This paper assessed the burden of adverse events (AEs) associated with azathioprine (AZA), cyclophosphamide (CYC), mycophenolate mofetil (MMF), methotrexate (MTX), and cyclosporine (CsA) in patients with systemic lupus erythematosus (SLE). Thirty-eight publications were included. Incidence of AEs ranged from 42.8% to 97.3%. Common AEs included infections (2.4–77%), gastrointestinal AEs (3.2–66.7%), and amenorrhea and/or ovarian complications (0–71%). More hematological cytopenias were associated with AZA (14 episodes) than MMF (2 episodes). CYC was associated with more infections than MMF (40–77% versus 12.5–32%, resp.) or AZA (17–77% versus 11–29%, resp.). Rates of hospitalized infections were similar between MMF and AZA patients, but higher for those taking CYC. There were more gynecological toxicities with CYC than MMF (32–36% versus 3.6–6%, resp.) or AZA (32–71% versus 8–18%, resp.). Discontinuation rates due to AEs were 0–44.4% across these medications. In summary, the incidence of AEs associated with SLE immunosuppressants was consistently high as reported in the literature; discontinuations due to these AEs were similar across treatments. Studies on the economic impact of these AEs were sparse and warrant further study. This paper highlights the need for more treatment options with better safety profiles.

No abstract

With major depressive disorder (MDD) associated with significant clinical, economic and health-related quality of life impact, we sought to systematically review and synthesize information relevant to the burden of MDD in Africa and the Middle East, from which published evidence is slim. Our literature search identified 54 publications assessing epidemiological (43), humanistic (5), clinical/treatment (7) or economic outcomes (2). General population MDD prevalence and that among chronic disease populations were similar in Africa and the Middle East. No MDD-related economic literature specific to Africa or the Middle East was identified. Five studies of humanistic outcomes were identified; four African studies documented significant reduction of health-related quality of life related to MDD. The frequency of certain risk factors for MDD, such as disease, trauma and associated stress, as well as patterns of MDD treatment, suggest the potential for a higher burden of disease in Africa and the Middle East than in western countries.

Osteoarthritis and rheumatoid arthritis are conditions that are associated with significant clinical burden, and impact on patients' functional status and quality of life. Medical costs related to treating these common and disabling conditions place an economic strain on healthcare systems. This systematic review was conducted to investigate the impact of celecoxib on healthcare costs for patients with rheumatoid arthritis and osteoarthritis. In total, 24 studies examined economic outcomes associated with celecoxib in patients with these conditions. Six of these studies evaluated economic outcomes in developing regions, including Mexico, Asia and Turkey. Across all geographies, most studies were cost-effectiveness analyses comparing celecoxib with nonselective NSAIDs alone or in combination with gastroprotective agents. Overall, based on local standards, economic models indicated favorable cost-effectiveness profiles for celecoxib compared with nonselective NSAIDs and other active-treatment options. Cost analyses indicated that the use of celecoxib resulted in lower direct medical costs.

ing task with five trials and an interference list (15 new words -List B) read to the subject after the fifth trial of List A. The original RAVLT also includes a recognition trial in which subjects are asked to identify List A words from a larger list of words that includes distractor words. In most versions of the RAVLT, the distractor list is comprised of words from List B as well as other words, most having either a semantic and/or a phonetic link with words from Lists A and/or B. The objective of this abstract is to present the translation process of the RAVLT into US Spanish (six pairs of recall lists and six recognition lists). METHODS: For the recall words, a direct translation, in collaboration with a speech therapist and a neuropsychologist, was recommended, with frequency of use similar to the original as well as word length (Ϯ1 syllable or Ϯ2 syllables and Ϯ2 characters). For the recognition words, the translations had to respect the semantic and phonetic links to the recall words. RESULTS: Fifty out of 180 words from the recall lists raised discussions because of difficulties in finding translations with the appropriate word length. Thirty-four out of 120 words from the recognition list proved difficult to translate because of problems in finding direct translations that respected the phonetic or semantic links to the recall words. For instance, the recognition word "Balloon," OBJECTIVES: To review the methodology of studies evaluating pregnancy/birth/ child development outcomes of prenatal antidepressant exposure (PAE) and, when appropriate, assess the impact on study results using meta-regression. METHODS: A Medline search was conducted up to October 2011, restricting to English and human literature. The MeSH term "antidepressive agents," was combined with MeSH terms for spontaneous abortion, preterm birth(PB), birth weight, small for gestational age, or poor child development. We added relevant articles from reference lists of reviews and included studies. We proposed that antidepressant class, type of data source, adjustment for maternal depression, exposure definition, duration and timing, and adjustment for more than three covariates would impact study results. Cochran's Q statistic was used to test for heterogeneity of results. When heterogeneity existed, meta-regression using a random-effects model was performed to examine the impact of different methodological choices on study results. Meta-regression is a regression analysis in which each study is a unit of observation and the effect estimate is regressed on study characteristics. RESULTS: Of 33 studies included, we found differences in the definition of PAE, data sources, and covariates adjusted. Thirteen studies focused on selective serotonin reuptake inhibitors. Five studies defined exposure as one prescription of antidepressant during pregnancy versus 13 studies required PAE for at least one trimester. Pregnancy information services, birth registries, and referrals from hospitals/clinics were the most common data sources. Only 10 studies...