Persistence and adherence to interferon and glatiramer acetate in patients with multiple sclerosis.

OBJECTIVES: To analyse persistence and adherence in patients with multiple sclerosis receiving first-line treatment with subcutaneous glatiramer acetate 20 mg (GA), subcutaneous interferon ß1a (IFNß1a-sc), intramuscular interferon ß1a (IFNß1a-im) and subcutaneous interferon ß1b (IFNß1b-sc) and to identify associated factors and reasons for discontinuation. METHODS: An observational retrospective study was performed between January 1999 and November 2014. Persistence was defined as the time from treatment initiation until discontinuation, and adherence as the number of units dispensed since treatment initiation until its interruption divided by the theoretical number of units needed to cover said period as a percentage. A patient was considered adherent if ≥95%. Persistence was measured using the Kaplan-Meier method and univariate Cox regression; adherence was measured using a univariate binary logistical regression model. RESULTS: The study included 224 patients. The median persistence was 1349 days (95% CI 1017.4 to 1680.6). Patients receiving IFNß1a-im continued treatment for a longer time (1720 days; 95% CI 1196.8 to 2243.2), while patients treated with IFNß1a-sc had the lowest persistence (771 days; 95% CI 377.4 to 1164.6) (HR=1.7; 95% CI 1.02 to 2.72). Patients with Expanded Disability Status Scale (EDSS) 1.5-6 discontinued treatment earlier than those with EDSS 0-1 (HR 1.5; 95% CI 1.01 to 2.25); 94.4% of patients discontinued treatment due to medical decision, primarily due to lack of efficacy (24.6%) and adverse effects (17.4%), while 80.8% of patients had good adherence. GA had the highest adherence, with no major difference from IFNß1a-im, while IFNß1b-sc showed the highest non-adherence (OR 3.5; 95% CI 1.29 to 9.28). CONCLUSIONS: The persistence levels obtained were lower than in similar studies. EDSS was identified as an independent predictor of treatment interruption. Acceptable adherence was achieved among the population, comparable to other studies and influenced by the drug.

Respuesta autores - Profilaxis post-exposición frente VIH: visión desde Urgencias / Post-exposure prophylaxis against HIV, the view from the emergency department - authos's response

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Post-exposure prophylaxis against HIV, do we use our resources appropriately? / Profilaxis post-exposición frente VIH, ¿utilizamos adecuadamente nuestros recursos?

Introduction. Post-exposure prophylaxis (PEP) against human immunodeficiency virus can be occupational, non-occupational or vertical transmission. The aim of our study was to analyse the indication and treatment carried out in a hospital. Methods. Retrospective observational study that included all patients who received PEP between 2006 and 2014. The project was approved by the Committee for Ethics in Clinical Research. Results. We evaluated 54 PEP, which were started at 11.8 hours’ average. The antiretroviral drugs were adequately chosen, but the duration pattern did not adjusted to the recommendations published at that time. Tolerance was good, being gastrointestinal symptoms the most frequent adverse effects; only once was necessary to replace the pattern. There were usual losses during follow up, reaching in some subgroups 50%. Conclusion. Indication and choice of drugs were adequate in the three kinds of contact risks, but monitoring should improve (AU)

Introducción. La profilaxis post-exposición (PPE) frente al virus inmunodeficiencia humana puede ser ocupacional, no ocupacional o transmisión vertical. El objetivo de este estudio fue analizar la indicación y pautas de tratamiento en un hospital. Métodos. Estudio observacional descriptivo retrospectivo, de las PPE iniciadas entre 2006-2014. El proyecto fue aprobado por el Comité Ética e Investigación Clínica. Resultados. Se evaluaron 54 PPE, iniciadas a 11,8 horas como media desde el contacto de riesgo. Los fármacos antirretrovirales elegidos fueron adecuados, aunque la duración no se ajustó a las recomendaciones publicadas en ese momento. La tolerancia fue buena, siendo los síntomas gastrointestinales los efectos adversos más frecuentes; únicamente fue necesaria la sustitución de la pauta en una ocasión. Hubo habituales pérdidas durante el seguimiento, superando en algunos subgrupos el 50%. Conclusión. La indicación y elección de los fármacos fueron adecuadas en los tres tipos de contacto, pero el seguimiento es un claro área susceptible de mejorar (AU)

Hepatitis tóxica por linagliptina / Linagliptin-induced liver toxicity

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