Comparing medication adherence tools scores and number of controlled diseases among low literacy patients discharged from a Brazilian cardiology ward.

Background Adherence to prescribed drug therapy is associated with lower rates of cardiovascular causes of death. In view of the relevance for public health, it is important to understand the relation between medication adherence tools' scores, especially in low literacy patients discharged from a cardiology ward. Objectives We aimed to assess: (a) the association between number of controlled clinical conditions and adherence tools scores, and (b) the correlation between the scores of three instruments to assess adherence. Methods We conducted a prospective study and included patients discharged from a specialized cardiovascular ward in Brazil. The results of the Beliefs about Medicines questionnaire (BMQ), the Adherence to Refills and Medication Scale (ARMS) and the MedTake test were compared. Results Of 53 included patients, most of them were elderly, and did not complete primary school. On average, there were six health conditions per patient, where two of them were not controlled. ARMS was the only tool that was associated with number of controlled health conditions (r = -0.312, p < 0.05). Moreover, ARMS (average score 15.6 ± 3.4) had significant correlation with MEDTAKE (r = 0.535, p < 0.01) and BMQ (r = 0.38, p < 0.01). BMQ and MEDTAKE were also positively correlated (r = 0.311, p < 0.05). Conclusions Clinically, higher ARMS scores (>12) suggest assumed non-adherence. It is also negatively correlated with the number of controlled clinical conditions in low literacy elderlies with cardiovascular diseases.

Morbidade e mortalidade relacionadas a medicamentos no Brasil: revisão sistemática de estudos observacionais / Drug-related morbidity and mortality in Brazil: a systematic review of observational studies

Este estudo avaliou a morbimortalidade relacionada a medicamentos no Brasil, sua prevalência, grupos farmacológicos e fatores de risco, Foi realizada uma revisão sistemática de estudos observacionais publicados até agosto de 2012, sem restrição de data de início, nas bases de dados Medline, Lilacs, Scielo, Embase, IPA, Science Direct, Scopus e Web of Science, Foram selecionados estudos nacionais avaliando a ocorrência de qualquer tipo de dano ocasionado por medicamento, Foram incluídos 45 estudos, A maior prevalência de evento adverso a medicamento foi observada em hospitais, em adultos e idosos, variando de 15,6% a 34,1%, Nas creches, 19,9% das crianças sofreram alguma reação adversa, Em serviços de emergência, 25% dos adultos ou idosos sofreram dano relacionado à falha terapêutica, Medicamentos atuantes no sistema nervoso central foi o principal grupo farmacológico envolvido, Os principais fatores de risco foram idade, presença de comorbidades e uso de > 5 medicamentos, Os resultados encontrados são alarmantes e demonstram a necessidade da avaliação e estratificação de risco populacional, ações preventivas e de intervenção precoce que possam reduzir o impacto da morbimortalidade relacionada a medicamentos no Brasil...

This study evaluated the drug-related morbidity and mortality in Brazil, its prevalence, the pharmacological groups and risk factors associated. We performed a systematic review of observational studies published up to August 2012, without restriction start date, in the databases Medline, Lilacs, SciELO, EMBASE, IPA, Science Direct, Scopus and Web of Science. Were selected national studies evaluating the occurrence of any damage caused by medications. We included 45 studies. The highest prevalence of adverse drug events was observed in hospitals for adults and elderly, ranging from 15.6% to 34.1%. In nurseries, 19.9% of the children suffered some adverse drug reaction. In emergency departments, 25% of adults and elderly suffered harm related to therapeutic failure. Medications acting on the central nervous system were the main pharmacological group involved. The main risk factors were age, comorbidities and use of more than 5 medications. The results are alarming and demonstrate the need for screening and medication risk stratification in the population, and preventive or early interventions that can reduce the impact of drug-related morbidity and mortality in Brazil...

Efficacy and safety of biologics in the treatment of moderate to severe psoriasis: a comprehensive meta-analysis of randomized controlled trials / Eficácia e segurança de agentes biológicos no tratamento da psoríase moderada a grave: uma meta-análise de ensaios clínicos randomizados e controlados / Eficacia y seguridad de los agentes biológicos en el tratamiento de la psoriasis moderada a severa: un metaanálisis de ensayos aleatorios y controlados

We conducted a systematic review and metaanalysis of randomized placebo-controlled trials in moderate-to-severe psoriasis treated with biological agents, with a follow-up of 10-14 weeks. Overall, 41 studies, with mean Jadad score of 4.4, and 15,586 patients were included. For the efficacy outcomes PASI 50, 75 and 90 our findings are not conclusive to point what biological agent has the greatest response in short term follow-up. There were no statistical differences between placebo and biologics for the occurrence of infections and serious adverse events. Ustekinumab 45mg showed lower withdrawal due to adverse events compared with the placebo. Based on data available up to now, it is not possible to determine which biological agent is the best for PASI 50, 75 or 90 after 10-14 weeks of treatment. At the same follow-up, overall safety seems to be the same for all biological agents and Ustekinumab 45mg the most well tolerated drug. To better understand efficacy and safety, indirect meta-analysis comparing drug-to-drug is required since randomized placebo-controlled trials may not be feasible.

Conduziu-se uma revisão sistemática e metaanálise de ensaios clínicos randomizados em pacientes com psoríase moderada a grave, tratados com biológicos ou placebo por 10 a 14 semanas. Foram incluídos 41 estudos, com escore de Jadad médio de 4,4, totalizando 15.586 pacientes. Para os desfechos de eficácia PASI 50, 75 e 90 os resultados não são conclusivos para definir qual é o melhor agente biológico no curto prazo. Não houve diferença estatística entre placebo e biológicos para ocorrência de infecções e eventos ad-versos sérios. Ustequinumabe 45mg foi o biológico com menor ocorrência de descontinuação por conta de eventos adversos. Baseado na evidência até então disponível, não é possível determinar qual agente biológico é o melhor para se atingir resposta PASI 50, 75 e 90 após 10-14 semanas de tratamento. Para o mesmo intervalo, a segurança global parece ser a mesma para todos os biológicos e ustequinumabe 45mg o tratamento melhor tolerado. Para melhor compreender a eficácia e segurança, meta-análise indireta comparando droga-a-droga são necessárias já que ensaios clínicos randomizados podem não ser viáveis.

Se realizó una revisión sistemática y metaanálisis de ensayos controlados aleatorios en pacientes con psoriasis moderada a severa tratados con biológicos o placebo por 10-14 semanas. Se incluyeron 41 estudios con una puntuación de Jadad de 4,4, un total de 15.586 pacientes. Para variables de eficacia PASI 50, 75 y 90, los resultados no son concluyentes para definir cuál es el mejor agente biológico en el corto plazo. No hubo diferencia estadística entre el placebo y la ocurrencia biológica de las infecciones y los eventos adversos graves. Ustequinumabe 45mg fue el biológico con una menor incidencia de la interrupción debido a eventos adversos. Basado en la evidencia disponible hasta el momento, no es posible determinar qué agente biológico es lograr la mejor respuesta PASI 50, 75 y 90 después de 10-14 semanas de tratamiento. Para el mismo período, la seguridad global parece ser el mismo para todos los tratamientos y ustequinumabe 45mg el mejor tolerado. Para comprender mejor la eficacia y seguridad, es necesario un metaanálisis indirecto comparando medicamento a medicamento.

Efficacy and safety of biologics in the treatment of moderate to severe psoriasis: a comprehensive meta-analysis of randomized controlled trials.

We conducted a systematic review and metaanalysis of randomized placebo-controlled trials in moderate-to-severe psoriasis treated with biological agents, with a follow-up of 10-14 weeks. Overall, 41 studies, with mean Jadad score of 4.4, and 15,586 patients were included. For the efficacy outcomes PASI 50, 75 and 90 our findings are not conclusive to point what biological agent has the greatest response in short term follow-up. There were no statistical differences between placebo and biologics for the occurrence of infections and serious adverse events. Ustekinumab 45 mg showed lower withdrawal due to adverse events compared with the placebo. Based on data available up to now, it is not possible to determine which biological agent is the best for PASI 50, 75 or 90 after 10-14 weeks of treatment. At the same follow-up, overall safety seems to be the same for all biological agents and Ustekinumab 45 mg the most well tolerated drug. To better understand efficacy and safety, indirect meta-analysis comparing drug-to-drug is required since randomized placebo-controlled trials may not be feasible.