Reduction In Number Of Relapses Research Articles

Effectiveness of Anti-Cluster of Differentiation 20 as a Disease-Modifying Therapy in Multiple Sclerosis Across Its Different Phenotypes at the University Hospital of Caen.

BackgroundMultiple sclerosis is a chronic, demyelinating disorder occurring primarily as two main forms of relapsing-remitting multiple sclerosis (RRMS) found predominantly in women, and primary progressive multiple sclerosis (PPMS) occurring predominantly in men. In this retrospective single-center study, we aimed to explore the effects of anti-cluster of differentiation (CD)20 treatment for both relapsing-remitting and primary progressive forms of multiple sclerosis (MS) in a population-based cohort treated at the university hospital. MethodologyThe diagnostic factors being assessed were forms of multiple sclerosis (MS), age at first relapse, whereas therapeutic factors were age at first disease-modifying therapy (DMT), age at starting anti-CD20, reason to switch to anti-CD20 and the duration of anti-CD20 treatment. Primary outcomes measured were number of relapses and progression in disability as measured by the Expanded Disability Status Scale, while secondary outcomes measures being assessed number of cerebral lesions on MRI and level of IgG at the beginning and end of the 12-month treatment.ResultsTreatment with anti-CD20 demonstrated a reduction in number of relapses 12 months after treatment, no change in the progression of disability in RRMS type, but an increase in PPMS type. No change was observed in cerebral MRI lesions at the end of treatment after 12 months. A statistically significant reduction in serum IgG value was observed after 12 months from the start of treatment, where only one out of 26 (3.8%) patients developed hypogammaglobulinemia with IgG less than 6 g/L but none developed hypogammaglobulinemia of less than 5 g/L.ConclusionAnti-CD20 antibodies as disease-modifying therapy can profoundly impact the course and progression of MS in both its forms if utilized at an earlier stage in patients and therefore greatly improve the quality of life in patients living with multiple sclerosis.

Second-generation LAI are associated to favorable outcome in a cohort of incident patients diagnosed with schizophrenia

ObjectiveInvestigate the associations of long-acting injectable (LAI) second generation antipsychotic drugs with number of relapses, psychiatric admissions, days hospitalized, intentional self-harm events, and costs linked to hospitalizations in incident patients diagnosed with schizophrenia. MethodA nationwide, population-based, retrospective study utilizing mirror-image models before and after initiation of LAI SGA. Results10,509 patients were included as study population, with analyses being conducted on 2223 patients in a six-month period, 1383 in a 12-month period, 713 in a 24-month period. After initiation of LAI antipsychotics, patients experienced a reduction in number of relapses with an incidence rate ratio (IRR) of 0.60 for the first six months, IRR 0.64 for the first 12 months and IRR 0.64 for the first 24 months following initiation of LAI, all P < 0.001. The number of psychiatric admissions was reduced in a similar manner with respective IRR of 0.59, 0.60 and 0.64, all P < 0.001. Psychiatric bed-days were reduced with 58, 100 and 164 days for the respective periods after LAI initiation, all P < 0.001. In a Cox regression model in patients initiated on LAI, higher age at diagnosis, hazard rate ratio (HR) 0.99, 95%CI(0.98–0.99), P < 0.001, and a later calendar year of diagnosis, HR 0.99, 95%CI(0.98–1.00), P < 0.05, were associated with a lower risk of relapse, whereas mainly psychiatric comorbidity, HR 1.07, 95% CI (1.04–1.11), P < 0.001, and cardiovascular disease, HR 1.12, 95%CI(1.01–1.26), P < 0.05, were associated with relapse. ConclusionEven though the design does not allow inferences regarding causality, these population-based findings support the use of second generation LAI antipsychotics.

PGI7: BUDESONIDE CIR IS COST-EFFECTIVE IN MAINTENANCE THERAPY OF CROHN'S DISEASE IN FINLAND

OBJECTIVE: To assess the economic outcome, from a health care budget perspective, of treating Crohn's disease (CD) patients with budesonide controlled ileal release (CIR) 6 mg per day as maintenance therapy compared to no maintenance therapy (NMT). METHODS: A validated decision-analytic model (Noble et al., 1998) on the treatment of (CD) was used. The model was adjusted to specifically depict CD patient management in Finland. The analysis was based on pooled patient data from randomised, double blind clinical trials comparing budesonide CIR (n = 90) in maintenance therapy with placebo (n = 90). In accordance with the clinical trials the analysis covered a study period of up to one year. The analysis took into account clinical outcomes and consequences of these in terms of health care resource use and associated costs, e.g., costs of hospitalisations, diagnostic and surgical procedures, outpatient care and drug consumption. Panel and literature data was used for events not investigated in the clinical trials. Cost inputs were derived from Tampere University Hospital for year 1998. Days in remission and relapse were translated into Quality Adjusted Life Years (QALYs) using CD specific health-state utility data from the literature. RESULTS: The outcomes of the clinical trials were reflected in the model as a 26.4% reduction in annual number of relapses for the average patient in the budesonide CIR treatment group. Mean annual health care cost per patient was 17,740 FIM (2,000 USD) for the budesonide CIR patient and 16,608 FIM (1,877 USD) for the NMT patient. The difference between the groups amounted to a cost per gained QALY of 68,610 FIM (7,753 USD), which is well in line with what is considered a cost-effective treatment strategy. CONCLUSION: Budesonide CIR means fewer relapses per average patient and is a cost-effective treatment strategy for the treatment of Crohn's disease in Finland.