatine kinase (CK) increase > 10 × ULN and rhabdomyolysis) during follow-up.ResultsAmong study participants (n = 1,334), 3.1% and 2.8% presented with clinically relevant liver enzyme increase and SAMS at least once during a median follow-up of 6 years (4–10). Only 11% (n = 5) of subjects with a clinically relevant liver enzyme increase and 6% (n = 2) of those with SAMS did not tolerate any statin at any dose. Most subjects with a history of a clinically relevant liver enzyme increase or SAMS were eventually treated with a moderate- or high-intensity statin (76% and 80%, respectively) or with combination treatment of a statin plus another lipid-lowering drug (15% and 36%, respectively). No risk factors for these statin-associated side effects were identified.ConclusionsThe incidence of statin-associated side effects is low in the setting of a lipid clinic. The vast majority of these individuals were still able to tolerate statin treatment.