Incidence of refractory CMV infection with or without antiviral resistance in Spain: A systematic literature review.

INTRODUCTION: Solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) recipients are susceptible to cytomegalovirus (CMV) infection. The incidence of refractoriness to antivirals, with or without resistance, is unclear. The purpose of this review was to describe the epidemiology of refractory CMV infection in Spain to understand the current unmet needs. METHODS: PubMed, EMBASE, Cochrane and MEDES were searched systematically for relevant articles. We included randomized controlled trials and observational studies published during the period from January 1990 to June 2021. RESULTS: From 212 screened records, we selected 19 papers including 1973 transplant recipients. Refractory infection ranged from 3 to 10% in studies with SOT recipients. The incidence of CMV resistance ranged from 1% to 36% in these patients. The incidence of CMV refractory infection in HSCT recipients ranged from 11 to 50%, while values for resistant infection ranged from 0% to 21%. CONCLUSION: The wide range of definitions and values observed does not allow us to establish the true incidence of refractory CMV infection with or without resistances in SOT and HSCT patients in Spain. This review highlights the gap between clinical practice and clinical trials' definitions which needed to be updated to be easier followed in current clinical practice.

Treatment patterns and intensification within 5 year of follow-up of the first-line anti-TNFα used for the treatment of IBD: Results from the VERNE study.

BACKGROUND: Anti-TNFα represent one of the main treatment approaches for the management of inflammatory bowel diseases (IBD). Therefore,the evaluation of their treatment patterns over time provides valuable insights about the clinical value of therapies and associated costs. AIMS: To assess the treatment patterns with the first anti-TNFα in IBD. METHODS: Retrospective, observational study. RESULTS: 310 IBD patients were analyzed along a 5-year follow-up period. 56.2% of Crohn's disease (CD) patients started with adalimumab (ADA), while 43.8% started with infliximab (IFX). 12.9% of ulcerative colitis (UC) patients initiated with ADA, while 87.1% initiated with IFX. Treatment intensification was required in 28.9% of CD and 37.1% of UC patients. Median time to treatment intensification was shorter in UC than in CD (5.3 vs. 14.3 months; p = 0.028). Treatment discontinuation due to reasons other than remission were observed in 40.7% of CD and 40.5% of UC patients, although, in UC patients there was a trend to lower discontinuation rates with IFX (36.6%) than with ADA (66.7%). Loss of response accounted for approximately one-third of discontinuations, in both CD and UC. CONCLUSIONS: Around one-third of IBD biologic-naive patients treated with an anti-TNFα required treatment intensification (earlier in UC) and around 40% discontinued the anti-TNFα due to inappropriate disease control.

Futuro de las glitazonas en el tratamiento de la diabetes tipo 2. Programa de ensayos clínicos con rosiglitazona / Future role of glitazones in the therapy of type 2 diabetes. On-going clinical trials with rosiglitazone

La diabetes tipo 2 es una enfermedad común asociada con un incremento del riesgo de complicaciones a largo plazo. Las guías terapéuticas actuales recomiendan ciertos objetivos de tratamiento que son a veces complicados de conseguir. Como ya se vio en el estudio UKPDS, el tratamiento con metformina, sulfonilureas o insulina, mejora el control glucémico a corto plazo pero no previene el progresivo deterioro en la función de las células Beta o el deterioro a largo plazo de la glucemia. La resistencia a la insulina es un defecto común en estos pacientes y se relaciona con este deterioro de la célula Beta, así como con el desarrollo de otros factores de riesgo cardiovascular. Las glitazonas mejoran la sensibilidad a la insulina y, debido a esto, producen una serie de cambios beneficiosos más allá del propio control de la glucemia. Si estos beneficios determinan una modificación del curso de la diabetes tipo 2, es algo que responderán los programas de ensayos clínicos en marcha. El estudio DREAM (Diabetes REduction Approacbes witb Ramipril and Rosiglitazone Medications), el estudio ADOPT (A Diabetes Outcomes and Progression Trial), el RECORD (Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of glycemia in Diabetes) y el estudio BARI 20, el estudio PPAR, el APPROACH... son algunos de los trabajos en marcha en el programa de ensayos clínicos de rosiglitazona, para clarificar estas preguntas y que incluyen en total a más de 29.000 pacientes

Type 2 diabetes is a common disease associated with an increased risk of long-term complications. Current guidelines recornmend certain therapy targets which have been shown to be difficult to achieve. As we have leamed from the UKPDS data, treatment with metformin, sulfonylureas or insulin improve glycemic control in the short term but do not prevent progressive beta cell failure or long term deterioration of glycemia. Insulin resistance is a common defect in these patients and is related with this deterioration of the beta cell function, as well as with the development of other cardiovascular risk factors. Glitazones improve insulin sensitivity and, subsequentiy, patients experience beneficial changes which may go beyond glycaemic control. Whether these benefits result in a modification of the course of type 2 diabetes is something that the ongoing clinical trials programme will probably answer. DREAM (Diabetes REduction Approaches with Ramipril and Rosiglitazone Medications), ADOPT (A Diabetes Outcomes and Progression Trial), RECORD (Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of glycaemia in Diabetes) and BARI 20, PPAR, APPROACH are some of the studies being made to clarify these questions, within the rosiglitazone clinical trials programme, which includes more than 29000 patients

Factors influencing medical treatment of heart failure patients in Spanish internal medicine departments: a national survey.

BACKGROUND: The medical management of heart failure (HF) in clinical practice varies considerably by country and by medical specialty. AIM: To assess the treatment of HF patients admitted to Internal Medicine departments, and to evaluate out-patient management prior to admission, by specialty. DESIGN: Prospective cross-sectional multi-centre survey. METHODS: Of 55 randomly selected Spanish hospitals, 51 agreed to participate. All patients (n = 2145) consecutively admitted for decompensated HF to the Departments of Internal Medicine of these hospitals, over 5 months, were included. Twenty variables were analysed, including aspects relating to out-patient management prior to admission. RESULTS: Mean +/- SD age was 77.2 +/- 10.5 years, 57.3% were female, 47% had systolic dysfunction. Prescriptions at discharge: loop diuretics 85.6%, spironolactone 29.8%, ACEIs 65.8%, beta-blockers 8.7%, cardiac glycosides 39%. At admission, 86% already had a diagnosis of HF. Of these, 53% (older patients and more women) were being treated on an out-patient basis by primary care physicians. Primary care physicians requested fewer echocardiograms than internists (38% vs. 69%, p<0.001) and prescribed fewer drugs (ACEIs 40% vs. 54%, p<0.001; spironolactone 15% vs. 23%, p<0.05; beta-blockers 6% vs. 13%, p<0.01). The internists treated more incapacitated patients than the cardiologists (p<0.001), prescribed more high-dose ACEIs (20% vs. 13%, p<0.01) and spironolactone (26% vs. 20%, p<0.05), and fewer anticoagulants (32% vs. 39%, p<0.05). DISCUSSION: Patients admitted to medical departments with HF are different to those found in clinical trials. Their management is currently suboptimal. Differences in treatment between internists and cardiologists appear to be accounted for by differences in the patients they treat.

Dosificación de digoxina: lo habitual y lo óptimo / Digoxin dosing: the habitual and the optimal thing

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