Incidence of COVID-19 in a cohort of adult and paediatric patients with rheumatic diseases treated with targeted biologic and synthetic disease-modifying anti-rheumatic drugs.

Objectives: To investigate the incidence of COVID-19 in a cohort of adult and paediatric patients with rheumatic diseases receiving targeted biologic and synthetic disease modifying anti-rheumatic drugs (tDMARDs) and to explore the possible effect of these treatments in the clinical expression of COVID-19. Methods: A cross-sectional study comprising of a telephone survey and electronic health records review was performed including all adult and paediatric patients with rheumatic diseases treated with tDMARDs in a large rheumatology tertiary centre in Barcelona, Spain. Demographics, disease activity, COVID-19 related symptoms and contact history data were obtained from the start of the 2020 pandemic. Cumulative incidence of confirmed cases (SARS-CoV-2 positive PCR test) was compared to the population estimates for the same city districts from a governmental COVID-19 health database. Suspected cases were defined following WHO criteria and compared to those without compatible symptoms. Results: 959 patients with rheumatic diseases treated with tDMARDs were included. We identified 11 confirmed SARS-CoV-2 positive cases in the adult cohort and no confirmed positive cases in the paediatric cohort. COVID-19 incidence rates of the rheumatic patient cohort were very similar to that of the general population [(0.48% (95% CI 0.09 to 0.87%)] and [0.58% (95% CI 0.56 to 0.60%)], respectively. We found significant differences in tDMARDs proportions between the suspected and non-suspected cases (p=0.002). Conclusion: Adult and paediatric patients with rheumatic diseases on tDMARDs do not seem to present a higher risk of COVID-19 or a more severe disease outcome when compared to general population.

Interdisciplinary recommendations document to improve adherence in patients with chronic inflammatory diseases: Adhing recommendations / Documento interdisciplinar de recomendaciones para mejorar la adherencia en pacientes con enfermedades inflamatorias crónicas: recomendaciones Adhing

Objective: Patient compliance in chronic inflammatory diseases is essential to achieve treatment effectiveness. The study objective is to develop a recommendations document for healthcare professionals to encourage treatment compliance. Methods: A sequential methodology was followed: 1. Systematic review of EBM Reviews, Embase and MedLine without time restriction of interventions on compliance in chronic inflammatory diseases. Studies were selected according to previously defined criteria (confirmed diagnosis of chronic inflammatory disease of patients included, assessment of adherence interventions and experimental study design). 2. Three expert workshops (hospital pharmacy, nursing and medical specialties) to elaborate recommendations. 3. Expert online voting about the degree of agreement with recommendations. 4. Final face to face consensus workshop. Results: A total of 1 115 papers were identified, 84 were fully reviewed and 30 were selected according to criteria. A preliminary list of 8 recommendations based on evidence was developed and discussed in the expert workshops. As a result, a new version of 14 recommendations was created. Later, online voting showed a high degree of agreement among experts: 7 out of 14 recommendations obtained unanimous approval; in the other 7, 1 to 3 experts were partially in disagreement. Recommendations without unanimous agreement were further reviewed and modified in the face to face meeting and final recommendations were approved unanimously. Conclusions: This consensus statement gathers all relevant aspects to be interdisciplinary considered to detect, monitor and assess medication adherence, involving the patient in the process. Further studies are needed to assess the impact of inter ventions to improve compliance in patients with chronic inflammatory diseases both in terms of adherence and in health outcomes (AU)

Objetivo: La adherencia terapéutica en los pacientes con enfermedades inflamatorias crónicas es fundamental para alcanzar la efectividad del tratamiento. El objetivo de este trabajo es crear un documento de recomendaciones para los profesionales de la salud que promueva la adherencia al tratamiento. Métodos: Se siguió una metodología secuencial: 1. Revisión sistemática en Evidence Based Medicine Reviews (EBMR), Embase y MedLine de intervenciones en adherencia en enfermedades inflamatorias crónicas sin restriciones temporales. Los estudios se seleccionaron según criterios previamente definidos (pacientes diagnosticados de enfermedad inflamatoria crónica, evaluación de intervenciones para la mejora de la adherencia y diseño experimental de estudio). 2. Reunión con tres grupos de expertos (farmacia hospitalaria, enfermería y especialidades médicas) para generar recomendaciones. 3. Votación electrónica de los expertos sobre el grado de acuerdo con las recomendaciones. 4. Reunión presencial final de las recomendaciones. Resultados: Se identificaron 1.115 citas, se revisaron 84 y se seleccionaron 30 de acuerdo a los criterios de elegibilidad. Se redactó un listado inicial de 8 recomendaciones basadas en la evidencia, que se discutió en las reuniones de expertos y dio lugar a una nueva versión de 14 recomendaciones. La posterior votación electrónica de esta versión evidenció un elevado grado de acuerdo entre los expertos: en 7 recomendaciones, acuerdo unánime; en las 7 restantes, entre 1 y 3 expertos parcialmente en desacuerdo. En la reunión presencial se volvieron a revisar y modificar las recomendaciones, sin acuerdo unánime, que finalmente se aprobaron por unanimidad. Conclusiones: Estas recomendaciones recogen los aspectos relevantes para detectar, monitorizar y evaluar la adherencia terapéutica de forma multidisciplinar, implicando de forma activa al paciente. Son necesarios nuevos estudios para evaluar el impacto de las intervenciones para mejorar la adherencia en los pacientes con enfermedades inflamatorias crónicas y su influencia tanto en los aspectos relativos al cumplimiento como en los resultados en salud (AU)

Interdisciplinary recommendations document to improve adherence in patients with chronic inflammatory diseases: Adhing recommendations.

OBJECTIVE: Patient compliance in chronic inflammatory diseases is essential to achieve treatment effectiveness. The study objective is to develop a recommendations document for healthcare professionals to encourage treatment compliance. METHODS: A sequential methodology was followed: 1. Systematic review of EBM Reviews, Embase and MedLine without time restriction of interventions on compliance in chronic inflammatory diseases. Studies were selected according to previously defined criteria (confirmed diagnosis of chronic inflammatory disease of patients included, assessment of adherence interventions and experimental study design). 2. Three expert workshops (hospital pharmacy, nursing and medical specialties) to elaborate recommendations. 3. Expert online voting about the degree of agreement with recommendations. 4. Final face to face consensus workshop. RESULTS: A total of 1 115 papers were identified, 84 were fully reviewed and 30 were selected according to criteria. A preli minary list of 8 recommendations based on evidence was developed and discussed in the expert workshops. As a result, a new version of 14 recommendations was created. Later, online voting showed a high degree of agreement among experts: 7 out of 14 recommendations obtained unanimous approval; in the other 7, 1 to 3 experts were partially in disagreement. Recommendations without unanimous agreement were further reviewed and modified in the face to face meeting and final recommendations were approved unanimously. CONCLUSIONS: This consensus statement gathers all relevant aspects to be interdisciplinary considered to detect, monitor and assess medication adherence, involving the patient in the process. Further studies are needed to assess the impact of interventions to improve compliance in patients with chronic inflammatory diseases both in terms of adherence and in health outcomes.

Objetivo: La adherencia terapéutica en los pacientes con enfermedades inflamatorias crónicas es fundamental para alcanzar la efectividad del tratamiento. El objetivo de este trabajo es crear un documento de recomendaciones para los profesionales de la salud que promueva la adherencia al tratamiento. Métodos: Se siguió una metodología secuencial: 1. Revisión sistemática en Evidence Based Medicine Reviews (EBMR), Embase y MedLine de intervenciones en adherencia en enfermedades inflamatorias crónicas sin restriciones temporales. Los estudios se seleccionaron según criterios previamente definidos (pacientes diagnosticados de enfermedad inflamatoria crónica, evaluación de intervenciones para la mejora de la adherencia y diseño experimental de estudio). 2. Reunión con tres grupos de expertos (farmacia hospitalaria, enfermería y especialidades médicas) para generar recomendaciones. 3. Votación electrónica de los expertos sobre el grado de acuerdo con las recomendaciones. 4. Reunión presencial final de las recomendaciones. Resultados: Se identificaron 1.115 citas, se revisaron 84 y se seleccionaron 30 de acuerdo a los criterios de elegibilidad. Se redactó un listado inicial de 8 recomendaciones basadas en la evidencia, que se discutió en las reuniones de expertos y dio lugar a una nueva versión de 14 recomendaciones. La posterior votación electrónica de esta versión evidenció un elevado grado de acuerdo entre los expertos: en 7 recomendaciones, acuerdo unánime; en las 7 restantes, entre 1 y 3 expertos parcialmente en desacuerdo. En la reunión presencial se volvieron a revisar y modificar las recomendaciones, sin acuerdo unánime, que finalmente se aprobaron por unanimidad. Conclusiones: Estas recomendaciones recogen los aspectos relevantes para detectar, monitorizar y evaluar la adherencia terapéutica de forma multidisciplinar, implicando de forma activa al paciente. Son necesarios nuevos estudios para evaluar el impacto de las intervenciones para mejorar la adherencia en los pacientes con enfermedades inflamatorias crónicas y su influencia tanto en los aspectos relativos al cumplimiento como en los resultados en salud.

Susceptibilidad de la población española a los efectos adversos por sulfasalazina: revisión sistemática / Susceptibility of the spanish population to adverse effects by sulfasalazine: systematic review

Introducción: La experiencia clínica hace sospechar que la población española pudiera sufrir más efectos adversos por la sulfasalazina (SSZ). Se realizó una revisión sistemática de la literatura existente con el objetivo de analizar la susceptibilidad a desarrollar eventos adversos producidos por la SSZ en la población española. Material y método: Se definió una estrategia de búsqueda bibliográfica sensible en EMBASE, IBECS y MEDLINE desde 1973 hasta marzo de 2007. En los artículos seleccionados se buscó la descripción de los efectos adversos, tanto en el texto como en las tablas, así como los motivos de retirada, la población estudiada y la discusión sobre la opinión de las diferencias en los efectos adversos de los diferentes grupos de tratamiento. Resultados: De un total de 106 artículos rescatados se seleccionaron 36 para realizar un análisis detallado de los 34 artículos seleccionados en MEDLINE y EMBASE y de los 2 de IBECS. No se encontró ningún estudio que evidencie que la población española sea más susceptible a los efectos adversos por SSZ. Conclusiones: Los efectos adversos por SSZ varían según el patrón de acetilación. En la población española la prevalencia de acetiladores lentos es mayor que en otros grupos étnicos; por tanto, cabría inferir que la incidencia de efectos adversos secundarios a la SSZ podría ser mayor en la población española que en otros grupos. No encontramos evidencia en la literatura de que la población española sea más susceptible a los efectos adversos por la SSZ (AU)

Background: Clinical experience raises suspicion that the spanish population could suffer higher rates of side effects of sulfasalazine (SSZ) therapy. We conducted a systematic review of existing literature to analyze the susceptibility to developing adverse events produced by SSZ in the Spanish population. Material and method: A literature search was conducted in EMBASE, IBECS, and MEDLINE from 1973 to March 2007. The items sought were those describing adverse effects, both in text and tables, and reasons for withdrawal, the population under study and discussion of differences in side effects of the different treatment groups. Results: Of the 106 retrieved articles, 36 were selected for review and detailed analysis. 34 articles were selected from MEDLINE and EMBASE and 2 from IBECS. We did not find any study that showed that the Spanish population was more susceptible to SSZ. Conclusions: The adverse effects of SSZ vary with the pattern of acetylation. Thus, in slow-acetylators, depending on the dosage of SSZ, the side effects increase significantly. In the Spanish population slow-acetylators prevalence is higher than in other ethnic groups. Therefore, one could infer that the incidence of adverse side effects by SSZ could be higher in the Spanish population than in others different ethnic groups. We found no evidence that the Spanish population was more likely to suffer adverse effects by SSZ than other ethnic groups (AU)

[Susceptibility of the spanish population to adverse effects by sulfasalazine: systematic review]. / Susceptibilidad de la población española a los efectos adversos por sulfasalazina: revisión sistemática.

BACKGROUND: Clinical experience raises suspicion that the spanish population could suffer higher rates of side effects of sulfasalazine (SSZ) therapy. We conducted a systematic review of existing literature to analyze the susceptibility to developing adverse events produced by SSZ in the Spanish population. MATERIAL AND METHOD: A literature search was conducted in EMBASE, IBECS, and MEDLINE from 1973 to March 2007. The items sought were those describing adverse effects, both in text and tables, and reasons for withdrawal, the population under study and discussion of differences in side effects of the different treatment groups. RESULTS: Of the 106 retrieved articles, 36 were selected for review and detailed analysis. 34 articles were selected from MEDLINE and EMBASE and 2 from IBECS. We did not find any study that showed that the Spanish population was more susceptible to SSZ. CONCLUSIONS: The adverse effects of SSZ vary with the pattern of acetylation. Thus, in slow-acetylators, depending on the dosage of SSZ, the side effects increase significantly. In the Spanish population slow-acetylators prevalence is higher than in other ethnic groups. Therefore, one could infer that the incidence of adverse side effects by SSZ could be higher in the Spanish population than in others different ethnic groups. We found no evidence that the Spanish population was more likely to suffer adverse effects by SSZ than other ethnic groups.