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Biological Products , Psoriasis , Databases, Factual , Humans , National Health Programs , UncertaintyABSTRACT
No disponible
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Humans , Biomedical Research/trends , Dermatology/trends , 50088 , Periodicals as Topic/statistics & numerical dataABSTRACT
No disponible
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Humans , Psoriasis/drug therapy , Pharmaceutical Preparations/blood , Drug Monitoring , Treatment OutcomeABSTRACT
No disponible
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Humans , Psoriasis/drug therapy , Biological Availability , Immunosuppressive Agents/pharmacokinetics , Survival Analysis , Proportional Hazards Models , Treatment Outcome , Patient Safety , Cyclosporine/pharmacokineticsSubject(s)
Antirheumatic Agents/administration & dosage , Biological Factors/administration & dosage , Drug Evaluation/methods , Immunosuppressive Agents/administration & dosage , Outcome Assessment, Health Care/methods , Psoriasis/drug therapy , Antirheumatic Agents/adverse effects , Antirheumatic Agents/economics , Antirheumatic Agents/therapeutic use , Biological Factors/adverse effects , Biological Factors/economics , Biological Factors/therapeutic use , Biomarkers , Drug Administration Schedule , Drug Costs , Drug Evaluation/statistics & numerical data , Drug Substitution , Humans , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/economics , Immunosuppressive Agents/therapeutic use , Outcome Assessment, Health Care/statistics & numerical data , Time FactorsABSTRACT
BACKGROUND: Few reported studies compare drug survival in moderate-to-severe psoriasis vulgaris. OBJECTIVES: To describe and compare drug survival of systemic drugs, including biologic agents (infliximab, etanercept, adalimumab and ustekinumab) and classical drugs (acitretin, ciclosporin and methotrexate) in moderate-to-severe psoriasis. METHODS: This was a multicenter, prospective, cohort study of patients receiving systemic therapies between 2008 and 2013 in 12 hospitals in Spain. Baseline data and drug discontinuation were collected. Drug survival is presented using Kaplan-Meier survival curves. We compared adjusted risk ratios of serious adverse events (AEs) with results of survival analysis for AEs. RESULTS: A total of 1956 patients were included for analysis (1240 exposed to biologics during follow-up and 1076 to classic therapies). Median follow-up time was 3.3 years (0.0-5.1 years). There were 2209 discontinuations out of 3640 therapy cycles started. The main reason for discontinuation was lack of efficacy (36.4%) and remission (27.2%). Biologics showed a higher drug survival than classics and the pattern of survival results for all outcomes (positive or negative) were very similar. Adjusted risk ratios of serious AEs did not agree with results of survival analysis. LIMITATIONS: A limitation is that this is an observational study with potential selection bias. CONCLUSION: Survival as a proxy measure of drug safety in psoriasis is inadequate.
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Dermatologic Agents/therapeutic use , Psoriasis/drug therapy , Registries , Humans , Prospective StudiesABSTRACT
No disponible
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Humans , Ichthyosis/epidemiology , Patient Care Management/organization & administration , Patient Care Team/organization & administration , Health Care Surveys/statistics & numerical dataSubject(s)
Ichthyosis, Lamellar/therapy , Alopecia/prevention & control , Genetic Therapy/methods , Health Priorities , Humans , Infant, Newborn , Interprofessional Relations , Keratolytic Agents/therapeutic use , Perinatal Care/organization & administration , Pruritus/etiology , Quality of Life , Retinoids/adverse effectsABSTRACT
El síndrome LEOPARD es una enfermedad autosómica dominante producida por mutaciones germinales en la vía RAS-MAPK. El acrónimo agrupa las manifestaciones más importantes de la enfermedad (Lentiginosis, ECG conduction anomalies, Ocular hypertelorism/hypertrophic Obstructive cardiomyopathy, Pulmonary stenosis, Abnormalities of genitalia, growth Retardation and Deafness), pero ninguna de ellas es patognomónica ni constante, por lo que muchos pacientes no las presentan en el momento del diagnóstico. Presentamos 2 casos de síndrome LEOPARD sin sordera ni estenosis pulmonar en los que la detección de la mutación en el gen PTPN11 permitió confirmar la enfermedad, y señalamos la importancia del seguimiento continuado para la detección precoz de las complicaciones, ya que las mismas pueden aparecer en el transcurso de la enfermedad
LEOPARD syndrome is an autosomal dominant disease caused by germline mutations in the RAS-MAPK (mitogen-activated protein kinase) pathway. LEOPARD is an acronym for the main manifestations of the syndrome, namely, multiple Lentigines, Electrocardiographic conduction abnormalities, Ocular hypertelorism, Pulmonary stenosis, Abnormalities of genitalia, Retardation of growth, and sensorineural Deafness. None of these characteristic features however, are pathognomonic of LEOPARD syndrome, and since they are highly variable, they are often not present at the time of diagnosis. We describe 2 cases of LEOPARD syndrome without hearing loss or pulmonary stenosis in which diagnosis was confirmed by identification of a mutation in the PTPN11 gene. Regular monitoring is important for the early detection of complications, as these can occur at any time during the course of disease
Subject(s)
Child , Humans , Male , LEOPARD Syndrome/diagnosis , Deafness/epidemiology , Pulmonary Valve Stenosis/epidemiology , Cafe-au-Lait Spots/epidemiology , Lentigo/epidemiologySubject(s)
Continuity of Patient Care , Ichthyosis/therapy , Continuity of Patient Care/statistics & numerical data , Health Care Surveys , Humans , Ichthyosis/epidemiology , Medicine , Patient Care Team/statistics & numerical data , Referral and Consultation/statistics & numerical data , Societies, Medical , Spain/epidemiologyABSTRACT
LEOPARD syndrome is an autosomal dominant disease caused by germline mutations in the RAS-MAPK (mitogen-activated protein kinase) pathway. LEOPARD is an acronym for the main manifestations of the syndrome, namely, multiple Lentigines, Electrocardiographic conduction abnormalities, Ocular hypertelorism, Pulmonary stenosis, Abnormalities of genitalia, Retardation of growth, and sensorineural Deafness. None of these characteristic features, however, are pathognomonic of LEOPARD syndrome, and since they are highly variable, they are often not present at the time of diagnosis. We describe 2 cases of LEOPARD syndrome without hearing loss or pulmonary stenosis in which diagnosis was confirmed by identification of a mutation in the PTPN11 gene. Regular monitoring is important for the early detection of complications, as these can occur at any time during the course of disease.
Subject(s)
LEOPARD Syndrome/genetics , Protein Tyrosine Phosphatase, Non-Receptor Type 11/deficiency , Child , Exons , Hearing Loss , Humans , Male , Mutation, Missense , Phenotype , Point Mutation , Protein Tyrosine Phosphatase, Non-Receptor Type 11/genetics , Pulmonary Valve Stenosis , Symptom AssessmentABSTRACT
INTRODUCCIÓN Y OBJETIVOS: Las revisiones sistemáticas son la forma de revisión más exhaustiva y deberían ser consideradas antes de realizar un ensayo clínico o revisión sobre un tema. El objetivo de este estudio es describir la utilización de revisiones sistemáticas en los ensayos clínicos y revisiones narrativas publicadas en dermatología. MATERIAL Y MÉTODOS: Se diseñó un estudio descriptivo transversal. Se seleccionaron ensayos clínicos aleatorizados y revisiones narrativas de las revistas más relevantes (por factor de impacto) de investigación clínica de dermatología y de Actas Dermosifiliográficas y se evaluó si hacían referencia a revisiones sistemáticas y Cochrane (en caso de existir) en la bibliografía. RESULTADOS: En el grupo de ensayos clínicos se hacía referencia a alguna de las revisiones sistemáticas existentes en el 33,3% de los artículos (15,6% de las revisiones Cochrane que existían y 32,2% de las no Cochrane sobre el tema). En el grupo de revisiones narrativas alguna de las revisiones sistemáticas existentes eran referenciadas en el 41,7% de los trabajos (20% Cochrane y 35,3% no Cochrane). En Actas Dermosifiliográficas existían muy pocos ensayos clínicos publicados; las revisiones narrativas reproducían lo que se observaba en el resto de revistas. CONCLUSIONES: Las revisiones sistemáticas son poco tenidas en cuenta en la realización de ensayos clínicos y revisiones narrativas, lo que puede llevar a estudios y publicaciones redundantes. Además las revisiones Cochrane parecen ser incluso menos empleadas, obviando así los autores una de las principales fuentes de evidencia existentes
INTRODUCTION AND OBJECTIVES: Systematic reviews -the most comprehensive type of literature review-should be taken into account before a clinical trial or a narrative review on a topic is undertaken. The objective of this study was to describe the use of systematic reviews in clinical trials and narrative reviews in dermatology. MATERIAL AND METHODS: This was a descriptive cross-sectional study. We selected randomized clinical trials and narrative reviews from the dermatological clinical research journals identified as most important (according to impact factor) and from Actas Dermosifiliográficas , and studied the bibliographies to ascertain whether the authors made reference to existing systematic reviews and Cochrane reviews. RESULTS: Of the 72 clinical trials for which a systematic review was available, 24 (33.3%) cited at least 1 review; reference was made to relevant Cochrane reviews in 15.6% of cases and to non-Cochrane reviews in 32%. In the case of the 24 narrative reviews for which a review was available, 10 (41.7%) cited at least 1 review; Cochrane reviews were cited in 20% and non-Cochrane reviews in 35.3%.In the case of Actas Dermosifiliográficas , very few clinical trials were found and the findings for narrative review articles were similar to those observed for the other journals. CONCLUSIONS: Systematic reviews are not often taken into account by the authors of clinical trials and narrative reviews and this may lead to redundant studies and publications. Authors appear to use Cochrane reviews even less than non-Cochrane reviews and are therefore ignoring one of the main sources of available evidence
Subject(s)
Clinical Trials as Topic/methods , Skin Diseases , Review Literature as Topic , Evidence-Based Medicine , Biomedical Research/methodsABSTRACT
INTRODUCTION AND OBJECTIVES: Systematic reviews -the most comprehensive type of literature review-should be taken into account before a clinical trial or a narrative review on a topic is undertaken. The objective of this study was to describe the use of systematic reviews in clinical trials and narrative reviews in dermatology. MATERIAL AND METHODS: This was a descriptive cross-sectional study. We selected randomized clinical trials and narrative reviews from the dermatological clinical research journals identified as most important (according to impact factor) and from Actas Dermosifiliográficas, and studied the bibliographies to ascertain whether the authors made reference to existing systematic reviews and Cochrane reviews. RESULTS: Of the 72 clinical trials for which a systematic review was available, 24 (33.3%) cited at least 1 review; reference was made to relevant Cochrane reviews in 15.6% of cases and to non-Cochrane reviews in 32%. In the case of the 24 narrative reviews for which a review was available, 10 (41.7%) cited at least 1 review; Cochrane reviews were cited in 20% and non-Cochrane reviews in 35.3%.In the case of Actas Dermosifiliográficas, very few clinical trials were found and the findings for narrative review articles were similar to those observed for the other journals. CONCLUSIONS: Systematic reviews are not often taken into account by the authors of clinical trials and narrative reviews and this may lead to redundant studies and publications. Authors appear to use Cochrane reviews even less than non-Cochrane reviews and are therefore ignoring one of the main sources of available evidence.
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Dermatology , Evidence-Based Medicine , Randomized Controlled Trials as Topic , Review Literature as Topic , Cross-Sectional Studies , HumansSubject(s)
Nevus, Halo/complications , Nevus, Pigmented/complications , Skin Neoplasms/complications , Vitiligo/complications , Adolescent , Child , Humans , Infant, Newborn , Male , Nevus, Halo/pathology , Nevus, Pigmented/congenital , Pigmentation , Remission, Spontaneous , Skin Neoplasms/congenital , Vitiligo/pathologyABSTRACT
Introducción y objetivos: Las revisiones sistemáticas son una de las fuentes más importantes de Medicina basada en la evidencia. No obstante, existe una impresión de que estas revisiones rara vez aportan resultados con evidencia suficiente para cambiar nuestra práctica. El objetivo de este trabajo es determinar el porcentaje de revisiones publicadas por el Cochrane Skin Group (Grupo Cochrane de Piel) con resultados útiles para guiar nuestras decisiones clínicas. Material y métodos: Se ha realizado un análisis bibliométrico de las revisiones sistemáticas realizadas por el Cochrane Skin Group y publicadas hasta el 16 de agosto de 2012. Se obtuvieron un total de 55 revisiones, las cuales fueron analizadas y clasificadas de forma independiente por 2 investigadores en: 0) no existe evidencia suficiente para apoyar o rechazar ninguna intervención; 1) no existe evidencia suficiente para rechazar o apoyar una intervención pero sí existe suficiente evidencia para hacer recomendaciones o sugerencias; y 2) existe una fuerte evidencia para apoyar o rechazar una intervención. Resultados: Del total de las revisiones publicadas por el Cochrane Skin Group el 25,5% (14/55) no mostraban evidencia suficiente en ninguna de las intervenciones estudiadas para sustentar su rechazo o aprobación. Un 29,1% (16/55) obtuvo resultados con una fuerte evidencia a favor o en contra de alguna de las intervenciones estudiadas y el 45,5% (25/55) mostraba evidencia suficiente, aunque no fuerte, para hacer sugerencias o recomendaciones. Conclusiones: La mayoría de las revisiones sistemáticas del Cochrane Skin Group aportan información útil para mejorar nuestra actividad clínica. Los clínicos deberían leerlas y compararlas con su práctica actual (AU)
Background and objective: Systematic reviews are one of the most important sources of information for evidence-based medicine. However, there is a general impression that these reviews rarely report results that provide sufficient evidence to change clinical practice. The aim of this study was to determine the percentage of Cochrane Skin Group reviews reporting results with the potential to guide clinical decision-making. Material and methods: We performed a bibliometric analysis of all the systematic reviews published by the Cochrane Skin Group up to 16 August, 2012. We retrieved 55 reviews, which were analyzed and graded independently by 2 investigators into 3 categories: 0 (insufficient evidence to support or reject the use of an intervention), 1 (insufficient evidence to support or reject the use of an intervention but sufficient evidence to support recommendations or suggestions), and 2 (sufficient evidence to support or reject the use of an intervention). Results: Our analysis showed that 25.5% (14/55) of the studies did not provide sufficient evidence to support or reject the use of the interventions studied, 45.5% (25/25) provided sufficient but not strong evidence to support recommendations or suggestions, and 29.1% (16/55) provided strong evidence to support or reject the use of 1 or more of the interventions studied. Conclusions: Most of the systematic reviews published by the Cochrane Skin Group provide useful information to improve clinical practice. Clinicians should read these reviews and reconsider their current practice (AU)
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Humans , Databases, Bibliographic , Skin Diseases , Evidence-Based Medicine , Information Storage and RetrievalABSTRACT
BACKGROUND AND OBJECTIVE: Systematic reviews are one of the most important sources of information for evidence-based medicine. However, there is a general impression that these reviews rarely report results that provide sufficient evidence to change clinical practice. The aim of this study was to determine the percentage of Cochrane Skin Group reviews reporting results with the potential to guide clinical decision-making. MATERIAL AND METHODS: We performed a bibliometric analysis of all the systematic reviews published by the Cochrane Skin Group up to 16 August, 2012. We retrieved 55 reviews, which were analyzed and graded independently by 2 investigators into 3 categories: 0 (insufficient evidence to support or reject the use of an intervention), 1 (insufficient evidence to support or reject the use of an intervention but sufficient evidence to support recommendations or suggestions), and 2 (sufficient evidence to support or reject the use of an intervention). RESULTS: Our analysis showed that 25.5% (14/55) of the studies did not provide sufficient evidence to support or reject the use of the interventions studied, 45.5% (25/25) provided sufficient but not strong evidence to support recommendations or suggestions, and 29.1% (16/55) provided strong evidence to support or reject the use of 1 or more of the interventions studied. CONCLUSIONS: Most of the systematic reviews published by the Cochrane Skin Group provide useful information to improve clinical practice. Clinicians should read these reviews and reconsider their current practice.
