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1.
Expert Rev Pharmacoecon Outcomes Res ; 21(5): 1135-1144, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34165377

RESUMO

BACKGROUND: As healthcare management of highly active-relapsing-remitting multiple sclerosis (HA-RRMS) patients is more complex than for the whole multiple sclerosis (MS) population, this study assessed the related economic burden from a National Health Insurance's (NHI's) perspective. RESEARCH DESIGN AND METHODS: Study based on French NHI databases, using individual data on billing and reimbursement of outpatient and hospital healthcare consumption, paid sick leave and disability pension, over 2010-2017. RESULTS: Of the 9,596 HA-RRMS adult patients, data from 7,960 patients were analyzed with at least 2 years of follow-up. Mean annual cost/patient was €29,813. Drugs represented 40% of the cost, hospital care 33%, disability pensions 9%, and all healthcare professionals' visits combined 8%. Among 3,024 patients under 60 years-old with disability pension, disability pension cost €7,168/patient/year. Among 3,807 patients with paid sick leave, sick leave cost €1,956/patient/year. Mean costs were €2,246/patient higher the first year and increased by €1,444 between 2010 and 2015, with a €5,188 increase in drug-related expenditures and a €634 increase in healthcare professionals' visits expenditures but a €4,529 decrease in hospital care expenditures. CONCLUSIONS: The cost of health care sick leaves, and disability pensions of HA-RRMS patients was about twice as high as previously reported cost of MS patients.


Assuntos
Efeitos Psicossociais da Doença , Hospitalização/estatística & dados numéricos , Esclerose Múltipla Recidivante-Remitente/terapia , Esclerose Múltipla/terapia , Adulto , Estudos de Coortes , Bases de Dados Factuais , Atenção à Saúde/economia , Atenção à Saúde/métodos , Pessoas com Deficiência , Feminino , Seguimentos , França , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/economia , Esclerose Múltipla Recidivante-Remitente/economia , Programas Nacionais de Saúde/economia , Pensões/estatística & dados numéricos , Estudos Retrospectivos , Licença Médica/economia
2.
Mult Scler Relat Disord ; 47: 102659, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33291032

RESUMO

BACKGROUND: Fatigue is a frequent and disabling symptom of multiple sclerosis (MS) often associated with impaired quality of life (QoL) in patients. Teriflunomide is a once-daily oral immunomodulator used for the treatment of relapsing remitting forms of MS. However, its effect on fatigue is not well known in real life practice. We evaluated the impact of teriflunomide on fatigue in patients with relapsing remitting MS (RRMS) after 2 years of treatment in the real-world Teri-FAST study. METHODS: Teri-FAST was a 2-year, prospective, observational study conducted in France in RRMS patients treated with teriflunomide 14 mg. Fatigue was assessed using the French version of the modified fatigue impact scale (EMIF-SEP). The primary endpoint was the change from baseline in EMIF-SEP score after 2 years of treatment. Secondary endpoints included evaluation of depression (Beck Depression Inventory [BDI]), health-related QoL (Two-Life Scale TLS-QoL 10), self-reported physical activity, and adverse events. RESULTS: 210 eligible patients were included in the study with a mean age of 45.4 years and a mean ± SD Expanded Disability Status Scale score of 1.76 ± 1.43 at baseline. About half (52.4%) of patients had no previous treatment for MS. In the 163 patients who completed at least 1 follow-up visit, the mean change in EMIF-SEP score at Year 2 was -1.54 (95% CI: -4.02, 0.94) indicating that fatigue remained stable. Similarly, there were no changes in depression level and QoL after 2 years of treatment. Physical activity slightly improved with 57% of patients reporting being physically active after 2 years as compared to 46% at baseline. The safety profile of teriflunomide was consistent with that seen during clinical development, and compliance with treatment was high. CONCLUSION: Fatigue scores remained stable in RRMS patients treated with teriflunomide 14 mg over 2 years in real-life setting. Teriflunomide did not negatively impact depression or QoL.


Assuntos
Esclerose Múltipla Recidivante-Remitente , Esclerose Múltipla , Crotonatos , Fadiga/tratamento farmacológico , Fadiga/etiologia , França , Humanos , Hidroxibutiratos , Pessoa de Meia-Idade , Esclerose Múltipla Recidivante-Remitente/complicações , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Nitrilas , Estudos Prospectivos , Qualidade de Vida , Toluidinas
3.
Atherosclerosis ; 185(2): 361-7, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16137695

RESUMO

BACKGROUND: With the advent of antiretroviral therapy regimens in HIV positive patients, it is crucial to consider their long-term benefits to risk ratios. The responsibility of treatment in premature atherosclerosis is not clear. Thus, the aim of this study is to evaluate the impact of exposure to reverse transcriptase inhibitors (nucleosidic and non-nucleosidic) and to protease inhibitors on the cardiovascular status of an entire hospital based cohort of patients. METHODS: 154 patients were included. Using a linear analysis, we sought an association between the cumulative time of exposure to these three classes of antiretroviral drugs and the carotid intima-media thickness measured by ultrasonography and a cardiovascular composite score. RESULTS: The study confirms premature atherosclerosis, which not only correlates with the usual risk factors, such as triglyceride level, but also with protease inhibitor exposure, especially that of lopinavir. Nevertheless as regards current drug exposure, the clinical impact was low: five clinical complications of atherosclerosis and only one out of 35 scintigraphic and ECG exercise tests warranted a coronary angiography which was negative. CONCLUSION: These data should not lead to the rejection of protease inhibitors but should strengthen the prevention of cardiovascular diseases as an integral part of the management of HIV patients.


Assuntos
Antirretrovirais/uso terapêutico , Aterosclerose/patologia , Soropositividade para HIV/tratamento farmacológico , Adulto , Antirretrovirais/efeitos adversos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Aterosclerose/etiologia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/diagnóstico , Artéria Carótida Primitiva/patologia , Estudos de Coortes , Inibidores da Protease de HIV/efeitos adversos , Inibidores da Protease de HIV/uso terapêutico , Soropositividade para HIV/complicações , Humanos , Lipídeos/sangue , Pessoa de Meia-Idade , Inibidores da Transcriptase Reversa/efeitos adversos , Inibidores da Transcriptase Reversa/uso terapêutico , Fatores de Risco , Túnica Íntima/efeitos dos fármacos , Túnica Íntima/patologia , Túnica Média/efeitos dos fármacos , Túnica Média/patologia
4.
Haematologica ; 91(6 Suppl): ECR22, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16785125

RESUMO

The discovery of an asymptomatic and spontaneous internal carotid occlusion in a young HIV-infected patient, without atherosclerosis, asks the question of cardio-vascular disease's mechanism. A pro-atherogenic profile HAART-associated does not fully explain the high cardio-vascular disease's incidence among the HIV infected population. Carotid stenosis and/or thrombophilic conditions are emergent problems among HIV-infected persons.


Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Estenose das Carótidas/induzido quimicamente , Infecções por HIV/tratamento farmacológico , Adulto , Contagem de Linfócito CD4 , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/patologia , Infecções por HIV/imunologia , Humanos , Masculino , Túnica Íntima/patologia , Túnica Média/patologia , Ultrassonografia
5.
Joint Bone Spine ; 70(1): 73-6, 2003 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-12639624

RESUMO

Cutaneous sensory neuropathy manifests as multiple, sharply demarcated areas of hypoesthesia with a variable degree of pain. This rare neuropathy is caused by a multifocal infection or inflammation of the small sensory nerves of the skin. We report a case in a patient with febrile arthritis and eosinophilia. Her chronic cough and the presence of extravascular infiltrates of eosinophils in a neuromuscular biopsy specimen suggested Churg-Strauss syndrome. The course was favorable under corticosteroid therapy.


Assuntos
Síndrome de Churg-Strauss/complicações , Doenças do Sistema Nervoso Periférico/complicações , Transtornos de Sensação/complicações , Adulto , Anti-Inflamatórios/uso terapêutico , Artrite/etiologia , Síndrome de Churg-Strauss/tratamento farmacológico , Síndrome de Churg-Strauss/fisiopatologia , Eosinofilia/etiologia , Feminino , Febre/etiologia , Humanos , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/fisiopatologia , Prednisona/uso terapêutico , Transtornos de Sensação/tratamento farmacológico , Transtornos de Sensação/fisiopatologia , Pele/inervação
6.
Presse Med ; 37(4 Pt 1): 579-84, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18313892

RESUMO

OBJECTIVE: Metabolic syndrome (MetS) is directly related to a high incidence of cardiovascular disease in the general population. The association is more doubtful among HIV-infected patients, although MetS has an elevated prevalence in this population. We explored the impact of MetS on early atherosclerosis markers. RESEARCH DESIGN AND METHODS: All HIV-infected outpatients followed at the Brest University Hospital were included in this cross-sectional hospital-based study (SHIVA study, France) (n=154). The MetS status (NCEP ATPIII definition, at least three of these five criteria: fasting glucose, triglycerides, HDL-C, waist circumference and hypertension.) of each patient was analyzed (Mann-Whitney test) according to carotid intima-media thickness, number of plaques, and a combined cardiovascular score. RESULTS: After exclusion of 6 patients treated with statins or insulin or both, MetS status was available for 140 (90.9%) patients and positive for 10 (7.1%). MetS status was due predominantly to blood glucose and triglyceride levels and was strongly correlated with all atherosclerosis markers (p < or = 0.01). CONCLUSION: The MetS prevalence in this population is low for a group with HIV infection, even after inclusion of the statin-treated patients (11.4%), but remains higher than among the general population. MetS in this population is probably a heterogeneous cluster of side effects of antiretroviral therapy (high triglycerides, lower HDL-C, and hypertension) and direct effects of HIV (glucose disturbances). Because it is strongly linked to the presence of plaque and intimal thickness, it is a pertinent criterion for deciding about cardiovascular prevention.


Assuntos
Aterosclerose/epidemiologia , Infecções por HIV/epidemiologia , Síndrome Metabólica/epidemiologia , Adulto , Glicemia/análise , HDL-Colesterol/sangue , Estudos Transversais , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Triglicerídeos/sangue , Túnica Íntima/patologia
7.
Curr HIV Res ; 5(3): 361-4, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17504179

RESUMO

In the HIV infection, the short time-scale between the HIV-induced cardiovascular events and the onset of antiretroviral therapy elicits a thrombophilic co-factor that worsens the induced atherosclerosis. We compared the factor VIII plasma activity, previously implicated in arterial and venous thrombosis, with a surrogate marker of atherosclerosis, the carotid intima-media thickness, and with the usual atherosclerosis risk factors in 154 HIV infected outpatients. The FVIII plasma activity is significantly associated with the carotid intima-media thickness and, strongly, with blood glucose and triglycerides levels. A raised FVIII plasma activity is an important feature of the metabolic syndrome and a putative co-factor of HAART induced cardiovascular events. Thus the prevention of the HAART-induced cardio-vascular events should probably not be exclusively focused on atherosclerosis but likewise on the thrombus formation process.


Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Doenças Cardiovasculares/fisiopatologia , Artérias Carótidas/diagnóstico por imagem , Fator VIII/análise , Infecções por HIV/complicações , Adulto , Fármacos Anti-HIV/efeitos adversos , Biomarcadores , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/metabolismo , Feminino , Infecções por HIV/tratamento farmacológico , Síndrome de Lipodistrofia Associada ao HIV/sangue , Síndrome de Lipodistrofia Associada ao HIV/etiologia , Humanos , Masculino , Fatores de Risco , Ultrassonografia
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