Conventional Therapy In Patients Research Articles

Effect of spinal mobilization with leg movement as an adjunct to neural mobilization and conventional therapy in patients with lumbar radiculopathy: Randomized controlled trial

Background: In lumbar radiculopathy there is compression or inflammation of a spinal nerve and it may be accompanied by numbness and tingling, muscle weakness or loss of spinal reflexes in one or both lower limbs. Conventional physiotherapy which includes back extension exercises has varying degree of success in pain and functional outcome in lumbar radiculopathy. Mulligan's spinal mobilization with limb movement (SMWLM) and Shacklock's neural tissue mobilization are few of the techniques employed in the management of lumbar radiculopathy. The purpose of the study was to find out whether spinal mobilization with leg movement as an adjunct to neural mobilization and conventional therapy could bring better outcome in patients when compared to conventional therapy or neural mobilization and conventional therapy. Methods: 90 patients were selected randomly with lumbar radiculopathy. Duration of the study was for six weeks. The study included 3 groups, control group received back extension exercises and hot pack, experimental group 1 received neural mobilisation and conventional physiotherapy and experimental group 2 received SMWLM along with neural mobilisation and conventional physiotherapy. The outcomes included NPRS, SLR using goniometry and MOLBPQ which were assessed at day 1 and 2, 4, 6 week. ANOVA was done for inter group analysis and paired t-test was done for intra group analysis. Results: All the groups showed significant difference (P -0.000 < 0.05) at 2, 4, 6 weeks of NPRS, MOLBPQ and SLR. The mean difference and paired t-test values of experimental group 2 was more when compared to experimental group 1 and control group at the end of 6 weeks. Conclusion: All the three groups showed improvement in pain, functional disability and straight leg raise (SLR). SMWLM as an adjunct to neural mobilization and conventional therapy showed significantly better outcomes in pain, functional disability and SLR when compared to conventional therapy or neural mobilization and conventional therapy.

Effectiveness of Soft Tissue Mobilisation as an adjunct to the Conventional Therapy in patients with Ankylosing Spondylitis

Effectiveness of Soft Tissue Mobilisation as an adjunct to the Conventional Therapy in patients with Ankylosing Spondylitis

Effectiveness of Eccentric Strengthening of Wrist Extensors along with Conventional Therapy in Patients with Lateral Epicondylitis

Lateral epicondylitis is a common yet a complex musculoskeletal condition affecting many people. This disorder challenges the physical therapist daily as it is an injury that is difficult to treat as it is prone to recurrent bouts. Recent studies stated that isolated eccentric training was effective in treating chronic lateral epicondylitis as it provides neuromuscular benefits through central adaptation of both agonist and antagonist muscles. Grip strength provides an index for the functional integrity of the upper extremity. In clinical setting, hand grip strength is quantified by measuring the amount of static force applied by an instrument called dynamometer, which measures static grip strength and is widely accepted to measure the grip strength. The pre and post-test value for pain using Numerical pain rating scale (NPRS) and for grip strength using hand held dynamometer were recorded for a period of 2 weeks. The study shows decreased in the values of NPRS from a mean value of 5.50 to 4.13. The grip strength was found to be significant increase from a mean value of 15.60 to 24.56. This shows that grip strength values are gradually increasing with the P value (<0.001) statistically significant. Thus the study concludes that eccentric strengthening of wrist extensors along with conventional treatment is more effective in increasing the grip strength and decreasing pain. Therefore, the purpose of this study is to assess the efficacy of eccentric wrist extensor strengthening exercise added to standard treatment for chronic lateral epicondylitis.

PGI27 - Cost Utility Analysis of Infliixmab and Adalimumab Compared with Conventional Therapy in Patients with Crohn Disease in the Islamic Republic of Iran

PGI27 - Cost Utility Analysis of Infliixmab and Adalimumab Compared with Conventional Therapy in Patients with Crohn Disease in the Islamic Republic of Iran

Efficacy of corticosteroid treatment for severe community-acquired pneumonia: A meta-analysis

BackgroundThe benefits and adverse effects of corticosteroids in the treatment of severe community-acquired pneumonia (CAP) have not been well assessed. The aim of this systematic review of the literature and meta-analysis was to evaluate the clinical efficacy of adjuvant corticosteroid therapy in patients with severe CAP. MethodsThe following databases were searched: PubMed, the Cochrane database, Embase, Wanfang, the China National Knowledge Infrastructure (CNKI), and the WeiPu (VIP) database in Chinese. Published randomized controlled clinical trial results were identified that compared corticosteroid therapy with conventional therapy for patients with severe CAP, up to November 2016. The relative risk (RR), weighted mean difference (WMD), and 95% confidence interval (CI) were evaluated. Statistical analysis was performed using STATA 10.0. The quality of the published studies was evaluated using the Oxford quality scoring system (Jadad scale). ResultsTen randomized controlled trials (RCTs) were identified that included 729 patients with severe CAP. Data analysis showed that corticosteroid therapy did not have a statistically significant clinical effect in patients with severe CAP (RR: 1.19; 95% CI: 0.99–1.42), mechanical ventilation time (WMD: −2.30; 95% CI: −6.09–1.49). However, corticosteroids treatment was significantly associated with reduced in-hospital mortality (RR: 0.49; 95% CI: 0.29–0.85), reduced length of hospital stay (WMD: −4.21; 95% CI: −6.61 to −1.81). ConclusionCorticosteroids adjuvant therapy in patients with severe CAP may reduce the rate of in-hospital mortality, reduce the length of hospital stay, and reduce CRP levels.

SHIVA: Randomized phase II trial comparing molecularly targeted therapy based on tumor molecular profiling versus conventional therapy in patients with refractory cancer—Overall survival (OS) analysis.

11515 Background: The SHIVA trial is a multicentric randomized phase II trial comparing molecularly targeted therapy among 11 drugs based on tumor molecular profiling versus conventional therapy in patients with any type of cancer that is refractory to standard of care (NCT01771458). Only patients who had a druggable molecular alteration (DMA) identified on a mandatory tumor sample from a metastatic site using targeted sequencing, CGH and IHC were randomized. Cross-over was allowed at disease progression. The trial did not show any difference for its primary endpoint (PFS) [Le Tourneau et al., Lancet Oncol 2015]. We report here the OS of randomized and non-randomized patients. Methods: OS was estimated in the 4 following groups: 1) randomized patients, 2) patients for whom a DMA was identified but who were not subsequently randomized because they did not meet the randomization criteria (PS of 0 or 1, adequate organ function), 3) non-randomized patients because of the absence of DMA, and 4) non-randomized patients because no genomic analyses were performed. Since 70% of patients randomized into the standard arm eventually crossed over to the targeted therapy arm, all randomized patients were analyzed in group 1. The groups were compared in terms of patient characteristics using student and χ2 tests. OS was estimated using the Kaplan Meier method. Results: Among 741 patients included in SHIVA, 8 patients were included twice. Follow-up data were available for 680 out of the 733 patients. 197, 78, 222 and 183 patients belonged to groups 1 to 4, respectively. Median OS of the whole cohort was 7.9 months [95% CI: 7.0–9.1].As compared to non-randomized patients due to the absence of identified DMA, non-randomized patients with a DMA had a significantly worse prognosis: HR = 2.3 [95% CI: 1.7–3.0] (p &gt; 0.0001) whereas randomized patients had a non-significant trend toward a better prognosis: HR = 0.85 [95% CI: 0.7–1.1] (p = 0.18). Conclusions: A statistically significant difference in OS was only observed in patients with a DMA who were not randomized. However, our analysis does not allow showing an intrinsic prognostic value of the DMA on OS.

Inhibition of GOT1 sensitizes colorectal cancer cells to 5-fluorouracil.

Almost all colorectal cancer (CRC) cell lines are known to overexpress aspartate aminotransferase (GOT1), which potentially regulates the intracellular levels of reactive oxygen species (ROS) via the production of NADPH, and supports tumor growth. In our study, the role of GOT1 in the anticancer efficacy of 5-fluorouracil (5-FU) was examined. HCT116, SW480, and HT-29 cells were transfected with lentiviral vectors expressing short hairpin RNA (shRNA) against GOT1. Following 5-FU treatment, cellular proliferation was evaluated, the NADP+/NADPH ratio was monitored, ROS was measured, and intracellular levels of glutamine (Gln), Aspartate (Asp), oxaloacetate (OAA), malate, and pyruvate were investigated using liquid chromatography-mass spectrometry (LC-MS). A CRC subcutaneous tumor model was performed to determine the impact of GOT1 inhibition on 5-FU efficacy in vivo. In response to 5-FU administration, CRC cells undergo metabolic adaptation, resulting in increased glutamine flux for the synthesis of aspartate. GOT1 is responsible for the conversion of glutamine-derived aspartate into OAA, which subsequently can be converted into malate and pyruvate. The GOT1-mediated metabolic process is able to maintain the NADP+/NADPH ratio, which counteracts 5-FU-induced oxidative stress. Inhibition of GOT1 impaired the defense against 5-FU-induced ROS, thereby sensitizing cells to 5-FU. The importance of GOT1 in supporting tumor growth during 5-FU treatment was also indicated in an in vivo tumor model of CRC. These findings show that GOT1 could serve as a promising target for increasing the anticancer efficacy of the conventional therapy in patients with CRC.

The role of circulating tumor cells in evaluation of prognosis and treatment response in advanced non-small-cell lung cancer.

Non-small-cell lung cancer (NSCLC) lacks validated biomarkers to predict the prognosis and treatment response. This study investigated whether circulating tumor cells (CTCs) detectable could reminder high risk of distant metastasis, provide prognostic information, and early indicate the response to the conventional therapy in patients with advanced NSCLC. In this single-center prospective study, blood samples for CTC analysis were obtained from 59 patients with previously untreated, stage III or IV NSCLC both before and after administration of two cycles of chemotherapy. CTCs took in peripheral blood were measured by Cell Search detect technique. Carcino-embryonic antigen and count of metastatic sites were positively related to CTC count analyzed by multiple linear regression (P < 0.05). The median overall survival was 11.2 months (95% CI: 10.37-12.03months) for the baseline CTC ≥ 2 group compared with 8.3months (95% CI: 7.72-8.88months) for the CTC < 2 group (log-rank test P < 0.05). Similarly, patients with CTC ≥ 2 at baseline had a significantly shorter median PFS (4.3 months, 95% CI: 3.7-4.9months) compared with patients with CTC < 2 (6.2months, 95% CI: 5.59-6.82months) (log-rank test P < 0.05). For the disease control (stable disease, partial response, or complete response), group CTC value before treatment did not present difference with that after therapy compared by pared-samples T test (t = 1.455, P = 0.154), similar to the result of progressed group (progressive disease) (t = -0.987, P = 0.335). The CTC value of progressed group was higher than that of disease control group either at baseline or post chemotherapy. These data provide an evidence of positive correlation between CTC counts with CEA, as well as count of metastatic sites. Meanwhile, CTCs could be an effective predictor of distant metastasis and poor prognosis. In this study, CTCs are poorly related to treatment response. Whether CTCs could be a predictor of curative effect in advanced NSCLC should be validated by more researches in the future.

Randomized phase II trial comparing molecularly targeted therapy based on tumor molecular profiling versus conventional therapy in patients with refractory cancer: cross-over analysis from the SHIVA trial

Several studies used the ratio of progression-free survival (PFS) on genotype-matched treatment to PFS on genotype-unmatched treatment to assess the efficacy of therapy guided by patients' tumor molecular profiling. We evaluated the PFS ratio from patients who cross-over in the SHIVA trial. The primary end point of the SHIVA trial was to compare PFS on molecularly targeted agents (MTAs) based on tumor molecular profiling and treatment at physician's choice (TPC) in patients with any kind of cancer who had failed standard-of-care therapy. The experimental treatment included only marketed MTAs given outside their indications according to a pre-specified treatment algorithm. Patients were allowed to cross-over at disease progression in both arms. Response was evaluated according to RECIST 1.1 at randomization and at cross-over. We evaluated the ratio of PFS on MTA (PFSMTA) to PFS on TPC (PFSTPC) in patients who crossed-over. Among 741 patients enrolled in the SHIVA trial, 197 were randomized, and 95 crossed-over, including 70 patients from the TPC to the MTA arm and 25 patients from the MTA to the TPC arm. Two patients crossed-over in the TPC arm without disease progression. The PFSMTA/PFSTPC ratio exceeded 1.3 in 37% of patients who crossed-over from the TPC to the MTA arm. The PFSMTA/PFSTPC ratio exceeded 1.3 in 61% of patients who crossed-over from the MTA arm to the TPC arm. The cross-over analysis of the SHIVA trial identified 37% of patients who crossed-over from TPC to MTA with a PFSMTA/PFSTPC ratio exceeding 1.3.

The role of Ivabradine in Diastolic Heart Failure with preserved Ejection Fraction. A Doppler-Echocardiographic study.

Background:Ivabradine (IVA) is effective in patients with coronary artery disease (CAD) or systolic heart failure in sinus rhythm. Its action consists in reducing heart rate (HR) and improving the time of left ventricular (LV) diastolic filling. The aim of this study was to evaluate the effects of IVA added to conventional therapy on patients with diastolic heart failure (DHF) and preserved ejection fraction (HFpEF).Methods:We evaluated 25 patients with DHF in the New York Heart Association (NYHA) Class II-III and sinus rhythm. In these, IVA per os (5 mg/twice a day) was added to the conventional medical therapy and given for 12 weeks. Immediately before the beginning of IVA therapy and 3 months later, patients underwent echocardiographic evaluation by two-dimensional (2D) ultrasound and tissue Doppler imaging (TDI). The patterns of diastolic mitral inflow and pulmonary venous flow were recorded using 2D echocardiography, while the diastolic phase of mitral flow was recorded by TDI, from the lateral mitral annulus.Results:Three months after the addition of IVA to conventional treatment, HR significantly decreased in comparison to the baseline values. On the contrary, the echocardiographic indexes of LV diastolic dysfunction improved.Conclusions:These results testify that the addition of IVA to conventional therapy in patients with HFpEF can improve LV diastolic function evaluated by 2D and tissue Doppler-echocardiographic patterns. These Doppler-echocardiographic results match with the clinical improvement of patients evaluated.

ANDROGEN DEFICIENCY AND PROGRESSION OF BENIGN PROSTATIC HYPERPLASIA IN PATIENTS WITH METABOLIC SYNDROME: IS THERE ANY CONTROVERSY? (A LITERATURE REVIEW)

The present review describes the mechanisms of benign prostatic hyperplasia (BPH) development in patients with metabolic syndrome (MS) and its association with androgen deficiency, which is frequently observed in these patients. We cover the data indicating that despite a reduced serum level of testosterone in patients with MS, they are more likely to be diagnosed with BPH, have more significant prostate enlargement, more rapid BPH progression, as well as deterioration of urination problems compared to patients of similar age without MS. The following factors are considered to trigger BPH in patients with MS: changes in the tissue metabolism of sex hormones with increased androgens and estrogens concentrations in the prostate gland despite the reduced serum androgen levels, relative prevalence of the estrogenic effects, chronic pelvic ischemia, stimulation of prostate cells proliferation due to the elevated insulin level and the increased secretion of growth factors, and developing chronic low-intensity inflammation. Specific features of BPH pathogenesis in individuals with MS suggest a correction of therapeutic approaches to BPH in such cases, because conventional therapy in patients with BPH and MS is less effective than in patients with BPH only.

Extraintestinal pathogenic Escherichia coli are associated with intestinal inflammation in patients with ulcerative colitis.

E. coli of the phylogenetic group B2 harbouring Extra intestinal Pathogenic Escherichia coli (ExPEC) genes are frequently seen as colonizers of the intestine in patients with active ulcerative colitis (UC). In this study, we describe the influence of E. coli Nissle (EcN) B2 as add-on treatment to conventional therapies in patients with active UC. For this study one hundred active UC patients were randomized to ciprofloxacin or placebo for 1 week followed by EcN or placebo for 7 weeks. Stool samples were collected at weeks 0, 1, 8, 12, where E. coli were characterized and fecal calprotectin was measured. We showed that in the active UC patient group receiving Placebo/EcN, fewer patients reached remission, in comparison to the patient group receiving Placebo/placebo (p < 0.05). Active UC patients initially colonized with E. coli B2 had increased fecal calprotectin values and Colitis Activity Index scores in comparison to patients colonized with E. coli A and D (p < 0.05*). In conclusion, treatment of UC patients with E. coli Nissle (B2) does not promote clinical remission and active UC patients colonized with E. coli B2 have an increased intestinal inflammation.

Estimulación térmica para la recuperación motora pos accidente cerebrovascular: revisión sistemática

Objetivo: determinar si existe evidencia científica que avale la efectividad de la estimulación térmica (ET) en la recuperación de la función motora, cuando se adiciona a un tratamiento convencional en pacientes pos accidente cerebrovascular (ACV). Estratégia de búsqueda: se incluyeron en la búsqueda estudios clínicos aleatorizados, las bases de datos usadas fueron: Medline, PEDro, Lilacs, Central, Cinahl y Rehabilitation &amp; Sport Medicine Source. Selección de estudios: se seleccionaron cinco artículos que cumplían con nuestros criterios de elegibilidad y se evaluó el riesgo de sesgo según el método de Cochrane. Síntesis de resultados: todos los estudios muestran que la ET en combinación a un programa de rehabilitación física mejora significativamente (p&lt;0,05) a corto plazo el movimiento y función. Conclusión: en pacientes con ACV agudo moderado a severo, existe evidencia a corto plazo que adicionar ET a un programa de rehabilitación física convencional facilita la recuperación motora comparado con un programa de visita.

Abstract 1524: Mutations and gene copy number variations landscape of metastases of various cancer types from patients enrolled in the SHIVA trial

Abstract Background The molecular landscape of primary tumors of several cancer types is available and tissue-independent classification of tumors on the basis of genetic and epigenetic alterations is emerging1. The molecular profile of metastatic cancers remains to be unraveled. Here we present mutations and gene copy number variations (CNV) of metastases across tumor types from patients enrolled in the SHIVA trial2. Patients and methods The SHIVA trial is a multicentric randomized proof-of-concept phase II trial comparing molecularly targeted therapy based on tumor molecular profiling versus conventional therapy in patients with any type of refractory cancer. Mutations using targeted NGS (AmpliSeq cancer panel on Ion Torrent / PGM (Life)), and CNV using Cytoscan HD (Affymetrix) were assessed on a mandatory biopsy from a metastatic site with ≥30% of tumor cell content. Sequencing data were processed in order to detect actionable somatic mutations. Detected variants were filtered according to their frequency (≥4% for SNVs and 5% for indels), strand ratio (≥0.2), and reads coverage (≥30X for SNVs and 100X for indels). Non polymorphic deleterious mutations were reported. Copy number and allele difference profiles were processed taking into account% of tumor cells and ploidy of the sample. Homozygous and heterozygous deletions and focal amplifications were reported for tumor suppressor genes and oncogenes. Between October 2012 and July 2014, 741 patients with any type of solid cancer were enrolled in the SHIVA trial. Among these, 507 and 496 patients had high quality NGS and CNV profiling, respectively. Results Major cancer types for which molecular analyses were possible on a metastatic biopsy were: breast (14%), colorectal (11%), lung (11%), ovarian (11%), pancreatic (8%), sarcoma (6%), head and neck (4%), cervical (4%), urothelial (4%), endometrial (3%), oesogastric (3%) cancers, adenoid cystic carcinoma (3%) and others (18%). TP53 mutations were present in 44% of metastatic patients. Major mutated oncogenes were KRAS (20%), PIK3CA (12%), MET (6%), FGFR3 (5%), EGFR (2%) and BRAF (2%). Tumor suppressor genes PTEN, FBXW7 and CDKN2A were mutated in 3% of patients. Alternatively, homozygous and heterozygous deletions of PTEN, FBXW7 and CDKN2A were observed in around half of the patients analyzed (40%, 40% and 54%, respectively). Conclusions Mutations and CNV analyses on metastatic tumors from patients enrolled in the SHIVA trial showed similar results in terms of frequency of previously reported genetic alterations1,3. The frequency of KRAS mutations (20%) was however higher than the frequency (7%) reported in the pan cancer cohort of the tumors portal3. This result needs to be interpreted in accordance with tumor types before suggesting potential resistance mechanisms in heavily pretreated patients. Clustering of these alterations in specific signaling pathways is currently ongoing. Citation Format: Maud Kamal, Nicolas Servant, Gaelle Pierron, Celine Callens, David Gentien, Alban Lermine, Georges Lucotte, Virginie Bernard, Anne Vincent-Salomon, Ivan Bièche, Christophe Le Tourneau. Mutations and gene copy number variations landscape of metastases of various cancer types from patients enrolled in the SHIVA trial. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1524.

Inhibition of phosphoserine phosphatase enhances the anticancer efficacy of 5-fluorouracil in colorectal cancer

Most colorectal cancer (CRC) cell lines are identified to overexpress phosphoserine phosphatase (PSPH), which regulates the intracellular synthesis of serine and glycine, and supports tumor growth. In this study, the effect of PSPH on 5-fluorouracil (5-FU) efficacy was evaluated. CRC cells exposed to 5-FU acquire metabolic remodeling, resulting in increased glucose flux for PSPH-mediated serine synthesis. Then serine is converted into GSH, which promotes cell survival through the detoxification of 5-FU-induced reactive oxygen species (ROS). Consequently, repression of PSPH by the use of shRNAs for PSPH impaired the defense against drug-induced oxidative stress, thereby sensitizing cells to 5-FU. The importance of the PSPH in supporting tumor growth during 5-FU treatment was also demonstrated in an in vivo tumor model of CRC. These findings indicate that the PSPH could serve as a target for increasing the anticancer efficacy of conventional therapy in patients with CRC.

SHIVA: Randomized phase II trial comparing molecularly targeted therapy based on tumor molecular profiling versus conventional therapy in patients with refractory cancer—PFS ratio from patients who crossed-over.

2535Background: Several studies used the ratio of progression-free survival (PFS) on genotype-matched treatment to PFS on genotype-unmatched treatment to assess the efficacy of therapy guided by patients’ tumor molecular profiling [von Hoff et al., JCO 2010; Tsimberidou et al., CCR 2012]. We evaluated the PFS ratio from patients included in the SHIVA trial who crossed-over [Le Tourneau et al., Lancet Oncol 2015] (NCT01771458). Methods: The primary endpoint of the SHIVA trial was to compare PFS on molecularly targeted agents (MTAs) based on tumor molecular profiling and treatment at physician’s choice (TPC) in patients with any kind of cancer who had failed standard-of-care therapy. Experimental treatment included only marketed MTAs given outside their indications according to a pre-specified treatment algorithm. Patients were allowed to cross-over at disease progression. Response was evaluated according to RECIST 1.1 at randomization and at cross-over. We evaluated the proportion of patients with a PFS ra...

P364. The efficacy of initial treatment with infliximab without previous conventional therapy in patients with moderate-to-severe ulcerative colitis

P364. The efficacy of initial treatment with infliximab without previous conventional therapy in patients with moderate-to-severe ulcerative colitis

Coats’ Disease: Very Long-Term Outcome After Early Stage Conventional Treatment

Purpose: To report on the outcome of conventional therapy in patients with Coats’ disease.Methods: Retrospective analysis of the charts of thirteen patients with Coats’ disease. Results: Mean age of 9 male (70%) and 4 female (30%) patients was 17.7 (range, 5-33) years; one female had bilateral disease. Eleven eyes with retinal telangiectasia and exudation were treated with argon laser photocoagulation alone or photocoagulation associated with cryotherapy; the mean follow up was 32.5 (range,17-41) years. In four eyes without foveal involvement (stage 2a) the mean presenting visual acuity (VA) remained at 0.8 or improved, whereas poor VA in seven stage 2b eyes deteriorated minimally over time. In one and two of the three eyes with total retinal detachment, phthisis or neovascular glaucoma ensued.Conclusion: About three decades after conventional treatment of Coats’ disease stage 2a, treated eyes maintained good VA, and stage 2b eyes did not progress to advanced stages.

Rituximab combined with conventional therapy versus conventional therapy alone for the treatment of mucous membrane pemphigoid (MMP)

The use of rituximab for refractory autoimmune blistering diseases is increasing. Data related to rituximab for the treatment of mucous membrane pemphigoid (MMP) are limited. We sought to compare the efficacy of adding rituximab with traditional immunosuppressive therapies in the treatment of MMP. The primary outcome was achievement and time to disease control. Patients with a diagnosis of MMP from August 2001 to June 2015 who had greater than 6 months of follow-up after the initiation of therapy were reviewed. In all, 24 patients were treated with rituximab and 25 were treated with conventional immunosuppression. Of patients, 100% in the rituximab group achieved disease control compared with 40% in the conventional group (P < .01), with a mean time to disease control of 10.17 months and 37.7 months (P = .02). Adverse events were seen in 33% of patients after rituximab, compared with 48% of patients in the conventional group (P = .2). Rituximab dosing was not uniform and the 2 groups were not matched in terms of disease severity, nor were they randomized. Our study indicates that the addition of rituximab to conventional therapy in patients with MMP results in more rapid and sustained disease control with potentially fewer adverse events.

Clinical and economic analysis of the use of apixaban for the treatment of venous thromboembolic events

Aim . Pharmacoeconomic analysis of apixaban use compared to conventional therapy in patients with venous thromboembolism (VTE). Material and methods . Economic evaluation was performed from a position of the health care system. The cost analysis, cost-effectiveness analysis, impact on the budget” analysis, and sensitivity analysis were fulfilled. Results. In real clinical practice in hospitals direct medical costs of apixaban treatment of deep vein thrombosis and pulmonary embolism make up 2331.67 and 3142.98 rubles, respectively, while the costs of the standard therapy - 6192.15 and 6225.75 rubles. Potential resource savings will reduce 2.65 times the cost of the health system. The share of the costs of treatment of adverse effects (bleeding) in the conventional therapy group was 4.8 times higher than the costs in apixaban group. The results of analysis of the effect on the budget show a decrease in the load on the budget when apixaban was included in the treatment regimen of VTE. Potential resource savings of the health system in the treatment of 1,000 patients with apixaban will account 3,911,860 rubles in comparison with conventional therapy. Conclusion. The inclusion of apixaban in the therapy of VTE can significantly reduce the burden on the budget of the health care system.