Adalimumab, etanercept and infliximab for the treatment of ankylosing spondylitis: a systematic review and economic evaluation

Institución donde se llevó a cabo el estudio: Universidad Tecnológica de Pereira Introducción. Los inhibidores del factor de necrosis tumoral alfa han presentado un consumo creciente y generan una importante carga económica para los sistemas de salud. Objetivo. Determinar los patrones de prescripción de inhibidores del factor de necrosis tumoral en una población de personas afiliadas al Sistema General de Seguridad Social en Salud de Colombia. Materiales y métodos. Se trata de un estudio descriptivo observacional, de 316 pacientes que recibieron inhibidores del factor de necrosis tumoral, entre enero de 2008 y junio de 2009. Se consideraron las indicaciones, criterios de inclusión, tiempo de evolución de enfermedad, enfermedades concomitantes y reacciones adversas. Se utilizaron las pruebas t de Student y de ji al cuadrado, para la comparación de variables cuantitativas y categóricas respectivamente; se hizo un análisis multivariado. Resultados. La edad promedio fue de 44,6±13,9 años; 63,9 % de los participantes fueron mujeres. El 17,1 % de los pacientes recibía monoterapia. El orden de prescripción de los medicamentos fue: adalimumab (37,3 %), infliximab (37,3 %) y etanercept (25,4 %), todos a dosis diarias definidas adecuadas. La medicación concomitante más frecuente fue: antirreumáticos modificadores de enfermedad (82,9 %), AINE (29,1 %), omeprazol (22,5 %), antihipertensivos (21,2 %) y ácido fólico (19,9 %). El 10,4 % de los pacientes tenía registro de alguna reacción adversa a los medicamentos. El costo promedio del tratamiento por paciente y año, fue de $23.464 dólares. Conclusiones. Los anti-TNF se emplearon a las dosis recomendadas, principalmente en artritis reumatoide y en combinación con otros antirreumáticos. El costo directo del tratamiento se consideró elevado para el sistema sanitario del país.Palabras clave: agentes antirreumáticos, factor de necrosis tumoral alfa, artritis reumatoide, artritis reumatoide juvenil, espondilitis anquilosante, psoriasis, Colombia. Profile of use of anti tumor necrosis factor in Colombian patientsIntroduction. Tumor necrosis factor-alpha antagonists (anti-TNFa) have shown an increasing consumption and generate a significant economic burden on health systems. Objectives. The prescribing patterns of tumor necrosis factor-alpha antagonists were determined in a patient population associated with the Sistema General de Seguridad Social en Salud in Colombia. Materials and methods. A descriptive observational study was conducted in 316 patients with respect to use of tumor necrosis factor-alpha antagonists during a treatment period from January 2008 to June 2009. The database examined contained indications of use, inclusion criteria to medication, duration of illness, co-morbidities and adverse reactions. The data were retrieved from the clinical histories. Student´s t test was used for the comparison of quantitative variables, and the chi-square test was used to establish associations between categorical variables and multivariate analysis were used. Results. Mean age was ...

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“…Algunos estudios han mostrado mejores relaciones de costo-efectividad para etanercept y adalimumab comparados con infliximab (15,22,23).…”

Section: Reacción Adversa Descrita N (%)unclassified

Perfil de utilización de los anti-factor de necrosis tumoral en pacientes de Colombia

Machado

Moncada²,

Pineda³

2011

biomedica

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“…5 Furthermore, the daily productivity of patients with active disease, which was substantially associated with functional impairment and disease activity, could greatly improve with infliximab, and this was associated with reduced workday loss in employed patients. In a metaanalysis of the cost effectiveness of anti-TNF␣ therapy, however, McLeod et al 16 found that none of the 3 agents was cost-effective in the short term. Thus, larger clinical trials are required to prove convincingly the cost effectiveness of anti-TNF␣ therapy.…”

Section: Recommendations Of Combined Asas/eular Groupsmentioning

confidence: 99%

Nonsurgical management of ankylosing spondylitis

Sangala

Dakwar

Uribe

et al. 2008

FOC

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Object The aim of this study was to review the current evidence-based nonsurgical management strategies of ankylosing spondylitis (AS) for spine surgeons. Whereas surgical management is indicated in a highly selected group, nonsurgical management is itself a useful measure for nearly all patients with AS. Methods The authors conducted a literature review of PubMed using relevant search words. All the articles published in English in the last 15 years were reviewed and the level of evidence provided by them was noted. Results Nonpharmacological treatments in the form of physical therapy and patient education have Level Ib evidence in maintaining function in AS. There is Level Ib evidence supporting the use of nonsteroidal antiinflammatory drugs (NSAIDs) and coxibs for treatment in patients with symptoms. There is not enough evidence to support the use of conventional disease-modifying antirheumatoid arthritis drugs. Tumor necrosis factor (TNF)α inhibitors (infliximab, etanercept, and adalimumab) are associated with Level Ib evidence in improving spinal pain, function, inflammatory biomarkers, and spinal inflammation detected by magnetic resonance imaging in patients in whom symptom duration has exceeded 3 months. Conclusions Physical therapy and patient education are useful for all patients diagnosed with AS. If symptomatic, patients are started with either a course of nonselective NSAIDs or a selective cyclooxygenase-2 inhibitor. The role of NSAIDs as a disease-modifying therapy in the treatment of AS is increasingly being understood. The central role of TNF in the pathogenesis of AS is now known, and the advent of biological treatment in the form of anti–TNFα factors has revolutionized the medical management of AS and is used in patients with axial disease whose symptoms persist despite an adequate dose of NSAIDs.

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“…Short term benefits include significant improvements in the control of the disease, function and quality of life. Younger patients with a shorter disease duration respond better to anti-TNF-a agents [35]. The pharmacological properties of the anti-TNF-a agents are summarised in Table 2 [36][37][38][39].…”

Section: Novel Drugsmentioning

confidence: 99%

Ankylosing spondylitis: recent developments and anaesthetic implications

Woodward

Kam

2009

Anaesthesia

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Summary Ankylosing spondylitis can present significant challenges to the anaesthetist as a consequence of the potential difficult airway, cardiovascular and respiratory complications, and the medications used to reduce pain and control the disease. There is also an increased risk of neurological complications in the peri‐operative period. Awake fibreoptic intubation is the safest option in those patients with a potentially difficult airway as it allows continuous neurological monitoring while achieving a definitive airway. Neurophysiological monitoring (somatosensory and motor evoked potentials) should be considered in patients undergoing surgery for cervical spine deformity. The medical management of the disease has improved with the use of anti‐tumour necrosis factor‐α agents. There is potential for increased wound infection in patients taking these drugs. This article reviews the anaesthetic issues in patients with ankylosing spondylitis. The challenge to the anaesthetist is in the understanding of these issues so that appropriate management can be planned and undertaken.

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Adalimumab, etanercept and infliximab for the treatment of ankylosing spondylitis: a systematic review and economic evaluation

Cited by 142 publications

References 47 publications

Perfil de utilización de los anti-factor de necrosis tumoral en pacientes de Colombia

Perfil de utilización de los anti-factor de necrosis tumoral en pacientes de Colombia

Nonsurgical management of ankylosing spondylitis

Ankylosing spondylitis: recent developments and anaesthetic implications

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