Background. Non-adherence to treatment, especially in chronic conditions, is a significant problem facing clinical medicine. Failure to adhere to treatment recommendations is often noted in the treatment of osteoporosis, which reduces the effectiveness of anti-osteoporotic drugs and a set of measures to prevent the occurrence of osteoporotic fractures.Aim. The aim of the study was to assess the adherence of patients of the Center for the Prevention and Treatment of Osteoporosis to treatment with anti-osteoporotic drugs of pathogenetic action.Materials and methods. This continuous observational study analyzed the adherence to long-term anti-osteoporotic therapy of patients observed at the Center for the Prevention and Treatment of Osteoporosis, the reasons for discontinuing treatment, doctors’ preferences in prescribing anti-osteoporotic therapy, reasons for changing the anti-osteoporotic drug. The study period is from July to December 2019.Results. During the analyzed period, 625 patients turned to the Center for the Prevention and Treatment of Osteoporosis. The preferences of doctors when prescribing anti-osteoporotic therapy have changed: the proportion of prescriptions for zoledronic acid and denosumab increased, mainly due to a reduction in the prescriptions of strontium ranelate, as well as risendronic acid, teriparatide, and calcitonin was no longer prescribed. Among 370 patients who received a therapeutic appointment (with an already known outcome of a therapeutic appointment), 40.0 ± 2.5% were non-compliant. Including: 9.7 ± 1.5% did not start taking the drug, interrupted the course ahead of schedule — 28.7 ± 2.4%. The termination of the course of therapy in 57.7% of cases was unauthorized, in another 42.3% it was associated with side effects. Patients started and continued further therapy with the initially prescribed drug in 53.8% of cases. As expected, the best adherence rates were found for drugs with parenteral administration once a year (zoledronic acid).Conclusions. Comparative analysis of the prescriptions of the main drugs of the pathogenetic action of patients of the center for the prevention and treatment of osteoporosis showed low compliance.
Introduction. Diffuse large B-cell lymphoma (DLBCL) is the most common (30-35%) type of B-cell lymphomas. Only about 60% of all newly diagnosed advanced-stage DLBCL can be completely treated by x6 CHOP-R only. High dose chemotherapy (HDCT) followed by autologous hematopoietic stem cell transplantation in the first remission (upfront auto-HSCT) can serve an option to improve prognosis in these patients (pts).Aim. To improve prognosis in DLBCL IV stage, IPI ≥2 pts by upfront auto-HSCT.Materials and methods. Included 105 pts: DLBCL NOS, age 18-65, stage IV, IPI ≥2, CR/PR after x6 CHOP/EPOCH + R from 2010 to 2019 at NMRC of Oncology named after N.N. Petrov of MoH of Russia were retrospectively analyzed. HSCT group includes pts with upfront HDCT followed by auto-HSCT (n = 35). The control group includes pts with non-invasive follow-up after induction only (n = 70). Primary endpoints were overall (OS) and progression-free survival (PFS). Secondary endpoints were response rate, relapse rate and treatment toxicity.Results and discussion. The 3-yr OS (p = 0.01) and 3-yr PFS (p = 0.018) were significantly higher in HSCT group. The complete response rate was significantly increased after upfront auto-HSCT (p < 0.001). Early relapse served as an independent negative prognostic factor in OS (p < 0.001) and experienced statistically less in HDCT group (p = 0.027). Early (ER) and late relapse (LR) rate were higher in pts with DEL (ER - p < 0.001, LR - p < 0.001 in control group and ER - p < 0.001, LR -p = 0.013 in all pts). The overall relapse rate was higher if pts had >1 extranodal site with lung involvement (p < 0.004 in the control group and p = 0.021 in all pts). Prognostic models suggested DEL and presence of >1 extranodal site with lung involvement as an independent negative prognostic factors for increasing the relapse probability in two years after treatment.Conclusion. Upfront HSCT can serve as a clinical option to consolidate the first remission in IV stage DLBCL pts with DEL and/or >1 extranodal sites with lung involvement.
Background. In addition to regulating mineral metabolism and bone metabolism, vitamin D is important for supporting structure and other types of connective tissue. Studies have shown the role of vitamin D deficiency in the pathogenesis of systemic inflammatory diseases of the connective tissue, autoimmune diseases. The results of studying this problem in countries with different geographic locations are also of interest.Aim. Comparative assessment of vitamin D status of patients with systemic inflammatory diseases of the connective tissue and patients without rheumatic diseases.Materials and methods. This cross-sectional observational study analyzed the vitamin D supply of the following groups: patients with systemic inflammatory diseases of the connective tissue who do not take vitamin D preparations, patients with systemic inflammatory diseases of the connective tissue who take vitamin D preparations, and «conditionally healthy» individuals, without complaints, examined in the same period comparable in gender and age with the patients of the main group. The vitamin D supply of the studied patients was determined by the level of the content of the vitamin D metabolite calcidiol in the blood serum 25 (OH) D. Study period: January 2019 to December 2020.Results. The data of 625 patients who applied to the Osteoporosis Prevention and Treatment Center for the specified period were analyzed. Among the patients of the main group who did not take vitamin D preparations, a deficiency was revealed in 54.7% of the examined, the optimal provision in 11.2%. The median serum 25 (OH) D concentration was in the range of 19.0 ng / ml deficiency. The study participants belonging to the comparison group had a deficit in 44.1% of cases and an optimal provision in 21.5%. The study group of the main group receiving vitamin D preparations had the maximum number of individuals with the optimal status – 37.0%, while a significant part of the examined had a deficit of varying severity – 29.1%. In addition, this group was characterized by the highest median serum metabolite 25 (OH) D – 26.0 ng / ml.Conclusion. A comparative analysis of the D-vitamin status of patients with systemic inflammatory diseases of the connective tissue and «conditionally healthy» individuals without complaints was carried out, which made it possible to establish differences in the provision depending on the existing disease, as well as depending on the therapy with vitamin D preparations. a lower supply of vitamin D than control group «healthy» individuals. In the case of receiving vitamin subsidies, the provision with it in the group of patients was statistically significantly higher, both in comparison with patients who did not take the vitamin, and in comparison, with individuals from the comparison group.
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