Systematic review and network meta-analysis (NMA) for cladribine tablets in achieving sustained disability improvement (SDI) in multiple sclerosis.

INTRODUCTION: This study was performed to compare probabilities of SDI on the Expanded Disability Status Scale (EDSS) in patients with relapsing-remitting multiple sclerosis (RRMS), treated with cladribine tablets (CT) or fingolimod (FTY), natalizumab (NAT), alemtuzumab (ALE) and ocrelizumab (OCR). CLINICAL RATIONALE FOR THE STUDY: Progression of neurological disability as measured by the EDSS has been a common endpoint in multiple sclerosis (MS) trials. Novel therapies can not only slow this process, but in some patients even reverse it. This effect can be measured by the sustained disability improvement (SDI) - an endpoint that seems to continuously gain importance in clinical practice. Despite that, SDI has rarely been explored as an outcome in MS clinical studies, mostly as post-hoc analyses from randomised trials or as retrospective analyses based on patient registry records. MATERIAL AND METHODS: A systematic review was conducted in Medline, Embase and Cochrane to identify clinical trials (RCT or non-RCT) evaluating 6-month SDI. An indirect comparison via network meta-analysis (NMA) was performed. Bayesian inference with Markov chains Monte Carlo methods were applied. RESULTS: Eight trials presenting SDI results and applicable for NMA were included: six non-RCTs, with control groups selected by propensity score matching, and two RCTs. NMA results revealed that probability of achieving 6-month SDI with CT was significantly higher compared to all other high efficacy disease-modifying drugs with available data - HR (95% Crl - Bayesian Credibility Interval) vs. FTY: 4.98 (2.11-11.79); vs. NAT: 3.12 (1.31-7.27); vs. ALE: 9.29 (3.40-25.21). The main results were confirmed in the sensitivity analyses. CONCLUSIONS: Of all considered therapies, treatment with cladribine tablets was associated with a higher probability of sustained disability improvement in RRMS patients. As this conclusion is based on available clinical data of limited quality, future studies, as well as real-world data, would be valuable to provide further evidence regarding the comparative effectiveness of RRMS therapies.

Impact of abdominal obesity on the frequency of hypertension and cardiovascular disease in Poland - results from the IDEA study (international day for the evaluation of abdominal obesity).

INTRODUCTION: Cardiovascular disease (CVD) is a major cause of mortality, and has risk factors, which can be treated by lifestyle changes or medications. Abdominal obesity has been identified as the second strongest risk factor for myocardial infarction. OBJECTIVES: To assess the frequency of abdominal obesity and its relationship with hypertension (HT) and CVD in patients in Poland, and to compare frequencies of adiposity, HT and CVD between Poland and the North-West Europe Region, obtained in the IDEA study. METHODS: In Poland, general practitioners included 5371 patients, aged 18-80 years, eligible for analysis. Waist circumference (WC) was measured, and the presence of HT and CVD recorded. RESULTS: Increasing WC was significantly associated with HT and CVD, after adjustment for age (p<0.001). The frequency of abdominal obesity (WC >102/88 cm) was higher in Poland than in North-West Europe (36% vs 33% in men and 54% vs 45% in women, respectively, p<0.0001). Similarly, the frequency of HT in Poland was higher than in North-West Europe (47 vs 36% in men and 45 vs 30% in women, respectively p<0.001). In Poland CVD was 1.7-fold more frequent in men and 2.5-fold more frequent in women, compared with North-West Europe. CONCLUSION: In Polish adiposity, both WC and body mass index (BMI) were strongly related to HT and CVD. The frequency of abdominal obesity, obesity, HT and CVD in primary care patients is substantially higher in Poland than in North-West Europe.

[Prevalence of abdominal aortic aneurysm and peripheral arterial diseases in ambulatory patients with coronary disease]. / Whystepowanie miazdzycy aorty i tetnic obwodowych u leczonych ambulatoryjnie osób z choroba wiencowa.

Presence of peripheral arterial disease in patients with coronary artery disease is associated with worse outcome. The aim of this epidemiological study was to evaluate the prevalence of different manifestation of atherothrombosis and its risk factors in the group of 2969 ambulatory patients with coronary artery disease. Mean age of investigated group was 61.2 +/- 10.5 years and 64% patients were male. Abdominal aortic aneurysm was diagnosed in 1.2% of patients, intermittent claudication in 13%, carotid stenosis in 5%. History of stroke was given in 4.4% cases and history of TIA in 7%. Only in 8% of patients with intermittent claudication ankle-brachial index was assessed. We conclude that among patients with coronary artery disease other arteries atherothrombotic involvement is diagnosed in our country infrequently and efforts to recognize other symptoms of atherothrombosis should be encouraged.