Stage at diagnosis and stage-specific survival of breast cancer in Latin America and the Caribbean : a systematic review and meta-analysis

Background: Female breast cancer is the most common cancer in Latin American and Caribbean (LAC) countries and is the leading cause of cancer deaths. The high mortality-to-incidence ratio in the regions is associated with mainly the high proportion of advanced stage diagnosis, and also to inadequate access to health care. In this study we aimed to systematically review the proportion of advanced stage (III-IV) at diagnosis (pas) and the five-year stage-specific survival estimates of breast cancer in LAC countries. Methods: We searched MEDLINE, Embase, and LILACS (Latin American and Caribbean Health Science Literature) to identify studies, in any language, indexed before Nov 5, 2018. We also conducted manual search by reviewing citations of papers found. pas was summarized by random effects model meta-analysis, and meta-regression analysis to identify sources of variation. Stage-specific survival probabilities were described as provided by study authors, as it was not possible to conduct meta-analysis. PROSPERO CRD42017052493. Results: For pas we included 63 studies, 13 of which population-based, from 22 countries comprising 221,255 women diagnosed from 1966 to 2017. The distribution of patients by stage varied greatly in LAC (pas 40.8%, 95%CI 37.0% to 44.6%; I2=99%; p<0.0001). The heterogeneity was not explained by any variable included in the meta-regression. There was no difference in pas among the Caribbean (pas 43.0%, 95%CI 33.1% to 53.6%), Central America (pas 47.0%, 95%CI 40.4% to 53.8%) and South America (pas 37.7%, 95%CI 33.1% to 42.5%) regions. For 5-year stage-specific survival we included 37 studies, comprising 28,988 women from ten countries. Seven of these studies were included also for pas. Since we were unable to adjust for age, comparability between countries and regions was hampered, and as expected, the results varied widely from study to study. Conclusions: LAC countries should look to address concerns with early detection and diagnosis of breast cancer, and wherever viable implement screening programs and to provide timely treatment

Adalimumabe no tratamento da artrite reumatoide: uma revisão sistemática e metanálise de ensaios clínicos randomizados

Desde a descoberta do papel do fator de necrose tumoral no processo fisiopatológico da artrite reumatoide, cinco medicamentos bloqueadores dessa citocina têm sido empregados como opção terapêutica. Para avaliar a eficácia e a segurança do adalimumabe no tratamento da artrite reumatoide foi conduzida uma revisão sistemática com metanálise de ensaios clínicos controlados e randomizados. Foi realizada busca de estudos relevantes nas bases de dados Medline (via PubMed) e LILACS em junho de 2011. A seleção dos estudos, coleta e análise de dados foram realizadas de forma pareada e independente por dois revisores e por um terceiro revisor em casos de discordância. A metanálise foi conduzida no software Review Manager® 5.1 usando o modelo de efeitos aleatórios. Onze artigos referentes ao adalimumabe foram incluídos e contemplaram nove estudos com 3461 pacientes. Dez estudos mostraram baixo risco de viés quanto ao cegamento dos participantes e pessoal e cegamento de avaliação de resultados. Os pacientes que receberam tratamento da associação de adalimumabe e metotrexato apresentam melhores resultados de eficácia e menor progressão radiográfica quando comparados ao grupo placebo + metotrexato em 24 a 104 semanas. Os pacientes que utilizaram adalimumabe em monoterapia apresentaram melhores resultados de eficácia em relação ao placebo em 24 e 26 semanas. Os resultados das metanálises de eventos adversos não foram estatisticamente significantes, exceto para reações no local de aplicação, na qual favoreceu o grupo controle. A eficácia do adalimumabe foi demonstrada em monoterapia e associado a algum MMCD, porém as evidências para o uso combinado são mais robustas

Rituximabe para o tratamento da artrite reumatoide: revisão sistemática

Introdu&#231;&#227;o: A artrite reumatoide (AR) &#233; uma doen&#231;a autoimune cr&#244;nica caracterizada por inflama&#231;&#227;o articular sist&#234;mica que, com frequ&#234;ncia, leva a significativa incapacita&#231;&#227;o. V&#225;rios agentes anti-TNF t&#234;m sido usados efetivamente, mas alguns pacientes demonstraram resposta inadequada. Rituximabe &#233; um anticorpo monoclonal terap&#234;utico indicado em tais casos. M&#233;todos: Realizou-se uma revis&#227;o sistem&#225;tica para avaliar a efic&#225;cia e a seguran&#231;a de rituximabe em pacientes com AR ativa previamente tratados ou n&#227;o com agentes anti-TNF e para relacionar o desfecho com a sorologia para FR e anti-CCP. Pesquisaram-se importantes bancos de dados eletr&#244;nicos e a literatura n&#227;o convencional, al&#233;m de se fazer uma busca manual de refer&#234;ncias. Para a meta-an&#225;lise, utilizou-se o programa Review Manager&#174; 5.1. Resultados: Consideramos seis ERCs comparando rituximabe 1000 mg com placebo. Em ambos os grupos usou-se Metotrexato. O tratamento com rituximabe foi mais efetivo em pacientes jamais tratados e nos que n&#227;o obtiveram sucesso com a terapia anti-TNF - crit&#233;rios ACR 20/50/70 e EULAR. No grupo de rituximabe, observaram-se mudan&#231;as menos expressivas nos escores de Sharp/Genant, de eros&#227;o e de estreitamento do espa&#231;o articular; nesse grupo, os escores SF-36, FACIT-T e HAQ-DI tamb&#233;m foram melhores. N&#227;o foram notadas diferen&#231;as entre grupos com rela&#231;&#227;o aos desfechos de seguran&#231;a, com exce&#231;&#227;o das rea&#231;&#245;es agudas &#224; infus&#227;o, que foram mais comuns no grupo de rituximabe. Ainda no grupo de rituximabe, um n&#250;mero maior de pacientes soropositivos para FR/anti-CCP alcan&#231;ou ACR20, em compara&#231;&#227;o com pacientes negativos para RF/anti-CCP. Conclus&#227;o: Os dados dispon&#237;veis falam em favor do uso de rituximabe para o tratamento da AR, como op&#231;&#227;o efetiva e segura para pacientes jamais tratados ou que n&#227;o obtiveram sucesso com o tratamento anti-TNF. FR e anti-CCP parecem influenciar os resultados do tratamento, mas essa infer&#234;ncia ainda est&#225; &#224; espera de futuras pesquisas

Effectiveness of first-line treatment for relapsing-remitting multiple sclerosis in Brazil: A 16-year non-concurrent cohort study.

BackgroundRelapsing-remitting multiple sclerosis (RRMM) is a chronic, progressive, inflammatory and immune-mediated disease that affects the central nervous system and is characterized by episodes of neurological dysfunction followed by a period of remission. The pharmacological strategy aims to delay the progression of the disease and prevent relapse. Interferon beta and glatiramer are commonly used in the Brazilian public health system and are available to patients who meet the guideline criteria. The scenario of multiple treatments available and in development brings the need for discussion and evaluation of the technologies already available before the incorporation of new drugs. This study analyses the effectiveness of first-line treatment of RRMS measured by real-world evidence data, from the Brazilian National Health System (SUS).Methods and findingsWe conducted a non-concurrent national cohort between 2000 and 2015. The study population consisted of 22,722 patients with RRMS using one of the following first-line drugs of interest: glatiramer or one of three presentations of interferon beta. Kaplan-Meier analysis was used to estimate the time to treatment failure. A univariate and multivariate Cox proportional hazard model was used to evaluate factors associated with treatment failure. In addition, patients were propensity score-matched (1:1) in six groups of comparative first-line treatments to evaluate the effectiveness among them. The analysis indicated a higher risk of treatment failure in female patients (HR = 1.08; P = 0,01), those with comorbidities at baseline (HR = 1.20; PConclusionsThis retrospective cohort suggests that glatiramer is associated with greater effectiveness compared to the three presentations of interferon beta. When evaluating beta interferons, the results suggest that the intramuscular presentation is not effective in the treatment of multiple sclerosis

Rituximab for rheumatoid arthrits treatment: a systematic review

AbstractIntroductionRheumatoid arthritis (RA) is a chronic autoimmune disease characterized by systemic joint inflammation that often leads to significant disability. Several effective anti-TNF agents have been used, but some patients have shown an inadequate response. Rituximab is a therapeutic monoclonal antibody indicated in such cases.MethodsWe conducted a systematic review to access efficacy and safety of rituximab in patients with active RA which have or have not been treated with anti-TNF agents before, and to relate outcome with RF and anti-CCP serology. We searched major electronics databases, grey literature and searched for references manually. We used Review Manager®5.1 for meta-analysis.ResultsWe included six RCTs comparing rituximab 1000mg with placebo. Methotrexate was used by both groups. Treatment with rituximab was more effective in naïve and in anti-TNF treatment failure patients - ACR20/50/70 and EULAR response. We observed lower changes in Total Genant-modified Sharp score, erosion score and joint narrowing scores in the rituximab group, and SF-36, FACIT-T and HAQ-DI scores were also better in this group. There were no differences between groups regarding safety outcomes, with exception of acute injection reactions, which were more common on rituximab group. More RF/anti-CCP seropositive patients achieved ACR20 than RF/anti-CP negative patients in rituximab group.ConclusionAvailable data support the use of rituximab for the treatment of RA, as it is an effective and safe option for naïve and anti-TNF treatment failure patients. RF and anti-CCP seam to influence treatment results, but this inference needs further research