Real-world evidence of sorafenib for the treatment of hepatocellular carcinoma: A single-center study.

Context: Hepatocellular carcinoma is the third leading cause of cancer death. Currently, sorafenib is the treatment of choice in advanced hepatocarcinoma. Aims: Assessing the effectiveness and toxicity of sorafenib in real-word clinical practice in patients with hepatocarcinoma. Settings and Design: Single-centered observational retrospective study. Methods and Material: We included patients with hepatocarcinoma who began treatment with sorafenib between 2008 and 2018. We evaluated overall survival, time to progression, and response using RECIST (Response Evaluation Criteria in Solid Tumors) criteria. Toxicity was assessed according to the Common Terminology Criteria for Adverse Events version 5. 2020. Statistical Analysis Used: Kaplan-Meier curves and the log-rank test were used to determine the survival time and estimate factors associated with these events. Data were analyzed with SPSS 19.0 software. Results: We included 36 patients (88.9% male) with an average age of 64 ± 3.4 years. The tumor stage was advanced (C) in 21 patients (61.8%). We obtained a median overall survival of 8.5 months (IQR 3.14-18.9) and a time to progression of 4.5 months (IQR 2.4-8.8). The main degree of response was progression in 19 patients (36.1%), followed by stable disease in 13 (52.8%). The most commonly reported adverse reactions were: constitutional (83.3%), gastrointestinal (55%) and dermatological symptoms (50.0%). The development of grades 3 or 4 toxicity was not associated with increased overall survival (P = 0.719). Conclusions: The findings of the survival analysis obtained in real practice are similar to those obtained in pivotal clinical trials. Adverse reactions were different from those expected.

Medication persistence on biological therapies prescribed for the treatment of chronic inflammatory arthropathies: a real-world data study.

OBJECTIVES: Medication persistence, defined as the duration of time from its initiation to its discontinuation, is a surrogate for treatment effectiveness. The aim of the study was to evaluate persistence and causes of biological therapy (BT) suspension in patients with chronic inflammatory arthropathies: rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. METHODS: Single institution, descriptive, retrospective cohort study. Adult patients with chronic inflammatory arthropathies on BT between January 2009 and December 2016 were included. Persistence to BT was compared considering the type of pathology and treatment. The Kaplan-Meier test was used to analyse medication persistanence and factors associated with it. An analysis of reasons for therapy discontinuation was performed. RESULTS: Three hundred and sixty-two patients were included in the study, which comprised 478 BT lines. For all patients, the 12-month persistence rate was 71.3% (341 out of 478). At the end of the study, 45.2% of the patients continued on their initial BT. Median treatment persistence was 1489 days (CI 95% 1195 to 1783). Longer BT persistence was associated with naïve BT patients: 1945 days (95% CI 1523 to 2367; P<0.001) and ankylosing spondylitis diagnosis: 2402 days (95% CI 1604 to 3200; P=0.014). The most frequent causes of treatment discontinuation were therapeutic failure (47.6%) and adverse drug events (28.2%). CONCLUSIONS: We found good long-term persistence in patients with chronic inflammatory arthropathies treated with BT. Patients with rheumatoid arthritis had significantly shorter persistence compared with those with ankylosing spondylitis and psoriatic arthritis. Naïve BT was associated with longer persistence. Therapeutic failure was the main cause of BT withdrawal.

Direct costs in patients with chronic inflammatory arthropathies on biological therapy: a real-world data study.

OBJECTIVES: The aim of the study was to assess the direct costs for the Spanish Health System of patients with chronic inflammatory arthropathies treated with biological therapies in daily clinical practice and to establish possible factors associated with lower costs. METHODS: A descriptive, observational and retrospective study was conducted. Patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis who started a biological therapy between 1 January 2009 and 31 December 2016 were included. Variables related to socioeconomic status, disease and biological therapy were included. The annual cost of biological treatment and other direct medical costs were calculated for each disease. The analysis of costs was based on the National Health Service perspective. The time horizon comprised the 8-year long study period. RESULTS: A total of 422 biological therapy lines were analysed. The annual biological therapy cost per patient was €12,494±3,865 for rheumatoid arthritis, €11,248±2,763 for ankylosing spondylitis and €12,263±35,155 for psoriatic arthritis (p=0.008). The cost of biological therapies entailed about 80% of the total cost of these diseases. Hospital admission was a factor which contributed to an increasing cost in all these conditions. A longer duration of the biological therapy was associated with lower cost in all the diseases. CONCLUSIONS: The cost of ankylosing spondylitis is lower than that of rheumatoid arthritis and psoriatic arthritis. The biological therapy is the factor with the highest impact on the overall cost of these diseases. Preventing hospital admissions and a higher persistence to the biological therapy can contribute to lower costs for the system.

Adherence to biological therapies in patients with chronic inflammatory arthropathies.

INTRODUCTION: The aims of the study were to quantify adherence, determine the factors that can  predict adherence and identify the consequences of poorer adherence in patients with chronic  inflammatory arthropathies treated with biological therapies in daily clinical practice. METHOD: A descriptive, observational and retrospective study was carried out. Patients with  rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis who started a biologic therapy  between 1 January 2009 and 31 December 2016 were included. Variables related to socioeconomic  status, the disease, the biological therapy and hospital resources were included. Adherence was  calculated by using the medication possession ratio. RESULTS: Three hundred and sixty-two patients and 423 lines of biological therapy were included.  Mean age ± standard deviation was 50.3 ± 13.9 years, and 228 (53.9%) were women. The  percentage of adherent patients was 187 out of 216 (87%) in rheumatoid arthritis, 91 out of 107  (85%) in ankylosing spondylitis and 84 out of 100 (84%) in psoriatic arthritis. Greater adherence was  associated with more frequent visits to the pharmacy service (odds ratio 1.2, 95% confidence  interval: 1.1-1.3 [p = 0.001]) and poorer adherence with a failure to attend scheduled appointments  at the rheumatology clinic (odds ratio 0.2, 95% confidence interval: 0.1-0.9 [p = 0.030]). There were  no differences between  adherent and non-adherent patients in terms of the number of hospital resources used. CONCLUSIONS: There are no differences in adherence to biological therapies among patients with  chronic inflammatory arthropathies. Adherence correlates with attendance at outpatient  appointments, but this does not imply an increase in the use of hospital resources.

Objetivo: Los objetivos del estudio fueron cuantificar la adherencia, determinar los factores  predictivos y conocer las consecuencias de una menor adherencia, en la práctica clínica diaria, en  pacientes con artropatías inflamatorias crónicas tratados con terapias biológicas. Método: Estudio descriptivo, observacional y retrospectivo. Se incluyeron pacientes con artritis  reumatoide, espondilitis anquilosante y artritis psoriásica que iniciaron una terapia biológica entre el 1  de enero de 2009 y el 31 de diciembre de 2016. Se recogieron variables sociodemográficas, relacionadas con la enfermedad, sobre las terapias biológicas y los recursos  hospitalarios. La adherencia se calculó mediante la ratio media de posesión.Resultados: Se incluyeron 362 pacientes y 423 líneas de terapia biológica. La media de edad ±  desviación estándar fue de 50,3 ± 13,9 años; 228 (53,9%) fueron mujeres. El porcentaje de  adherentes fue de 187 de 216 (87%) en artritis reumatoide, 91 de 107 (85%) en espondilitis  anquilosante y 84 de 100 (84%) en artritis psoriásica. La adherencia se relacionó con acudir con más  frecuencia a la consulta del servicio de farmacia(odds ratio de 1,2; intervalo de confianza 95%: 1,1- 1,3 [p = 0,001]) e inversamente con no acudir a las consultas de reumatología en la fecha prevista (odds ratio de 0,2; intervalo de confianza 95%: 0,1-0,9 [p = 0,030]). No hubo diferencias en  el número de recursos hospitalarios utilizados por pacientes adherentes y no adherentes.Conclusiones: La adherencia a las terapias biológicas entre las artropatías inflamatorias crónicas es  similar. Dicha adherencia se correlaciona con la frecuentación a consultas externas, pero no implica  un aumento del consumo de recursos.

[Effect of pharmacologic treatment of the nutritional status of neurologic patients]. / Efecto del tratamiento farmacológico en el estado nutricional del paciente neurológico.

Clinical manifestations accompanying neurological diseases are diverse and affect multiple organs. Nutritional status of patients with certain neurological diseases such as stroke, Alzheimer's disease, Parkinson's disease, Epilepsy and Multiple Sclerosis can be altered because of symptoms associated with disease course, including certain micronutrient deficiency (folic acid, zinc, vitamin B6 and B12, vitamin D, vitamin E and vitamin C), changes in energy expenditure, intake decreased, gastrointestinal disorders and dysfunction of the bone mass. Also, we have to take in account other factors as: advanced age, multiple co morbidities, polypharmacy, the use of herbal products, social habits, diet and pharmacological treatments effect. An assessment of the factors related to neurological treatment that cause alterations in metabolic and nutritional status was performed: side effects of anti-Parkinson drugs, antiepileptic drugs, and multiple sclerosis drugs; drug-nutrient interactions; and nutrient-drug interactions.

Efecto del tratamiento farmacológico en el estado nutricional del paciente neurológico / Effect of pharmacologic treatment of the nutritional status of neurologic patients

Las manifestaciones clínicas que acompañan a las enfermedades neurológicas son muy variadas, afectando a múltiples órganos. Los pacientes con ciertas patologías neurológicas como son el ictus, la enfermedad de Alzheimer, Parkinson, Epilepsia y Esclerosis Múltiple pueden ver su estado nutricional alterado a causa de determinados síntomas relacionados con el curso de la enfermedad, como el déficit de determinados micronutrientes (ácido fólico, zinc, vitaminas B6 y B12, vitamina D, vitaminas E y vitamina C), alteraciones del gasto energético, disminución de la ingesta, alteraciones gastrointestinales y disfunción de la masa ósea. A estas circunstancias, hay que añadir el efecto de otros factores: edad avanzada, múltiples comorbilidades, polifarmacia, la utilización de fitoterapia, hábitos sociales, la dieta y el efecto de los tratamientos farmacológicos (AU)

Clinical manifestations accompanying neurological diseases are diverse and affect multiple organs. Nutritional status of patients with certain neurological diseases such as stroke, Alzheimer’s disease, Parkinson’s disease, Epilepsy and Multiple Sclerosis can be altered because of symptoms associated with disease course, including certain micronutrient deficiency (folic acid, zinc, vitamin B6 and B12, vitamin D, vitamin E and vitamin C), changes in energy expenditure, intake decreased, gastrointestinal disorders and dysfunction of the bone mass. Also, we have to take in account other factors as: advanced age, multiple co morbidities, polypharmacy, the use of herbal products, social habits, diet and pharmacological treatments effect. An assessment of the factors related to neurological treatment that cause alterations in metabolic and nutritional status was performed: side effects of anti-Parkinson drugs, antiepileptic drugs, and multiple sclerosis drugs; drugnutrient interactions; and nutrient-drug interactions (AU)

[Role of omega-3 fatty acids in cardiovascular disease prevention]. / Papel de los ácidos grasos omega-3 en la prevención de enfermedades cardiovasculares.

Fatty acids, in addition to its known energy value and its structural function, have other beneficial properties. In particular, the polyunsaturated fatty acids omega-3 acting on the cardiovascular apparatus through many channels exerting a protective effect against cardiovascular risk. The benefits associated with the reduction in cardiac mortality and sudden death particular, are related to the incorporation of EPA and DHA in phospholipid membrane of cardiomyocytes. An index is established that relates the percentage of EPA + DHA of total fatty acids in erythrocytes and risk of death from cardiovascular disease may layering in different degrees. Therefore, the primary source of fatty fish w-3 PUFA, behaves like a reference food in cardiosaludables diets.

Los ácidos grasos, además de su conocido valor energético y su función estructural, presentan otro tipo de propiedades beneficiosas. En concreto, los ácidos grasos poliinsaturados omega-3 actúan sobre el aparato cardiovascular a través de multitud de vías ejerciendo un efecto protector frente al riesgo cardiovascular. Los beneficios asociados a la reducción de la mortalidad cardiaca y en concreto la muerte súbita, están relacionados con la incorporación de EPA y DHA en los fosfolípidos de la membrana de los cardiomiocitos. Se ha establecido un índice que relaciona el porcentaje de EPA+DHA del total de ácidos grasos en los eritrocitos y riesgo de muerte por enfermedad cardiovascular pudiendo estratificarlo en diferentes grados. Por lo tanto, el pescado graso principal fuente de AGPI w-3, se comporta como alimento de referencia en las dietas cardiosaludables.

[Lipid profile analysis of two species of hake "merluccius capensis and merluccius paradoxus" and its contribution to cardiovascular disease prevention]. / Análisis del perfil lipídico de dos especies de merluza "Merluccius capensis y Merluccius paradoxus" y su aportación a la prevención de enfermedades cardiovasculares.

INTRODUCTION: In recent years it has been shown that omega-3 PUFAs have multiple cardiovascular protective effects. Currently, fish is the main and most important source of Omega-3 fatty acids. OBJECTIVE: To analyze the fatty acid composition in two species of hake, its content of omega-3 fatty acids and study their contribution to the prevention of cardiovascular diseases. MATERIAL AND METHODS: We analyzed samples of two species of hake (Merluccius capensis and Merluccius paradoxus) in its natural state and frozen, cooked by microwave and boiled samples. We have studied the moisture content, lipid content and analysis, identification and composition of fatty acids. RESULTS: It was observed that the content of w-3 PUFA was higher than the w-6 PUFA. The omega-3 fatty acids DHA and EPA were the most representative of the omega-3 family, highlighting the DHA content in all samples analyzed. It has also demonstrated the safety of the cooking methods :microwave" and "boiling" as methods that ensure the integrity of the w-3 PUFA. CONCLUSION: Hake samples analyzed present an optimal lipid profile. Its content of w-3 PUFA and their properties, make hake fish is distinguished as hearthealthy diets reference.

Introducción: En los últimos 2013s se ha demostrado que los AGPI omega-3 presentan múltiples efectos protectores cardiovasculares. Actualmente, el pescado constituye la principal y la más importante fuente de ácidos grasos Omega-3. Objetivo: Analizar la composición en ácidos grasos en dos especies de merluza, determinar su contenido en ácidos grasos omega-3 y estudiar su aportación en la prevención de enfermedades cardiovasculares. Material y métodos: Se han analizado muestras de dos especies de merluza (Merluccius capensis y Merluccius paradoxus) en su estado natural y congeladas, cocinadas al microondas y muestras hervidas. Se ha estudiado el contenido en humedad, contenido lipídico y el análisis, composición e identificación de ácidos grasos. Resultados: Se observó que el contenido de AGPI w-3 fue mayor que el de AGPI w-6. Los ácidos grasos omega-3 DHA y EPA fueron los más representativos de la familia omega-3, destacando el contenido de DHA en todas lasmuestras analizadas. Asimismo, se ha demostrado la seguridad de los métodos de cocción «microondas¼ y «hervido¼ como métodos que aseguran la integridad de los AGPI w-3. Conclusión: Las muestras de merluza analizadas presentan un óptimo perfil lipídico. Su contenido en AGPI w-3 y sus propiedades, hacen que la merluza se distinga como pescado de referencia en dietas cardiosaludables.

Papel de los ácidos grasos omega-3 en la prevención de enfermedades cardiovasculares / Role of omega-3 fatty acids in cardiovascular disease prevention

Los ácidos grasos, además de su conocido valor energético y su función estructural, presentan otro tipo de propiedades beneficiosas. En concreto, los ácidos grasos poliinsaturados omega-3 actúan sobre el aparato cardiovascular a través de multitud de vías ejerciendo un efecto protector frente al riesgo cardiovascular. Los beneficios asociados a la reducción de la mortalidad cardiaca y en concreto la muerte súbita, están relacionados con la incorporación de EPA y DHA en los fosfolípidos de la membrana de los cardiomiocitos. Se ha establecido un índice que relaciona el porcentaje de EPA+DHA del total de ácidos grasos en los eritrocitos y riesgo de muerte por enfermedad cardiovascular pudiendo estratificarlo en diferentes grados. Por lo tanto, el pescado graso principal fuente de AGPI w-3, se comporta como alimento de referencia en las dietas cardiosaludables (AU)

Fatty acids, in addition to its known energy value and its structural function, have other beneficial properties. In particular, the polyunsaturated fatty acids omega-3 acting on the cardiovascular apparatus through many channels exerting a protective effect against cardiovascular risk. The benefits associated with the reduction in cardiac mortality and sudden death particular, are related to the incorporation of EPA and DHA in phospholipid membrane of cardiomyocytes. An index is established that relates the percentage of EPA + DHA of total fatty acids in erythrocytes and risk of death from cardiovascular disease may layering in different degrees. Therefore, the primary source of fatty fish w-3 PUFA, behaves like a reference food in cardiosaludables diets (AU)

Análisis del perfil lipídico de dos especies de merluza 'Merluccius capensis y Merluccius paradoxus' y su aportación a la prevención de enfermedades cardiovasculares / Lipid profile analysis of two species of hake 'Merluccius capensis and Merluccius paradoxus' and its contribution to cardiovascular disease prevention

Introducción: En los últimos años se ha demostrado que los AGPI omega-3 presentan múltiples efectos protectores cardiovasculares. Actualmente, el pescado constituye la principal y la más importante fuente de ácidos grasos Omega-3. Objetivo: Analizar la composición en ácidos grasos en dos especies de merluza, determinar su contenido en ácidos grasos omega-3 y estudiar su aportación en la prevención de enfermedades cardiovasculares.Material y Métodos: Se han analizado muestras de dos especies de merluza (Merluccius capensis y Merluccius paradoxus) en su estado natural y congeladas, cocinadas al microondas y muestras hervidas. Se ha estudiado el contenido en humedad, contenido lipídico y el análisis, composición e identificación de ácidos grasos. Resultados: Se observó que el contenido de AGPI w-3 fue mayor que el de AGPI w-6. Los ácidos grasos omega-3 DHA y EPA fueron los más representativos de la familia omega-3, destacando el contenido de DHA en todas las muestras analizadas. Asimismo, se ha demostrado la seguridad de los métodos de cocción "microondas" y "hervido" como métodos que aseguran la integridad de los AGPI w-3. Conclusión: Las muestras de merluza analizadas presentan un óptimo perfil lipídico. Su contenido en AGPI w-3 y sus propiedades, hacen que la merluza se distinga como pescado de referencia en dietas cardiosaludables (AU)

Introduction: In recent years it has been shown that omega-3 PUFAs have multiple cardiovascular protective effects. Currently, fish is the main and most important source of Omega-3 fatty acids. Objective: To analyze the fatty acid composition in two species of hake, its content of omega-3 fatty acids and study their contribution to the prevention of cardiovascular diseases. Material and Methods: We analyzed samples of two species of hake (Merluccius capensis and Merluccius paradoxus) in its natural state and frozen, cooked by microwave and boiled samples. We have studied the moisture content, lipid content and analysis, identification and composition of fatty acids. Results: It was observed that the content of w-3 PUFA was higher than the w-6 PUFA. The omega-3 fatty acids DHA and EPA were the most representative of the omega-3 family, highlighting the DHA content in all samples analyzed. It has also demonstrated the safety of the cooking methods "microwave" and "boiling" as methods that ensure the integrity of the w-3 PUFA. Conclusion: Hake samples analyzed present an optimal lipid profile. Its content of w-3 PUFA and their properties, make hake fish is distinguished as heart-healthy diets reference (AU)