Cost-effectiveness Analysis of Ocrelizumab for the Treatment of Relapsing and Primary Progressive Multiple Sclerosis in Portugal

Objectives: Ocrelizumab demonstrated significant clinical benefit for the treatment of relapsing (RMS) and primary progressive (PPMS) multiple sclerosis (MS), an incurable disease characterized by disability progression. This study evaluated the clinical and economic impact of ocrelizumab relative to current clinical practice, including other disease-modifying therapies (DMT), available in Portugal. Methods: Markov models for MS were adapted to estimate the impact of ocrelizumab across three patient populations: treatment-naïve RMS, previously treated RMS, and PPMS. Health states were defined according to the Expanded Disability Status Scale. For RMS, the model further captured the occurrence of relapses and progression to secondary progressive multiple sclerosis (SPMS). A lifetime time-horizon and Portuguese societal perspective were adopted. Results: For RMS patients, ocrelizumab was estimated to maximize the expected time (years) without progression to SPMS (10.50) relative to natalizumab (10.10), dimethyl fumarate (8.64), teriflunomide (8.39), fingolimod (8.38), interferon β-1a (8.33) and glatiramer acetate (8.18). As the most effective option, with quality-adjusted life year (QALY) gains between 0.3 and 1.2, ocrelizumab was found to be cost-saving relative to natalizumab and fingolimod, and presented incremental cost-effectiveness ratios (ICER) below €16,720/QALY relative to the remaining DMT. For PPMS patients, the ICER of ocrelizumab versus best supportive care was estimated at €78,858/QALY. Conclusions: Ocrelizumab provides important health benefits for RMS and PPMS patients, comparing favourably with other widely used therapies. In RMS, ocrelizumab was revealed to be either cost-saving or have costs-per-QALY likely below commonly accepted cost-effectiveness thresholds. In PPMS, ocrelizumab fills a clear clinical gap in the current clinical practice. Overall, ocrelizumab is expected to provide good value for money in addressing the need of MS patients.info:eu-repo/semantics/publishedVersio

The characterization of a new set of EST-derived simple sequence repeat (SSR) markers as a resource for the genetic analysis of Phaseolus vulgaris

<p>Abstract</p> <p>Background</p> <p>Over recent years, a growing effort has been made to develop microsatellite markers for the genomic analysis of the common bean (<it>Phaseolus vulgaris</it>) to broaden the knowledge of the molecular genetic basis of this species. The availability of large sets of expressed sequence tags (ESTs) in public databases has given rise to an expedient approach for the identification of SSRs (Simple Sequence Repeats), specifically EST-derived SSRs. In the present work, a battery of new microsatellite markers was obtained from a search of the <it>Phaseolus vulgaris </it>EST database. The diversity, degree of transferability and polymorphism of these markers were tested.</p> <p>Results</p> <p>From 9,583 valid ESTs, 4,764 had microsatellite motifs, from which 377 were used to design primers, and 302 (80.11%) showed good amplification quality. To analyze transferability, a group of 167 SSRs were tested, and the results showed that they were 82% transferable across at least one species. The highest amplification rates were observed between the species from the <it>Phaseolus </it>(63.7%), <it>Vigna </it>(25.9%), <it>Glycine </it>(19.8%), <it>Medicago </it>(10.2%), <it>Dipterix </it>(6%) and <it>Arachis </it>(1.8%) genera. The average PIC (Polymorphism Information Content) varied from 0.53 for genomic SSRs to 0.47 for EST-SSRs, and the average number of alleles per locus was 4 and 3, respectively. Among the 315 newly tested SSRs in the BJ (BAT93 X Jalo EEP558) population, 24% (76) were polymorphic. The integration of these segregant loci into a framework map composed of 123 previously obtained SSR markers yielded a total of 199 segregant loci, of which 182 (91.5%) were mapped to 14 linkage groups, resulting in a map length of 1,157 cM.</p> <p>Conclusions</p> <p>A total of 302 newly developed EST-SSR markers, showing good amplification quality, are available for the genetic analysis of <it>Phaseolus vulgaris</it>. These markers showed satisfactory rates of transferability, especially between species that have great economic and genomic values. Their diversity was comparable to genomic SSRs, and they were incorporated in the common bean reference genetic map, which constitutes an important contribution to and advance in <it>Phaseolus vulgaris </it>genomic research.</p

Ectopia cordis: caso clínico

Introduction: ectopia cordis is a rare congenital malformation, with an estimated incidence of 5 to 8 per million live births. It is defined as a malformation in which the heart is located in an extra-thoracic position. Ectopia cordis may occur as an isolated malformation or associated with other anomalies such as omphalocele, congenital heart disease or integrating Cantrell syndrome. The size and location of the defect influence the prognosis. Description: we report a case of a 24-year-old nulliparous woman, with no relevant family or personal history, in which the prenatal fetal ultrasound, performed at 21 weeks of gestation, revealed a defect of the anterior chest wall with exteriorization of the heart. Discussion: fetal echocardiography revealed a severe congenital heart disease. The parents decided to continue the pregnancy, after being duly informed by a multidisciplinary team. Delivery occurred at 37 weeks of gestation but the female newborn died one hour afterwards. Pathological examination confirmed the sonographic findings

Using method frequency scanning based on direct digital synthesizers for geotechnical monitoring of buildings

The possibility of using the principle of frequency scanning as an alternative to the spectral-time analysis method for isolating the own frequencies of structures to provide their geotechnical accelerometric phase-metric method is considered in the article. As the devices realizing this method, direct digital synthesizers, are considered, their determining advantages are indicated and the main drawback associated with the presence of a lot of parasitic spectral components in the spectrum of the synthesized signal is indicate

Supernovae from rotating stars

The present paper discusses the main physical effects produced by stellar rotation on presupernovae, as well as observations which confirm these effects and their consequences for presupernova models. Rotation critically influences the mass of the exploding cores, the mass and chemical composition of the envelopes and the types of supernovae, as well as the properties of the remnants and the chemical yields. In the formation of gamma-ray bursts, rotation and the properties of rotating stars appear as the key factor. In binaries, the interaction between axial rotation and tidal effects often leads to interesting and unexpected results. Rotation plays a key role in shaping the evolution and nucleosynthesis in massive stars with very low metallicities (metallicity below about the Small Magellanic Cloud metallicity down to Population III stars). At solar and higher metallicities, the effects of rotation compete with those of stellar winds. In close binaries, the synchronisation process can lock the star at a high rotation rate despite strong mass loss and thus both effects, rotation and stellar winds, have a strong impact. In conclusion, rotation is a key physical ingredient of the stellar models and of presupernova stages, and the evolution both of single stars and close binaries. Moreover, important effects are expected along the whole cosmic history.Comment: 36 pages, 15 figures, published in Handbook of Supernovae, A.W. Alsabti and P. Murdin (eds), Springe

Kinome rewiring reveals AURKA limits PI3K-pathway inhibitor efficacy in breast cancer.

Dysregulation of the PI3K-AKT-mTOR signaling network is a prominent feature of breast cancers. However, clinical responses to drugs targeting this pathway have been modest, possibly because of dynamic changes in cellular signaling that drive resistance and limit drug efficacy. Using a quantitative chemoproteomics approach, we mapped kinome dynamics in response to inhibitors of this pathway and identified signaling changes that correlate with drug sensitivity. Maintenance of AURKA after drug treatment was associated with resistance in breast cancer models. Incomplete inhibition of AURKA was a common source of therapy failure, and combinations of PI3K, AKT or mTOR inhibitors with the AURKA inhibitor MLN8237 were highly synergistic and durably suppressed mTOR signaling, resulting in apoptosis and tumor regression in vivo. This signaling map identifies survival factors whose presence limits the efficacy of targeted therapies and reveals new drug combinations that may unlock the full potential of PI3K-AKT-mTOR pathway inhibitors in breast cancer