To conduct a systematic review and meta-analysis investigating the effect of tofacitinib and baricitinib on venous thromboembolism (VTE) risk. Search of PubMed, EMBASE, Web of Science, Scopus, Clini-calTrials.gov, LILACS, and Google Scholar databases to identify controlled observational and clinical trials reporting on adverse effects in patients treated with oral tofacitinib or baricitinib up to July 2020. The outcome measure was occurrence of VTE events. We analyzed 59 studies involving 14,335 patients treated with tofacitinib or baricitinib and 11,612 patients who received another active drug or placebo. The meta-analysis showed an odds ratio (OR) for VTE events of 0.29 (95% confidence interval [CI] = 0.10-0.84) overall for tofacitinib based on data from 10 clinical trials with 15 treatment arms; similar ORs were observed for the 10 mg/d dose (OR = 0.18; 95% CI = 0.02-1.60) and the 20 mg/d dose (OR = 0.19; 95% CI = 0.04-0.91). The ORs for VTE events for baricitinib were 3.39 (95% CI = 0.82-14.04) overall, 3.05 (95% CI = 0.12-75.43) for 2 mg, 3.64 (95% CI = 0.59-22.46) for 4 mg, and 3.0 (95% CI = 0.12-76.49) for 7 mg. The indirect meta-analysis comparing tofacitinib with baricitinib (10 clinical trials with 15 treatment arms) showed an OR for VTE events of 0.086 (95% CI = 0.02-0.51) for tofacitinib and a superior safety profile for VTE events. In the meta-regression analysis (19 clinical trials with 21 treatment arms), the effect was 0.02 (95% CI = À0.04 to 0.08) for tofacitinib and À0.01 (95% CI = À1.29 to 1.26 for baricitinib. Plotting of the data for tofacitinib showed that VTE risk increased with high doses. The effect, however, was less than 1 for the 10-mg and 20mg doses, indicating a protective effect. This effect was not observed for baricitinib. Tofacitinib is not associated with an increased risk of VTE and has a superior safety profile to baricitinib in this respect. Tofacitinib may exert a protective effect against VTE.
BackgroundThe inappropiate use of antibiotics is leading to the appearance of resistance that, along with the decline in the development of new antibacterials, makes some experts talk about a future post-antibiotic period. Approximately between 80% and 90% of antibiotics use occurs in outpatients. It is estimated that about half of the antibiotic prescriptions in outpatients are inappropriate due either to antibiòtic selection, dosage or duration.PurposeThe primary objective of the project is to measure the impact of a multimodal intervention on the use of antibiotics in the emergency department (ED) of a primary care area (PCA).Material and methodsProspective study with intervention in ED of a PCA (population: 260,517) from January to June 2017. Recorded variables: defined daily dose (DDD) of amoxicillin, amoxicillin/clavulanic, macrolides, quinolones and other antibiotics from January to June 2017. The information was extracted from patients’ medical prescriptions.Intervention1) Emergency physiciansa) Commitment: The programme was presented to the head of the ED medical service, emergency physicians and primary care centre directors, through face-to-face sessions. Poster reminders of the project were placed in medical consultations and the ED.b) Actions directed to improve the prescription of antibiotics: An antimicrobial stewardship guideline was designed with local antimicrobial recommendations.c) Audit and feedback: Information was provided to emergency physicians, with their antimicrobial consumption rate establishing a comparison between physicians and the ED average.d) Education and experience: Interactive clinical sessions were held on different pathologies included in the antimicrobial stewardship programme.2) PatientsPosters and educational brochures for waiting rooms and consultations were designed.ResultsFrom January to June 2017 total antibiotic use was reduced by 14.4% DDD compared to the same period of 2016. A decrease in the main families of antibiotics was observed: 22.42% amoxicillin, 6.89% amoxicillin/clavulanic, 21.96% macrolides, 32.42% quinolones and 1.73% of other antibiotics.ConclusionThe strategy designed to improve the use of antibiotics in the ED of the PCA led to a decrease in antibiotic consumption.References and/or AcknowledgementsNo acknowledgementsNo conflict of interest
BackgroundHyperglycaemia is the most frequent complication in patients with parenteral nutrition (PN). Numerous factors may favour its appearance.PurposeIdentify the predictive factors of hyperglycaemia in patients with PN in order to guide the design of a starting PN.Material and methodsRetrospective observational study (January to December 2016) performed in a 450-bed university hospital.All adult patients with central venous PN were included.Recorded variables: sex, age, body mass index (BMI), patient classification (surgical, critical and medical), diagnosis, comorbidities, duration and carbohydrates/kg (HC/kg) provided in PN, glycaemia prior to PN initiation, renal clearance (Clr), presence of sepsis and treatment with potentially hyperglycaemic drugs. Hyperglycaemia was defined as three consecutive blood glucose levels>150 mg/dL or two>180 mg/dL.Descriptive, bivariate and multivariate statistical analysis (binary logistic regression) was performed using the SPSS. v. 24 program.ResultsTwo hundred and thirty-four patients were included, 65.8% male, mean age 65.3±14.2 years and BMI of 26.1±6.0 kg/m2. 66.7% were surgical, 16.2% critical and 17.1% medical patients. 20.1% had diabetes mellitus (DM), 19.2% dyslipidaemia, 10.3% hypertension, 7.3% kidney failure (KF), 4.3% heart failure (HF) and 1.3% hepatic failure. The mean duration of PN was 9.3±7.5 days, with a mean of 3.0±0.7 g HC/kg. Mean pre-glycaemia was 135.7±47.3 mg/dL. 16.7% received corticosteroids, 7.3% octreotide and none immunosuppressants. The prevalence of hyperglycaemia was 44% and 11.1% of sepsis.The predictive factors identified after the multivariate analysis were DM (p<0.001 95% CI: 3.028 to 31.697 OR: 11), previous glycaemia (p<0.001, 95% CI: 1.026 to 1.051 OR: 1), corticosteroid treatment (p=0.023, 95% CI: 1.183 to 9.219 OR: 3.3) and Clr (p=0.010, 95% CI: 0.968 to 0.996 OR: 0.982). No statistical significance was obtained in relation to age, KF, HF, dyslipidaemia, sepsis, PN duration and HC/kg, these variables were significant in the bivariate analysis.ConclusionDM, previous elevated blood glucose levels, critical patient, low Clr and treatment with corticosteroids are predictive factors of developing hyperglycaemia, so it would be convenient to consider them in the design of the PN formula.References and/or AcknowledgementsI wish to acknowledge the help provided by the pharmacy membersNo conflict of interest
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