Background Therapeutic drug monitoring (TDM) is currently planned and ordered by doctors at an outer metropolitan hospital. Previous audits looking at clozapine and low-molecular weight heparin (LMWH) TDM found that sample timing was
Background: The treatment with Trastuzumab (T) is associated with a certain degree of cardiotoxicity. This study sought to evaluate the level of nt-pro-BNP as a possible marker of cardiotoxicity so accurate as the value of left ventricular ejection fraction (LVEF)
Patients and methods: Forty patients with breast cancer treated with T were prospectively measured LVFE with echocardiography and nt-pro-BNP level before and every 3 months during T treatment. Median age: 50years(27;70). Received T as adjuvant treatment: 82.5% of the patients and 17.5% for metastatic disease.Patients with previous chemotherapy: 13(32.5%)neoadjuvant, 23(57.5%)adjuvant and 7(17.5%) for metastastic disease. Patients with previous treatment with anthracyclines: 12(30%)neoadjuvant, 21(52.5%)adjuvant and 2(5%)for metastatic disease(one patient had received anthracyclines too during adjuvant treatment).None received anthracyclines and T concomitant. Chi-square analyzed the correlation of high pathological level of nt-pro-BNP (values over the normal ***range, adjusted by the patient age) and a significative decrease of LVEF (more than 10% when LVEF >50% or more than 5% when LVEF< 50%)
Results: A decrease in LVEF was observed in 6 patients(15%) and pathological high levels of nt-pro-BNP in 7(17.5%).Two patients(5%) presented cardiac insufficiency with clinical symptoms, in both nt-pro-BNP was higher than 600pg/ml and LVEF lower than 40%. In the other patients the decreases of LVEF(never were<40%) or high levels of nt-proBNP(never were>600pg/ml)were not related to any clinical symptoms. Chi-square analysis showed a correlation between pathological high levels of nt-pro-BNP and significative decrease of LVEF (p=0.001), The estimated risk of a false negative nt-pro-BNP result (nt-pro-BNP normal value and significative LVEF decrease) was 2.735% (95 % confidence interval: 0.878 to 8.522 %) and the estimated risk of a false positive nt-pro-BNP result (nt-pro-BNP pathological value and no significative LVEF decrease) was 0.132%(95% confidence interval: 0.39 to 0.448%) Conclusion:The level of nt-pro-BNP is a possible marker of cardiotoxicity so accurate as the value of LVEF in patients with breast cancer treated with T.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-20-02.
OBJECTIVES: Biologic disease-modifying anti-rheumatic drugs (bDMARDs) are a major contributor to the substantial costs associated with psoriatic arthritis (PsA), a chronic inflammatory rheumatic disease associated with psoriasis. Currently there are no cost-effectiveness analyses (CEAs) comparing the interleukin-17A antagonists ixekizumab and secukinumab in Spain. A CEA was conducted from the perspective of the Spanish National Health System to compare the cost-effectiveness of ixekizumab versus secukinumab in bDMARD-naïve patients with PsA and concomitant moderate-to-severe psoriasis. METHODS: A Markov model with a lifetime horizon and monthly cycles was developed based on the widely accepted York model. The model included four health states: induction period (12 weeks), continuous treatment, best supportive care (BSC) and death. The response criterion was a combination of Psoriatic Arthritis Response Criteria and 90% improvement in Psoriasis Area Severity Index (PASI90). At the end of the bDMARD induction period, responders transitioned to continuous treatment with the induction bDMARD. Non-responders and patients who discontinued continuous treatment transitioned to BSC. Clinical efficacy data were derived from network meta-analyses. Health utilities were generated by applying a regression analysis to PASI and Health Assessment Questionnaire scores collected in the SPIRIT studies with ixekizumab in PsA for bDMARD-naïve patients with moderate-to-severe psoriasis. Only direct medical costs were included (year of costing 2017). RESULTS: Ixekizumab was associated with incremental reductions in costs of V5,333 and comparable gains in quality-adjusted life-years (QALYs) with a difference of 0.01 in favour of ixekizumab. Deterministic and probabilistic sensitivity analyses globally confirmed the base case results. CONCLUSIONS: Yielding comparable QALY gains at lower cost, ixekizumab is cost-effective versus secukinumab in biologic-naïve PsA patients with concomitant moderate-to-severe psoriasis in Spain.
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