Assessment of real-world usage of lanreotide AUTOGEL 120 in Polish acromegalic patients - results from the prospective 12-month phase of Lanro-Study.

AIM OF THE STUDY: To assess resource utilization and costs of treatment with lanreotide AUTOGEL 120 mg (ATG120) administered as part of routine acromegaly care in Poland. MATERIAL AND METHODS: A multicentre, non-interventional, observational study on resource utilization in Polish acromegalic patients treated with ATG120 at 4 weeks or extended (> 4 weeks) dosing interval. The study recruited adult acromegalic patients treated medically for ≥ 1 year including at least 3 injections of ATG120. Data on dosing interval, aspects of administration, and resource utilization were collected prospectively during 12 months. Costs were calculated in PLN from the public health-care payer perspective for the year 2013. RESULTS: 139 patients were included in the analysis. Changes in dosing regimen were reported in 14 (9.4%) patients. Combined treatment was used in 11 (8%) patients. Seventy patients (50%) received ATG120 at an extended dosing interval; the mean number of days between injections was 35.56 (SD 8.4). ATG120 was predominantly administered in an out-patient setting (77%), by health-care professionals (94%). Mean time needed for preparation and administration was 4.33 and 1.58 min, respectively, mean product wastage - 0.13 mg. Patients were predominantly treated in an out-patient setting with 7.06 physician visits/patient/year. The most common control examinations were magnetic resonance imaging of brain and brain stem (1.36/patient/year), ultrasound of the neck (1.35/patient/year), GH (1.69/patient/year), glycaemia (1.12/patient/year), IGF-1 (0.84/patient/year), pituitary-thyroid axis hormone levels assessment (TSH-0.58/patient/year, T4-0.78/patient/year). There were 0.43 hospitalizations/patient/year. For direct medical costs estimated at PLN 50 692/patient/year the main item was the costs of ATG120 (PLN 4103.87/patient/month; 97%). The mean medical cost, excluding pharmacotherapy, was PLN 1445/patient/year (out-patient care - 49%, hospitalization - 23%, diagnostics/laboratory tests - 28%). CONCLUSIONS: These results represent the current use of ATG120 in the population of Polish acromegalic patients in a realistic clinical setting. Findings that 50% of patients could be treated with dose intervals of longer than 28 days support the potential of ATG120 to reduce the treatment burden.

[Two cases of serious hepatic injury caused by antithyroid drugs]. / Dwa przypadki istotnego uszkodzenia watroby po leczeniu tyreostatykami.

We present two cases of severe hepatotoxicity caused by antithyroid drugs in women with Graves disease. The first medication in both cases was methimazole replaced by propylhiouracil due to intolerance. The main symptom was jaundice lasting about 2 months. As a first step in the treatment we terminated the antithyroid drug administration and introduced prednisone and ursodesoksycholic acid therapy. The termination of thyrotoxicosis by means of 131 I administration had also positive influence on the course of disease. In summary we emphasise the significance of prompt discontinuation of antithyroid drug once toxic symptoms appeared and avoid replacement one thyrostatic drug for another in fovour of radioiodine treatment.

The rising incidence of type 1 diabetes in south-eastern Poland. A study of the 0-29 year-old age group, 1980-1999.

INTRODUCTION: Studies carried out over the last few years have provided information about the increase in the incidence of type 1 diabetes in different parts of the world including the European countries bordering Poland. THE AIM OF STUDY: The aim of this study was to determine the long-term trends in the incidence of type 1 diabetes over the 20 years between 1980 and 1999 and to compare the incidence during the decades preceding and following the 1989 economic and political transformation in Poland. MATERIAL AND METHODS: The registration of type 1 diabetes among people aged 0-29 was drawn up according to the DERI recommendations using three data sources. We calculated the age-standardised incidence rates for five-year age groups and determined the long-term trend in the incidence of type 1 diabetes in south-eastern Poland. RESULTS: A significant growth in the incidence of type 1 diabetes was observed among people aged 0-29 in the Rzeszów Province in the period between 1980 and 1999. The mean age-standardised incidence rate was 6.1/100,000, and a statistically significant difference was noted between the 1980s and the 1990s (5.3 [95%CI 4.5-6.0] and 6.8 [95%CI 5.9-7.6]). The male incidence of 6.7 significantly exceeded that for females--5.5/100,000. There was also a higher incidence in the group aged 0-14 in comparison with the group aged 15-29 (6.4 and 5.8/100,000 respectively). The highest incidence was found in boys aged 10-14 (11.5/100,000) and a significantly rising trend was observed in children of 0-4 years old. CONCLUSIONS: The mean incidence of type 1 diabetes among the study population was low. Nevertheless, we demonstrated a significantly increasing trend in the incidence during the 20-year observation period. The incidence in the 1990s, both in general and for males, was significantly higher when compared to the 1980s.

Kikuchi-Fujimoto disease: case report.

We present the case of a 27-year-old woman with local cervical lymphadenopathy without other symptoms. Due to a gradual progression of lesions, a biopsy was performed, and a specimen excised from an enlarged lymph node was subjected to histological examination. Kikuchi-Fujimoto disease (KFD), that is histiocytic necrotizing lymhadenitis, was diagnosed. Lymphadenopathy resolved without medical treatment over 6 months. KFD should be considered in the differential diagnosis of lymphadenopathy, even though this disease rarely occurs in Poland.

[Volume and echostructure of the thyroid and ioduria in an urban population of adults in the southeastern Polish city of Rzeszów]. / Objetosc i echostruktura tarczycy oraz joduria w miejskiej populacji osób doroslych w Rzeszowie.

The aim of this work was to determine the volume and echostructure of the thyroid and to examine urinary iodine excretion in an adult population of residents of Rzeszów, a city located in the Carpathian endemic region for goiter, after the introduction of mandatory iodine prophylaxis in 1997. 984 subjects, aged 19-60, were examined (540 females and 394 males). The mean level of urinary iodine in the examined population was 104.17 microg/l (+/- 85.22). Higher urinary iodine levels were seen in the group of males (p = 0.005) and in those who were taking medication containing iodine (p = 0.002). The mean volume of the thyroid in the examined group was 18.69 (+/- 10.01) ml and was larger in the group of males than females (p < 0.005). Nodular lesions were found in 17% of the examined thyroids and a statistically significant prevalence in the group of females (20.8%) over the group of males (11.4%) was found (p < 0.0005). The occurrence of nodules increased with age and was significantly higher in the 40-60 year age group than in the 19-25 years age group (p = 0.001). In single--and multi--factor analysis, a correlation was found between the occurrence of nodules and the female gender (r-2.04, 3.48; p < 0.005, < 0.0005) and the occurrence of nodules and the volume of the thyroid (r-1.1, 1.11; p < 0.005, < 0.0005). The occurrence of nodules did not correlate with ioduria (r-1, p = 0.8). Iodine prophylaxis was shown to be highly effective, although the examined region does not yet meet the criteria for the elimination of iodine deficiency as formulated by the ICCIDD.