Treatment adherence to different etanercept regimens, continuous vs. intermittent, in patients affected by plaque-type psoriasis.

Treatment adherence to anti-tumor necrosis factor alpha (anti-TNF-α) agents is marker of treatment success, but overall efficacy of anti-TNF-α therapy decreases over time leading to a progressive loss of adherence. The present observational study was conducted in order to estimate the long-term adherence to etanercept in patients affected by plaque-type psoriasis, evaluating differences among intermittent and continuous treatment regimen. Our findings reflect routine clinical practice in three academic referral centers and show high treatment adherence with etanercept in psoriatic patients. Treatment survival was consistently high in the short/medium term. The univariate analysis showed longer treatment duration in patients undergoing intermittent treatment regimen (mean 1,706 days) compared with continuous regimen (mean 1,249 days). Results showed that a flexible pulsed treatment with etanercept can be optimal in terms of clinical success and adherence.

Efficacy of auto-crosslinked hyaluronan gel for adhesion prevention in laparoscopy and hysteroscopy: a systematic review and meta-analysis of randomized controlled trials.

Prevention of postoperative adhesions is a clinical need. We undertook a systematic review to explore the available clinical evidence of the efficacy of auto-crosslinked hyaluronan gel for postoperative adhesion prevention following endoscopic gynecological surgery. An electronic database search of MEDLINE, Cochrane Database of Systematic Reviews and EMBASE, and a comprehensive hand-search of reference lists of published and review articles were performed. No language restrictions were applied. Randomized controlled trials (RCTs) on the use of auto-crosslinked hyaluronan gel for the prevention of postoperative adhesions in gynecological surgery were included in the meta-analysis if they reported outcomes as evaluated at a blind second-look assessment. Three authors independently selected studies and extracted data on study characteristics, quality and accuracy. The Jadad scoring system was used for validity assessment. Meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The outcome was the incidence of postoperative adhesions based on a binary response (present or not present). Only five RCTs were eligible for inclusion in the meta-analysis. The incidence of postoperative adhesions in patients who received auto-crosslinked hyaluronan gel was significantly lower than in patients who underwent standard surgery only. The gel prevented both intraperitoneal adhesions after laparoscopic myomectomy (OR 0.248, 95% CI 0.098, 0.628) and intrauterine adhesions after hysteroscopic surgery (OR 0.408, 95% CI 0.217, 0.766). Further RCTs are needed to assess the efficacy of auto-crosslinked hyaluronan gel in women undergoing different laparoscopic intra-abdominal surgical procedures.