From opportunity seeking to gap filling: Reframing Brazil in Lusophone Africa

This chapter inquires whether Brazil’s headways in Africa over recent years were organic in nature and in content or, in fact, were achieved at the expense of other previously established actors. By reframing Brazil’s agenda towards African lusophone countries in juxtaposition to the perceived external downturn of Portugal, the propitious context and consequences of a new player on the continent can be best brought into evidence. The push-and-pull forces enacted by both Brazil and Portugal towards Lusophone Africa are explored through the aftermath of the 2012 military coup in Guinea-Bissau and the adhesion of Equatorial Guinea to the Community of Portuguese Language Countries (CPLP) in 2014. The chapter offers a reinterpretation of Brazil’s net gains in Africa and argues for its fragility and susceptibility to changing political-economic cycles.info:eu-repo/semantics/acceptedVersio

Down-titration of biologics for the treatment of rheumatoid arthritis: A systematic literature review

Biologic therapies have improved the management of rheumatoid arthritis (RA) and the treat-to-target approach has resulted in many patients achieving remission. In the current treatment landscape, clinicians have begun considering dose reduction/tapering for their patients. Rheumatology guidelines in Asia, Europe, and the United States include down-titration of biologics but admit that the level of evidence is moderate. We conducted a systematic literature review to assess the published studies that evaluate down-titration of biologics in RA. The published literature was searched for studies that down-titrated the following biologics: abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, and tocilizumab. Eligible studies included randomized controlled trials (RCTs), non-RCTs, observational, and pharmacoeconomic studies. The outcomes of interest were (1) efficacy and health-related quality of life, (2) disease flares, and (3) impact on cost. Eleven full-text publications were identified; only three were RCTs. Study results suggest that dosing down may be an option in many patients who have achieved remission or low disease activity. However, some patients are likely to experience a disease flare. Across the studies, the definition of disease flare and the down-titration criteria were inconsistent, making it difficult to conclude which patients may be appropriate and when to attempt down-titration. Studies have evaluated the practice of dosing down biologic therapy in patients with RA; however, a relatively small number of RCTs have been published. Although down-titration may be an option for some patients in LDA or remission, additional RCTs are needed to provide guidance on this practice