Switching to Vortioxetine in Patients with Poorly Tolerated Antidepressant-Related Sexual Dysfunction in Clinical Practice: A 3-Month Prospective Real-Life Study.

Treatment-emergent sexual dysfunction (TESD) is one of the most frequent and persistent adverse effects of antidepressant medication. Sexual dysfunction (SD) secondary to SSRIs occurs in >60% of sexually active patients and >80% of healthy volunteers, with this causing treatment discontinuation in >35% of patients. However, this factor is rarely addressed in routine examinations, and only 15-30% of these events are spontaneously reported. A strategy of switching to a different non-serotonergic antidepressant could involve a risk of relapse or clinical worsening due to a lack of serotonergic activity. Vortioxetine appears to have less impact on sexual function due to its multimodal mechanism of action. No studies have been published on the effectiveness of switching to vortioxetine in patients with poorly tolerated long-term antidepressant-related SD in naturalistic settings. STUDY OBJECTIVES: To determine the effectiveness of switching to vortioxetine due to SD in a routine clinical practice setting. METHODOLOGY: observational pragmatic and naturalistic study to determine the effectiveness of the switch to vortioxetine (mean dosage 13.11 ± 4.03) in 74 patients aged 43.1 ± 12.65 (54% males) at risk of discontinuing treatment due to sexual dysfunction. The PRSexDQ*- SALSEX scale (* Psychotropic-Related Sexual Dysfunction Questionnaire) was applied at two moments: baseline visit and after 3 months of follow-up. RESULTS: global Sexual Dysfunction (SD) measured with the SALSEX scale decreased significantly between the baseline visit (10.32; SD 2.73) and the follow-up visit (3.78; SD 3.68), p < 0.001. There was a significant improvement (p < 0.001) at the endpoint including decreased libido, delay of orgasm, anorgasmia and arousal difficulties in both sexes. After switching to vortioxetine, 83.81% of patients experienced an improvement in sexual function (43.2% felt greatly improved). Most patients (83.3%) who switched to vortioxetine continued treatment after the follow-up visit. A total of 58.1% of patients showed an improvement in depressive symptoms from the baseline visit. CONCLUSION: switching to vortioxetine is an effective and reliable strategy to treat patients with poorly tolerated previous antidepressant-related sexual dysfunction in real-life clinical settings.

[Glucocorticoids in rheumatoid arthritis: almost always or hardly ever?]. / Glucocorticoides en artritis reumatoide: ¿casi siempre o casi nunca?

The use of glucocorticoids in rheumatoid arthritis has been the source of frequent debate in the last decades. There is evidence on its anti-inflammatory capacity and its power to decrease radiologic progression, particularly if used in recent onset rheumatoid arthritis. However, there are still some voices questioning its use. Their arguments are its potential side-effects, especially when the glucocorticoids are used in high doses and/or for extended periods of time. In this review, we will try to summarize the evidence regarding this issue, from the beginning of the discussion in the fifties to the last releases.

Glucocorticoides en artritis reumatoide: ¿casi siempre o casi nunca? / Glucocorticoids in rheumatoid arthritis: almost always or hardly ever?

El uso de los glucocorticoides en la artritis reumatoide ha sido objeto de debate en las últimas décadas. Parece existir evidencia probada, en cuanto a su capacidad antiinflamatoria y su poder de disminuir la progresión radiológica, principalmente si se utiliza en artritis reumatoide de inicio reciente. Sin embargo, sigue cuestionándose su uso debido a sus potenciales efectos secundarios, sobre todo cuando se utilizan en altas dosis y/o durante periodos prolongados. En esta revisión, intentaremos resumir la evidencia existente sobre este aspecto desde los inicios, allá por los años cincuenta del siglo xx, hasta las últimas publicaciones (AU)

The use of glucocorticoids in rheumatoid arthritis has been the source of frequent debate in the last decades. There is evidence on its anti-inflammatory capacity and its power to decrease radiologic progression, particularly if used in recent onset rheumatoid arthritis. However, there are still some voices questioning its use. Their arguments are its potential side-effects, especially when the glucocorticoids are used in high doses and/or for extended periods of time. In this review, we will try to summarize the evidence regarding this issue, from the beginning of the discussion in the fifties to the last releases (AU)