Caracterización del uso de tofacitinib como tratamiento para COVID-19 / si

Objetivo: El propósito principal de este estudio es caracterizar y comparar la población que recibió tofacitinib con aquella que no fue tratada con este fármaco para la COVID-19 en la Clínica Unión Médica del Norte, durante el año 2020. Métodos: Se realizó un estudio de tipo observacional, retrospectivo transversal de tipo exploratorio y de fuente secundaria. Se analizaron las características de los participantes y su tratamiento en relación con los parámetros de laboratorio y las características clínicas. Resultados: Se incluyeron 507 pacientes ingresados en la unidad de COVID-19 de la Clínica Unión Médica del Norte. Se determinó que las defunciones fueron menores en el grupo que se medicó con tofacitinib (6,45%) en comparación con el grupo que no utilizó dicho fármaco. Asimismo, los medicados con esta terapia ameritaron en menos proporción soporte ventilatorio, sin embargo, hubo más proporción de ingresos a la Unidad de Cuidados Intensivos. Además, se identificó una reducción mayor en la glucemia en aquellos pacientes medicados con tofacitinib, aunque mayores niveles de ferritina y dímero D. Conclusiones: El fármaco tofacitinib puede actuar de manera beneficiosa en relación con la mortalidad y la reducción del uso de ventilación mecánica. En adición, podría colaborar con la evolución de los pacientes. No obstante, nuestra investigación no es concluyente. Es necesario realizar futuras investigaciones confirmatorias de la eficacia de la terapia con tofacitinib para los pacientes con COVID-19.

Objective: The main purpose of this study is to characterize and compare the population that received tofacitinib with those that were not treated with the drug for COVID-19 at the Clínica Unión Médica del Norte, in 2020. Methods: An observational, retrospective, cross-sectional, exploratory, and secondary source study was conducted. A comparison was made between clinical and sociodemographic characteristics, laboratory results and their treatment option. Results: Five hundred and seven patients admitted to the COVID-19 unit of the Clínica Unión Médica del Norte were included. It was determined that lower death rates were registered in the group that received tofacitinib (6.45%) compared to the group that did not use the drug. Likewise, those receiving this therapy required less mechanical ventilation, however, a higher proportion of these patients were admitted to the Intensive Care Unit. In addition, a greater reduction in glycaemia was identified in the patients receiving tofacitinib, but they had higher levels of ferritin and D-dimer. Conclusions: Tofacitinib may be beneficial in terms of mortality rates and reduction in the use of mechanical ventilation. Furthermore, it is promising with respect to positive patient progression. However, our research is not conclusive. Future confirmatory research is needed on the efficacy of tofacitinib therapy for COVID-19 patients.

Pan-American League of Associations for Rheumatology-Central American, Caribbean and Andean Rheumatology Association Consensus-Conference Endorsements and Recommendations on the Diagnosis and Treatment of Chikungunya-Related Inflammatory Arthropathies in Latin America.

BACKGROUND/OBJECTIVE: Although mortality rates related with chikungunya (CHIK) outbreaks in Latin America's (LA's) dengue-endemic rural and new urban regions are low, dealing with symptoms and sequelae can both produce a significant burden of disease and diminish quality of life-from many months to years-after the acute phase of the infection, with a significant impact on public and individual health.The aim of this work was to establish Pan-American League of Associations for Rheumatology-Central American, Caribbean and Andean Rheumatology Association (ACCAR) consensus-conference endorsements and recommendations on the diagnosis and treatment of CHIK-related inflammatory arthropathies transmitted by Aedes aegypti and Aedes albopictus in LA. METHODS: Based on the Consensus Development Conference format, a panel of ACCAR rheumatologist voting members (n = 10) took part in this Pan-American League of Associations for Rheumatology initiative. Experts voted from a previous content analysis of the medical literature on CHIK, 4 subsequent topic conferences, and a workshop. Consensus represents the majority agreement (≥80%) achieved for each recommendation. RESULTS: The experts' panel reached 4 overarching principles: (1) CHIK virus (CHIKV) is a re-emergent virus transmitted by 2 species of mosquitoes: A. aegypti and A. albopictus; (2) CHIKV caused massive outbreaks in LA; (3) chronic CHIKV infection produces an inflammatory joint disease that, in some cases, can last for several months to years, and (4) currently, there are no vaccines or antivirals licensed for CHIKV infections. RECOMMENDATIONS: Pan-American League of Associations for Rheumatology-ACCAR achieved 13 endorsements and recommendations on CHIK categorized in 3 groups: (1) epidemiology and clinical manifestations, (2) diagnosis, and (3) treatment, representing the consensus agreement from the panel's members.

Educational website incorporating rheumatoid arthritis patient needs for Latin American and Caribbean countries.

Health education is fundamental in the management of RA patients. This study explored patient needs for educational material appropriate for RA patients in our region through a website. This study includes seven focus groups and semi-structured interviews across 4 countries (Argentina, Chile, Colombia, and Mexico) with 71 RA patients. Transcripts were analyzed by anthropologists using qualitative analysis (QA), resulting in themes and subthemes to be developed. Five themes and over 50 subthemes of interest were identified by patients. Grouped into categories as follows: (1) knowing the disease, (2) living with arthritis, (3) treatment and therapies for RA, (4) psychosocial support, and (5) information for families. A response was written by the team in plain Spanish on patient subthemes of interest including additional areas that the team considered relevant. Three videos for YouTube were produced: on patient-doctor relationships, patients at work, and home and at the clinic. Illustrations in a comic book format on RA diagnosis were created. The educational site on RA of PANLAR can be found at htpp://artritisreumatoide.cl. This project accomplished a comprehensive list of RA patient interests, revealing the complex relationship between the information on the disease, the experience of a chronic disease, and the way in which patients approach, conceive, and manage their disease. We expect to gather information on how the website will be used in the future for patients and their families and maintain and improve the website as well as adapt its content to different socioeconomic realities.

Education for patients with rheumatoid arthritis in Latin America and the Caribbean.

Patient education is highly recommended in rheumatoid arthritis (RA) to support patient management. The challenge is to adhere to the recommendations for providing health education to RA patients in Latin American and the Caribbean (LAC) countries taking into account factors such as patient health illiteracy, lack of rheumatologists, and lack of resources including access to disease-modifying antirheumatic drugs (DMARDs). As existing educational material in regional languages is not readily available and inadequate, we propose developing a web-based educational program that would fulfill the requirements of most patients with RA across LAC countries with an emphasis on the correct and safe use of methotrexate.

Treatment of early rheumatoid arthritis in a multinational inception cohort of Latin American patients: the GLADAR experience.

BACKGROUND: Treatment of rheumatoid arthritis (RA) has evolved dramatically in the last decade. However, little is known about the way rheumatologists in Latin America treat their patients in clinical practice, outside the scope of clinical trials. OBJECTIVE: The objective of this study was to describe treatment patterns at disease onset in early RA with data from a large, multicenter, multinational inception cohort of Latin American patients. METHODS: Consecutive patients with early RA (<1 year of disease duration as diagnosed by a rheumatologist) from 46 centers in 14 Latin American countries were enrolled in the study. Clinical data, laboratory assessments, and a detailed registry on type of prescriptions were collected at baseline and at 3, 6, 12, 18, and 24 months of follow-up. Hands and feet x-rays were obtained at baseline and at 12 and 24 months. All data were captured in Arthros 6.1 database. Continuous variables were expressed as means and SDs, and categorical variables were expressed as percentages and 95% confidence intervals (95% CIs). Only therapeutic data at baseline are presented, corresponding to the period between disease onset and second visit (3 months). RESULTS: A total of 1093 patients were included. Eighty-five percent were female, and 76% had a positive rheumatoid factor. Mean age at diagnosis was 46.5 (SD, 14.2) years, and mean disease duration at the first visit was 5.8 (SD, 3.8) months. Between baseline and second visit (3 months), 75% of patients (95% CI, 72%-78%) received disease-modifying antirheumatic drugs. Methotrexate (MTX) alone or in combination was the most frequently used (60.5%), followed by antimalarials (chloroquine or hydroxychloroquine, 32.1%), sulfasalazine (7.1%), and leflunomide (LEF, 4%). In 474 patients (43%), initiation of disease-modifying antirheumatic drugs was within the first month after the first visit. In addition, 290 patients (26%; 95% CI, 23%-29%) received combination therapy as initial treatment. The most frequently used combinations were MTX + chloroquine (45%), MTX + hydroxychloroquine (25%), and MTX + sulfasalazine (16%). Eleven patients (1%; 95% CI, 0.5%-1.8%) received biologics. Sixty-four percent (95% CI, 60%-66%) received corticosteroids. Of those, 80% (95% CI, 77%-84%) received 10 mg of oral prednisone or less. CONCLUSIONS: In this cohort of Latin American patients with early RA, most patients received MTX very early in their disease course. Combination therapy was used approximately in 1 of every 4 patients as initial therapy. Biologics were rarely used at this early stage, and low-dose prednisone was commonly used.