Purpose: Reduced heart rate variability significantly increases cardiovascular mortality. Metabolic syndrome increases the cardiac autonomic dysfunction. Recently, increasing cardiovascular mortality has been reported in patients with schizophrenia. This study was done to compare heart rate variability between adults with and without schizophrenia and to compare the relationship of heart rate variability to metabolic syndrome in hospitalized patients with schizophrenia. Methods: This was a descriptive and correlational study in which 719 adults without schizophrenia and 308 adults with schizophrenia took part between May and June 2008. We measured the following: five-minute heart rate variability; high-frequency, low-frequency, the ratio of low-frequency to high-frequency, and the Standard Deviation of all the normal RR intervals. Data was also collected on metabolic syndrome, abdominal obesity, triglycerides, HDL cholesterol, blood pressure and fasting glucose. Results: The Standard Deviation of all the normal RR intervals values of heart rate variability indices were 1.53±0.18. The low-frequency and high-frequency values of heart rate variability indices were significantly higher in hospitalized patients with schizophrenia (3.89±1.36; 3.80±1.20) than those in the healthy participants (2.20±0.46; 2.10±0.46). There were no significant differences between the schizophrenic patients with and without metabolic syndrome. Conclusion: The results of this study indicate that schizophrenia patients have significantly lower cardiac autonomic control, but they have significantly higher low-frequency and high-frequency values than those of healthy adults. Use of antipsychotic drug may affect the autonomic nervous system in schizophrenic patients. Metabolic syndrome was not associated with cardiac autonomic control in schizophrenia patients.
Background The concerns about development of adverse events (AEs) in elderly RA patients as a result of age-related changes in drug metabolism and the presence of comorbid illnesses are emphasizing due to increasing prevalence of rheumatoid arthritis (RA) in old age. However, they tend to be inadequately represented in RA clinical trials because of the exclusion criteria that are commonly applied. The tolerability and safety of TNF inhibitors in elderly patients have not been also evaluated in clinical practice. Objectives This study aimed to determine the safety of TNF inhibitors and predictors of its discontinuation in elderly RA patients. Methods We recruited 429 RA patients [838 patients-year (PY)] treated with TNF inhibitors from a retrospective biologics registry in Korea of REtrospective study for Safety and Effectiveness of Anti-RA treatment with biologiCs (RESEARCh). We divided patients into two groups of elderly (age ≥65 years) and young RA patients (age <65 years). The period of observation for evaluating safety was defined as the time between starting of TNF inhibitors and termination of treatment. Incidence rate (IR) of serious adverse events (SAEs) in elderly patients was compared to that of young patients. Drug retention rates of both groups were compared using Kaplan-Meier analysis. Potential predictors of discontinuation of TNF inhibitors were also examined using multivariate logistic regression analyses. Results Among total RA patients treated with TNF inhibitors (n=429), the 13.5% of patients (n=58, 110 PY) was classified in elderly group and 371 patients (728 PY) were included in young group. At the baseline, the elderly group had more male than young group (27.6% v.s. 11.9%, p=0.003) and were treated with lower dosage of methotrexate (13.0±3.64 v.s. 14.2±3.55 mg/week, p<0.001). Elderly patients had more comorbid condition such as pulmonary disease, diabetes mellitus and hypertension (p<0.001) and pulmonary tuberculosis history (p=0.017). For the safety, IR of SAE were slightly higher in elderly patients (7.27/100 PY) than young patients (5.22/100 PY). In elderly group, IR of malignancy (1.82/100 PY v.s. 0.96/100 PY) and respiratory disorder (1.82/100 PY v.s. 0.41/100 PY) were higher than young group. In the analysis of retention rates of TNF inhibitors, there was no significant difference between elderly and young patients (p=0.553 by log-rank test). However, there was a difference in the frequent reasons of discontinuation; development of AE (26.32%) and patients' need (26.32%) in elderly patients, while that was ineffectiveness (34.93%) in young patients. The predictors of discontinuation were also differ in two groups; age (OR 2.01, CI 1.10-1.45) and glucocorticoid use ≥5mg (OR 4.33, CI 1.01-18.60) in elderly group, while short disease duration (OR 2.01, CI 1.10-1.45), first user (v.s. switcher, OR 1.96, CI 1.19-3.13) and infliximab use (v.s. etanercept, OR 1.67, CI 1.05-2.64) in young group. Conclusions The IR of malignancy and respiratory disorder could be increased in elderly p...
Background Recently, it was reported that the antinuclear antibody (ANA) before starting anti-TNF treatment or development of ANA might be related with clinical response of TNF inhibitors or side effect of infusion reactions. Objectives The aims of this study were to examine the prevalence of positive ANA before starting TNF inhibitors in patients with RA and to investigate the impact of ANA positivity on persistency of anti-TNF treatment. Methods Among 355 RA patients who started their first TNF inhibitor between 2000 and 2011, 273 patients who had performed ANA test before starting anti-TNF treatmentwere identified in theretrospective biologics registry in Korea of REtrospective study for Safety and Effectiveness of anti-RA treatment with biologiCs (RESEARCh). We classified all patients into two groups according topositivity of ANA; positive group (ANAtitres at a dilution ≥1:160) and negativegroup (ANAtitres <1:160). The period of observation for evaluating drug survival was defined as the time between starting of TNF inhibitors and their discontinuation or their last study visit if they continued therapy. Kaplan-Meier survival analysis was used to assess persistence, log-rank tests were used to compare drug survival between ANA positive and negative groups, and Cox proportional hazards models were used to assess whether ANA positivity is a potential predictor of treatment discontinuation. Results Among 273 RA patients (mean age of 47.9 years and 85% of female), 131 (48%) patients were ANA positive before starting TNF inhibitors. At the baseline, ANA positive group was more commonly positive with rheumatoid factor (80% vs. 65%, p<0.01) and had higher disease activity with DAS 28 (6.2±0.9 vs. 5.9±0.9, p<0.01) compared to ANA negative group, while other potential predictors were comparable between two groups. In both groups, there was no significant difference in drug discontinuation rates due to all causes (P=0.97), side effects (p=0.83), and non-effectiveness (p=0.67). Cox-proportional hazards models showed that ANA positivity was not a risk factor for discontinuation due to all causes (OR 1.02, CI 0.63-1.65), side effects (OR 1.00, CI 0.98, 1.02), and non-effectiveness (OR 1.00, CI 0.97, 1.02). Conclusions The prevalence of ANA positivity in RA patients who started TNF inhibitors were 48% and ANA positive patients had higher disease activity and RF positivity compared to ANA negative RA patients. However, ANA positivity was not associated with TNF inhibitor discontinuation due to overall causes, side effects, and non-effectiveness. Acknowledgements This study was supported by a grant of the Korea Healthcare technology R&D Project, Ministry of Health and Welfare, Republic of Korea.(HI10C2020). Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4129
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