Tuberculosis (TB) remains as a leading cause of mortality in developing countries, persisting as a major threat to the global public health. Current treatment involving a long antibiotic regimen brings concern to the topic of patient compliance, contributing to the emergence of drug resistant TB. The current review will provide an updated outlook on novel anti-TB therapies that can be given as adjunctive agents to current anti-TB treatments, with a particular focus on modulating the host immune response to effectively target all forms of TB. Additional potential therapeutic pathway targets, including lipid metabolism alteration and vascular endothelial growth factor (VEGF)-directed therapies, are discussed.
BackgroundAlthough multiple therapies have emerged for the treatment of metastatic
renal cell carcinoma (mRCC), it is unclear whether application of these
agents is consistent in developed and developing countries. We sought to
determine patterns of care for mRCC in Brazil as a representative developing
country.Material and MethodsA commercial database was used to acquire information pertaining to patients
with mRCC receiving treatment at private or public hospitals in Brazil
between March 2013 and October 2016. Basic clinical and demographic criteria
were available, as well as information to ascertain the International
Metastatic Renal Cell Carcinoma Database Consortium risk. Treatment-related
data across multiple lines of therapy were collected.ResultsOf 4,379 patients assessed, 3,990 (91%) had metastatic disease, and 26%, 48%,
and 26% of patients had good, intermediate, and poor International
Metastatic Renal Cell Carcinoma Database Consortium risk disease,
respectively. Although 3,149 patients (79%) received first-line therapy,
only 641 (20%) and 152 (5%) received second- and third-line therapy,
respectively. In the first-line setting, vascular endothelial growth
factor–directed agents represented the most commonly used therapy,
whereas in the second-line setting, vascular endothelial growth
factor– and mammalian target of rapamycin–directed agents were
used with similar frequency. Marked differences were seen in receipt of
systemic therapy on the basis of treatment in private or public
hospitals.ConclusionRelative to developed countries, marked attrition is noted between each
subsequent line of therapy in Brazil. Patterns of care also vary greatly in
private and public settings, pointing to financial constraints as a
potential cause for discordances in treatment.
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