The comparative efficacy and safety of biologics and small molecules for treating patients with ulcerative colitis in Portugal: a systematic literature review and network meta-analysis.

OBJECTIVE: The use of biological drugs to treat ulcerative colitis (UC) represents a clear added value; nevertheless, many patients do not have a sustained response to these drugs. Small molecules were recently approved for the treatment of UC in Portugal. This network meta-analysis aimed to compare the efficacy and safety of the different therapies, including biological and small molecules, in patients prior exposed to biological treatment. MATERIALS AND METHODS: A systematic review of the literature was performed on January 6, 2022, identifying all the relevant reports about the efficacy and safety of biologics (adalimumab, golimumab, infliximab, vedolizumab, ustekinumab) and small molecules (upadacitinib, filgotinib, tofacitinib) in the treatment of UC in Portugal. Network meta-analysis (NMA) was conducted using Bayesian Markov Chain Monte Carlo simulations. Results were presented in median Odds Ratio and Surface Under the Cumulative RAnking (SUCRA) score for each treatment. RESULTS: Treatment of UC is divided into two phases: induction and maintenance. Upadacitinib 45 mg was the most efficacious therapy in achieving clinical remission and response and endoscopic improvement in the induction phase. Concerning the maintenance phase, upadacitinib 30 mg performed better than ustekinumab formulations in clinical remission and response, and endoscopic improvement. Regarding safety, there were no significant differences between all the drugs included in the analysis. CONCLUSIONS: This network meta-analysis showed that upadacitinib reflects better efficacy compared to the available treatments for bio-exposed patients with moderate to severe UC. The safety profile is comparable to the other drugs.

Displacement of the tendon of the superficial digital flexor muscle in dogs: 10 cases (1983-1991).

Displacement of the tendon of the superficial digital flexor muscle was diagnosed in 9 dogs (10 tarsi). Four of 10 displacements occurred in Shetland Sheepdogs. All dogs had an acute onset of lameness with swelling over the proximal end of the tuber calcanei. Lateral displacement occurred in 8 tarsi and medial displacement in 2 tarsi. Nonsurgical treatment (exercise restriction, bandaging, and administration of anti-inflammatory medication) was ineffective in the 5 dogs in which it was attempted. Surgical reconstruction of the supporting soft tissues resulted in return to normal function in 9 cases available for follow-up evaluation.

Spinal meningiomas in dogs: 13 cases (1972-1987).

Medical records of 13 dogs with spinal meningiomas were reviewed. Breed predilections were not found. Males outnumbered females 9 to 4, and most of the dogs were middle-aged. All dogs had motor deficits of various degrees, and approximately half of the dogs had clinical signs of mild to moderate spinal pain. The remainder had histories of clinical signs suggestive of chronic discomfort. There was a prolonged (greater than 3 months) delay between the onset of signs and diagnosis, except in 3 dogs. The neurologic courses usually were progressive. Results of noncontrast spinal radiography were normal in 10 dogs; in 3 dogs, the lamina appeared scalloped. Results of myelography contributed to the correct diagnosis in 10 of 12 dogs; however, in 2 dogs, intradural/extramedullary tumors were thought to be intramedullary lesions. A preponderance of cervical meningiomas was found, accounting for 10 of 13 tumors. Lumbar meningiomas were found in the remaining 3 dogs. Surgery was performed in 9 of the dogs, six of which improved after surgery. Poor results were correlated with tumors that involved spinal cord segments of an intumescence, ventrally located tumors, iatrogenic trauma, and tumor invasion into adjacent neural parenchyma. Four of 13 spinal meningiomas were found to be invasive into the spinal cord itself.

Lumbosacral stenosis in dogs.

Fifteen dogs with stenosis of the lumbosacral portion of the spinal canal were treated by laminectomy, bilateral facetectomy, and foraminotomy. Concomitant disk extrusion, spondylosis, fracture, infection, neoplasia, hemivertebrae, and spinal bifida were not associated with the stenosis and attendant cauda equina compression. The predominant neurologic signs were intermittent hindlimb lameness and motor weakness; hindlimb muscle atrophy; presumed paresthesia with resultant dermatologic manifestations from self mutilation of the hindlimbs, tail, perineum, anal area, and genitalia; urinaryu or fecal incontinence, or both; and consistently elicitable pain on manipulation of the lumbosacral spine. Surgical decompression of the stenotic canal alleviated the clinical signs in all cases.

Necrotizing myelopathy secondary to embolization of herniated intervertebral disk material in the dog.

Seven dogs (3 Great Danes, 2 German Shepherd Dogs, 1 Weimaraner, and 1 Boxer) ranging in age from 1 1/2 to 9 years were examined because of acute neurologic signs involving the limbs. All dogs were nonambulatory--3 tetraparetic and 4 paraparetic. In each case, treatment was unsuccessful or not advised, and each dog was euthanatized. Necropsy revealed hemorrhagic infarcts of the gray and white matter as a result of fibrocartilaginous embolization in leptomeningeal and parenchymal vessels of the spinal cord. The emboli were derived from disk material herniated into the vertebral venous sinuses.

Primary tumors of the spinal cord and meninges in six dogs.

Primary spinal cord tumors were detected in 6 mature dogs. Two of the tumors were astrocytomas, 2 were meningiomas, and 2 were neurilemmomas. Five tumors were in the cervical portion and 1 was in the lumbar portion of the spinal cord.

Spinal cord compression caused by osteocartilaginous exostoses of the spine in two dogs.

Two dogs, one 4 months old and the other 1 year old, had histories of progressive posterior weakness. In both cases, there was severe asymmetric proprioceptive loss but appreciable preservation of strength. Benign, cystic expansile lesions involving the facets and lamina of the thoracic spine were observed radiographically; a single lesioons was demonstrated in the other. Examination of biopsy speciments taken at the time of laminectomy revealed the lesions to be osteocartilaginous exostoses (osteochondromas, ecchondromas, exostoses). The progress of dogs 1 and 2 has been monitored for 1 1/2 years and 9 months, respectively. Dog 1 has no weakness or proprioceptive loss; dog 2 has a mild proprioceptive loss in the right hindlimb.