Reactivación de citomegalovirus en pacientes críticos con infección por COVID-19 / Cytomegalovirus reactivation in critically ill patients with COVID-19 infection

Introducción: Existe bastante evidencia sobre la reactivación del citomegalovirus (CMV) en pacientes críticos y se ha planteado que pueda ser una de las coinfecciones que puedan aumentar la morbimortalidad en pacientes con infección severa por COVID-19. Por ello, se plantea un estudio para analizar las características de los pacientes COVID-19 que recibieron tratamiento anticitomegalovirus en la Unidad de Ciudados Intensivos (UCI). Material y métodos: Estudio multidisciplinar, observacional, retrospectivo, unicéntrico que incluyó todos los pacientes con COVID-19 en UCI que fueron tratados con ganciclovir o foscarnet entre marzo-2020 y abril-2021 en un hospital terciario. Variables: demográficas, relacionadas con el tratamiento para CMV, tratamiento recibido para COVID-19, estancia hospitalaria, mortalidad intrahospitalaria y al alta. Resultados: En el período de estudio, 26 pacientes críticos con COVID-19, recibieron algún tratamiento anticitomegalovirus (69,2% hombres, mediana de edad 64 años). En 15 (57,7%) se confirmó la reactivación microbiológicamente, y estos pacientes tuvieron estancias más prolongadas que los tratados sin confirmación. La mortalidad en el grupo tratado fue del 84,6% (80,0% en los que se confirmó reactivación), frente al 43,0% de mortalidad en el global de 300 pacientes COVID-19 que requirieron UCI en ese período. La tasa de infección demostrada de CMV fue del 5,0%. Conclusiones: Aunque existen publicaciones que sugieren un mayor riesgo de reactivación de CMV en pacientes COVID-19, la incidencia en nuestro estudio fue inferior a la descrita en pacientes críticos COVID. Hay que destacar la elevada mortalidad en los pacientes del estudio frente al global de pacientes atendidos en UCI por COVID-19. (AU)

Introduction: There is considerable evidence on the reactivation of cytomegalovirus (CMV) in critically ill patients and it has been suggested that it may be one of the co-infections that may increase morbidity and mortality in patients with severe COVID-19 infection. Therefore, a study was proposed to analyze the characteristics of COVID-19 patients who received anti-cytomegalovirus treatment in the Intensive Care Unit (ICU). Material and methods: Multidisciplinary, observational, retrospective, single-center study that included all patients with COVID-19 in ICU who were treated with ganciclovir or foscarnet between March-2020 and April-2021 in a tertiary hospital. Variables: demographic, related to treatment for CMV, treatment received for COVID-19, hospital stay, in-hospital mortality and at discharge. Results: In the study period, 26 critically ill patients with COVID-19 received some anti-cytomegalovirus treatment (69.2% men, median age 64 years). In 15 (57.7%) reactivation was confirmed microbiologically, and these patients had longer stays than those treated without confirmation. Mortality in the treated group was 84.6% (80.0% in those with confirmed reactivation), compared to 43% mortality in the overall of 300 COVID-19 patients who required ICU in that period. The demonstrated infection rate of CMV was 5.0%. Conclusions: Although there are publications that suggest a higher risk of CMV reactivation in COVID-19 patients, the incidence in our study was lower than that described in critical COVID patients. It should be noted the high mortality in the study patients compared to the overall number of patients seen in the ICU for COVID-19. (AU)

Discontinuación y adherencia a largo plazo en la terapia con interferón beta en pacientes con esclerosis múltiple / Discontinuation and long-term adherence to beta interferon therapy in patients with multiple sclerosis

Objetivo Estudiar la frecuencia de discontinuación y el grado de adherencia en la primera línea de tratamiento con interferón beta (INFβ) en pacientes con esclerosis múltiple (EM), identificando sus causas y factores asociados. Método Estudio observacional retrospectivo que incluyó pacientes con EM clínicamente definida en tratamiento con INFβ durante el año 2001 en el área de pacientes externos de un servicio de farmacia hospitalaria. Se realizó un seguimiento desde el inicio del tratamiento hasta finales del año 2006. Las fuentes de datos utilizadas fueron la base de datos informatizada del área de pacientes externos, la historia clínica y los protocolos de solicitud de inicio y seguimiento de tratamiento para la EM. Se recopiló información sobre las características basales del paciente, tratamiento y continuidad del mismo. Resultados Se incluyeron 131 pacientes, a los que se les realizó un seguimiento medio de 7,4±2,6 años. El 64,1% fueron tratados con un solo fármaco durante todo el estudio. A los 2 años del inicio de la terapia con INFβ habían discontinuado la terapia el 9,9%, a los 5 años el 41,2% y a los 8 años y medio el 58,7%. Se mantenían más tiempo en tratamiento los hombres, pacientes con EM recurrente-remitente y tratados con INFβ1a-im, si bien solo fue significativo en los pacientes con 10 años o menos de evolución de la enfermedad al inicio del tratamiento. Las causas mayoritarias de discontinuación fueron la falta de efectividad (38,8%) y la aparición de efectos adversos (32,8%). Los pacientes adherentes discontinuaron menos el tratamiento (55,8 vs 75%).Conclusiones La continuidad a largo plazo en el tratamiento de la EM se ve reducida principalmente por la falta de efectividad y los efectos adversos. Una aproximación a la perspectiva del paciente puede ayudar a identificar aquellos con mayor riesgo de falta de adherencia para ayudar a optimizar la terapia(AU)

Objective To determine discontinuation rate and degree of adherence to first-line treatment with interferon-beta (INFβ) in patients with multiple sclerosis (MS), identifying causes and associated factors. Material and Method A retrospective observational study that included patients with MS treated with INFβ during 2001. The patients were followed-up from the beginning of treatment until the end of 2006. The data sources used were a computer database compiled in the outpatients’ area, medical records and application protocols for beginning and monitoring treatment for MS. Patient characteristics at baseline, treatment and continuity were included in the information collected. Results The study included 131 patients. Mean follow-up was 74±26 years. 641% of the patients were treated with only one drug during the study. At 2 years follow-up 99% of patients had discontinued INFβ therapy and at 5 years 412% had done so. Men, patients with relapsing-remitting MS and those treated with INFβ1a i.m. continued treatment for a longer period, but this was statistically significant only in patients with 10 years or less of disease progression at the beginning of therapy. Main causes of discontinuation were lack of efficacy (388%) and adverse effects (328%). Compliant patients presented lower discontinuation rates (558% vs. 75%).Conclusions treatment of MS patients with IFNβ is discontinued mainly due to lack of efficacy and adverse effects. Greater understanding of patients’ views can help to identify those at greatest risk of lack of adherence, thereby helping to improve treatment (AU)

[Discontinuation and long-term adherence to beta interferon therapy in patients with multiple sclerosis]. / Discontinuación y adherencia a largo plazo en la terapia con interferón beta en pacientes con esclerosis múltiple.

OBJECTIVE: To determine discontinuation rate and degree of adherence to first-line treatment with interferon-beta (INFß) in patients with multiple sclerosis (MS), identifying causes and associated factors. MATERIAL AND METHOD: A retrospective observational study that included patients with MS treated with INFß during 2001. The patients were followed-up from the beginning of treatment until the end of 2006. The data sources used were a computer database compiled in the outpatients' area, medical records and application protocols for beginning and monitoring treatment for MS. Patient characteristics at baseline, treatment and continuity were included in the information collected. RESULTS: The study included 131 patients. Mean follow-up was 74 ± 26 years. 641% of the patients were treated with only one drug during the study. At 2 years follow-up 99% of patients had discontinued INFß therapy and at 5 years 412% had done so. Men, patients with relapsing-remitting MS and those treated with INFß1a i.m. continued treatment for a longer period, but this was statistically significant only in patients with 10 years or less of disease progression at the beginning of therapy. Main causes of discontinuation were lack of efficacy (388%) and adverse effects (328%). Compliant patients presented lower discontinuation rates (558% vs. 75%). CONCLUSIONS: treatment of MS patients with IFNß is discontinued mainly due to lack of efficacy and adverse effects. Greater understanding of patients' views can help to identify those at greatest risk of lack of adherence, thereby helping to improve treatment.