Reasons for Discontinuation and Adverse Effects of TNFα Inhibitors in a Cohort of Patients With Rheumatoid Arthritis and Ankylosing Spondylitis.

BACKGROUND: The introduction of anti-tumor necrosis factor α (anti-TNFα) drugs has improved the clinical outcomes in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). However, these drugs may cause adverse effects that motivate a change in or discontinuation of the treatment. OBJECTIVE: To evaluate the causes of discontinuation or changes in the dosage regimen in a cohort of patients with RA and AS treated with infliximab, adalimumab, etanercept, and golimumab under clinical practice conditions. METHODS: This was a retrospective observational study that included patients with RA or AS treated with anti-TNFα drugs between 2008 and 2013. Changes in the dosage regimen, reasons for treatment discontinuation, and adverse effects were recorded and analyzed. Time to discontinuation was estimated using Kaplan-Meier survival analysis. RESULTS: A total of 123 patients with RA and 93 patients with AS were treated with anti-TNFα therapy. During the study, 55.3% of RA patients and 41.7% of AS patients had stopped the treatment. The most frequent changes were modifications in the dosing, and the most frequent adverse effects were reactions after the infusion or injection (53.8% and 66.7% in RA and AS, respectively). Drug survival of etanercept in RA (67.9%) is greater than for adalimumab and infliximab, whereas drug survival of infliximab in AS (70.0%) is greater than for etanercept and adalimumab at 5 years, although there were no significant differences ( P = 0.098 in RA and 0.194 in AS). CONCLUSIONS: The main cause of discontinuation of anti-TNFα is therapeutic failure in both diseases. Etanercept and infliximab have the best survival rates in RA and AS, respectively.

[Nab-Paclitaxel plus gemcitabine in patients with metastatic pancreatic adenocarcinoma: experience of use]. / Nab-Paclitaxel asociado a gemcitabina en el tratamiento del adenocarcinoma de páncreas metastásico: experiencia de uso.

OBJECTIVE: To evaluate the results obtained with the combined use of nab-paclitaxel and gemcitabine in the treatment of patients with metastatic pancreatic adenocarcinoma. MATERIALS AND METHODS: Retrospective observational study. Patients treated with nab-paclitaxel and gemcitabine between January of 2013 and January of 2014 were selected. Demographical and clinical data were gathered. RESULTS: 15 patients (mean age 59,4 ± 10,3 years) were included. All patients received the combination of nab-paclitaxel and gemcitabine in first-line metastatic disease. Nine received adjuvant treatment before the disease was metastatic. The median progression-free survival rate with combined nab-paclitaxel and gemcitabine was 5,6 months (95% CI: 4,44 - 8,03). In two patients the treatment was stopped due to toxicity. CONCLUSIONS: The treatment with nab-paclitaxel and gemcitabine in our patients resulted in progression-free survival rates similar to those published in clinical trials with good treatment tolerability.

Objetivo: Describir los resultados obtenidos en el uso de nab-paclitaxel y gemcitabina en el tratamiento de pacientes con adenocarcinoma de páncreas metastático. Material y métodos: Estudio observacional retrospectivo. Se seleccionaron pacientes en tratamiento con nab-paclitaxel asociado a gemcitabina entre enero 2013 y enero 2014. Se recogieron datos demográficos y clínicos. Resultados: Se incluyeron 15 pacientes (edad media: 59,4 ± 10,3 años). Todos ellos recibieron la combinación de nab-paclitaxel y gemcitabina en primera línea para la enfermedad metastásica. Nueve recibieron tratamiento adyuvante antes de que la enfermedad fuera metastásica, siendo la media de líneas de tratamiento previamente al uso de la combinación de 1,1. La mediana de supervivencia libre de progresión fue de 5,6 meses (IC 95%: 4,44 - 8,03). Sólo dos pacientes suspendieron el tratamiento por toxicidad. Conclusiones: El tratamiento con nab-paclitaxel y gemcitabina en nuestros pacientes ha resultado en una supervivencia libre de progresión similar a la de los ensayos clínicos publicados, presentando además una buena tolerancia.