The Economic Burden of Biological Therapy in Rheumatoid Arthritis in Clinical Practice: Cost-Effectiveness Analysis of Sub-Cutaneous Anti-TNFα Treatment in Italian Patients:

Rheumatoid arthritis (RA), with a prevalence of 0.46%, is found in about 272,004 patients in Italy. The socioeconomic cost of rheumatoid arthritis in Italy in 2002 has been estimated at €1,600 million. Cost-effectiveness evaluations have been based on the concept that, with treatment, patients will not progress to the next level(s) of disease severity or will take a longer time to progress, thus avoiding or delaying the high costs and low utility associated with more severe disease. Many cost-effective studies have been based on the variation of Health Assessment Questionnaire (HAQ) in clinical trials. The objective of this study is to perform a cost-effective analysis of 86 patients with rheumatoid arthritis in therapy with adalimumab 40 mg every other week and etanercept 50 mg/week for two years in a population of patients observed in clinical practice. The group of patients in therapy with adalimumab had also taken methotrexate, mean dose 12.4±2.5 mg/week (22 patients) or leflunomide 20 mg/day (16 patients). The group of patients in therapy with etanercept had also taken methotrexate, mean dose 11.7±2.6 mg/week (24 patients) or leflunomide 20 mg/day (24 patients). Incremental costs and QALYs (quality adjusted life years) gains are calculated compared with baseline, assuming that without biologic treatment patients would remain at the baseline level through the year. Conversion HAQ scores to utility were based on the Bansback algorithm. The results after two years showed: in the group methotrexate+adalimumab the QALY gained was 0.62±0.15 with a treatment cost of €26,517.62 and a QALY/cost of €42,521.13. In the group methotrexate+etanercept the QALY gained was 0.64±0.26 with a treatment cost of €25,020.96 and a QALY/cost of €39,171.76. The result of using etanercept in association with methotrexate is cost-effectiveness with a QALY gained under the acceptable threshold of €50,000. These are important data for discussion from an economic point of view when we choose a biologic therapy for rheumatoid arthritis in clinical practice

Scalar meson and glueball decays within a effective chiral approach

We study the strong and electromagnetic decay properties of scalar mesons above 1 GeV within a chiral approach. The scalar-isoscalar states are treated as mixed states of quarkonia and glueball configurations. A fit to the experimental decay rates listed by the Particle Data group is performed to extract phenomenological constraints on the nature of the scalar resonances. A comparison to other theoretical approaches in the scalar meson sector is discussed.Comment: 13 pages, accepted for publication in PL

K^+ production in the reaction 58Ni+58Ni^{58}Ni+^{58}Ni at incident energies from 1 to 2 AGeV

Semi-inclusive triple differential multiplicity distributions of positively charged kaons have been measured over a wide range in rapidity and transverse mass for central collisions of $^{58}$Ni with $^{58}$Ni nuclei. The transverse mass ($m_t$) spectra have been studied as a function of rapidity at a beam energy 1.93 AGeV. The $m_t$ distributions of K^+ mesons are well described by a single Boltzmann-type function. The spectral slopes are similar to that of the protons indicating that rescattering plays a significant role in the propagation of the kaon. Multiplicity densities have been obtained as a function of rapidity by extrapolating the Boltzmann-type fits to the measured distributions over the remaining phase space. The total K^+ meson yield has been determined at beam energies of 1.06, 1.45, and 1.93 AGeV, and is presented in comparison to existing data. The low total yield indicates that the K^+ meson can not be explained within a hadro-chemical equilibrium scenario, therefore indicating that the yield does remain sensitive to effects related to its production processes such as the equation of state of nuclear matter and/or modifications to the K^+ dispersion relation.Comment: 24 pages Latex (elsart) 7 PS figures to be submitted to Nucl. Phys

Polymyalgia rheumatica: inflammation suppression with low dose of methylprednisolone or modified-release prednisone

OBJECTIVE: Polymyalgia rheumatica (PMR) is an inflammatory disease that affects people aged > 50 years, and is characterised by pain and morning stiffness in the shoulder and pelvic girdle with synovitis of the proximal joints and extra-articular synovial structures. It is currently mainly treated with glucocorticoids (GCs). The aim of the study was to evaluate changes in inflammatory markers and their correlations with cortisol levels after treatment with 6-methylprednisolone (6-MP) or modified- release prednisone (MR-P) in patients with "early" PMR. PATIENTS AND METHODS: The study involved 81 GC-naive with "early" PMR diagnosed on the basis of the 2012 EULAR/ACR criteria: 38 treated with 6-MP at a starting dose of 12 mg at 8.00 a.m, gradually tapered to 8, 4 and 2 mg/day, and 43 treated with MR-P at a starting dose of 10 mg at 10 p.m, tapered to 7, 5, 3, 2 and 1 mg. The markers of inflammation (ESR mm/h, CRP mg/dL and fibrinogen mg/dL), the circulating serum levels of cytokines (TNF alpha and IL-6), and morning serum cortisol levels were evaluated at baseline and during GC treatment. RESULTS: There were significant differences between baseline and the end of treatment in the serum levels of IL-6 (5.3 +/- 9.3 vs 2.8 +/- 3.3 pg/mL; p < 0.05) and CRP (2.1 +/- 3.3 vs 0.9 +/- 1.7 mg/dL; p < 0.01) in the patients treated with MR-P, and in serum cortisol levels (15.8 +/- 6.4 vs 13.6+5.6 mu g/dL; p < 0.01) in the patients treated with 6-MP. After the first month of treatment, 76.7% of the patients treated with MR-P had IL6 levels at or below the upper normal limit, whereas 52.6% of those treated with 6-MP had normal IL6 levels (p < 0.05). There was also a significant difference in the percentage of patients in whom the daily GC dose was tapered within eight months (6.7% in the MR-P group vs 25% in the 6-MP group; p < 0.001) and, by the end of the study, respectively 59.5% vs 35.1% patients were receiving a low GC dose or had discontinued treatment altogether (OR 2.7, 95% CI 1.0-6.77; p < 0.001). After six and 12 months, respectively 10.3% and 14.3% of the patients had discontinued MR-P, as against none of the patients treated with 6-MP (p < 0.05). CONCLUSIONS: In this prospective observational study of PMR patients receiving low-dose GCs, the changes in inflammatory markers were similar in those treated with 6-MP or MR-P, whereas morning cortisol levels remained unchanged only in the MR-P group. During the first month of treatment, MR-P chronotherapy given at bedtime significantly decreased IL-6 levels. The percentage of patients stopping GC treatment was higher in the MR-P group than in the 6-MP group

Differential directed flow in Au+Au collisions

We present experimental data on directed flow in semi-central Au+Au collisions at incident energies from 90 to 400 A MeV. For the first time for this energy domain, the data are presented in a transverse momentum differential way. We study the first order Fourier coefficient v1 for different particle species and establish a gradual change of its patterns as a function of incident energy and for different regions in rapidity.Comment: 5 pages, Latex, 5 eps figures, accepted for publication in Phys. Rev. C (Rapid Communications). Data files available at http://www-linux.gsi.de/~andronic/fopi/v1.htm

Sideward flow of K+ mesons in Ru+Ru and Ni+Ni reactions near threshold

Experimental data on K+ meson and proton sideward flow measured with the FOPI detector at SIS/GSI in the reactions Ru+Ru at 1.69 AGeV and Ni+Ni at 1.93 AGeV are presented. The K+ sideward flow is found to be anti-correlated (correlated) with the one of protons at low (high) transverse momenta. When compared to the predictions of a transport model, the data favour the existence of an in-medium repulsive K+ nucleon potential.Comment: 16 pages Revtex, 3 ps-figures, submitted to Phys. Lett.

Systematics of pion emission in heavy ion collisions in the 1A GeV regime

Using the large acceptance apparatus FOPI, we study pion emission in the reactions (energies in GeV/nucleon are given in parentheses): 40Ca+40Ca (0.4, 0.6, 0.8, 1.0, 1.5, 1.93), 96Ru+96Ru (0.4, 1.0, 1.5), 96Zr+96Zr (0.4, 1.0, 1.5), 197Au+197Au (0.4, 0.6, 0.8, 1.0, 1.2, 1.5). The observables include longitudinal and transverse rapidity distributions and stopping, polar anisotropies, pion multiplicities, transverse momentum spectra, ratios for positively and negatively charged pions of average transverse momenta and of yields, directed flow, elliptic flow. The data are compared to earlier data where possible and to transport model simulations.Comment: 56 pages,42 figures; to be published in Nuclear Physics

Directed flow in Au+Au, Xe+CsI and Ni+Ni collisions and the nuclear equation of state

We present new experimental data on directed flow in collisions of Au+Au, Xe+CsI and Ni+Ni at incident energies from 90 to 400A MeV. We study the centrality and system dependence of integral and differential directed flow for particles selected according to charge. All the features of the experimental data are compared with Isospin Quantum Molecular Dynamics (IQMD) model calculations in an attempt to extract information about the nuclear matter equation of state (EoS). We show that the combination of rapidity and transverse momentum analysis of directed flow allow to disentangle various parametrizations in the model. At 400A MeV, a soft EoS with momentum dependent interactions is best suited to explain the experimental data in Au+Au and Xe+CsI, but in case of Ni+Ni the model underpredicts flow for any EoS. At 90A MeV incident beam energy, none of the IQMD parametrizations studied here is able to consistently explain the experimental data.Comment: RevTeX, 20 pages, 30 eps figures, accepted for publication in Phys. Rev. C. Data files available at http://www.gsi.de/~fopiwww/pub