Short-Term Therapy with Enoxaparin or Unfractionated Heparin for Venous Thromboembolism in Hospitalized Patients: Utilization Study and Cost-Minimization Analysis

AbstractObjectivesTo evaluate the direct costs of venous thromboembolism (VTE) treatment with unfractionated heparin (UFH) and low-molecular weight heparin, from the institutional perspective.MethodsThis is a real-world cohort study that included inpatients treated with UFH or enoxaparin for deep venous thromboembolism or pulmonary embolism in a tertiary public hospital. To estimate medical costs we computed the acquisition costs of drugs, supplies for administration, laboratory tests, and hospitalization cost according to the patient ward.ResultsOne hundred sixty-seven patients aged 18 to 92 years were studied (50 treated with UFH and 117 with enoxaparin). The median of days in use of heparin was the same in both groups. Activated partial thromboplastin time was monitored in 98% of patients using UFH and 56.4% using enoxaparin. Nonstatistically significant differences were observed between groups in the number of bleeding events (10.0% and 9.4%; P = 1.00); blood transfusion (2.0% and 2.6%; P = 1.00); death (8.0% and 3.4%; P = 0.24); and recurrent VTE, bleeding, or death (20.0% and 14.5%; P = 0.38). Daily mean cost per patient was US$12.63 ±$4.01 for UFH and US$9.87 ±$2.44 for enoxaparin (P < 0.001). The total costs considering the mean time of use were US$88.39 and US$69.11.ConclusionThe treatment of VTE with enoxaparin provided cost savings in a large teaching hospital located in southern Brazil

Interferon-lambda 3 and 4 polymorphisms increase sustained virological responses and regulate innate immunity in antiviral therapy with pegylated interferon-alpha

Sustained virologic response (SVR) in chronic hepatitis C (CHC) treatment denotes that the host genetics controls the immune response and unequivocally contribute to viral clearance or disease severity. In this context, single nucleotide polymorphisms (SNPs) in the locus of interferon lambda 3 and 4 genes (IFNL3/4) have been important genetic markers of responsiveness to CHC as prognostic markers for the pegylated-Interferonalpha/ ribavirin (Peg-IFN-a/RBV). Here, we analyzed 12 SNPs at the IFNL3/4 region in 740 treatment-naïve patients with CHC infected with hepatitis C virus (HCV) genotypes 1, 2, or 3 treated with Peg-IFN-a/RBV. Individually, rs12979860-CC, rs8109886-CC, or rs8099917-TT were predictive markers of SVR, while rs12979860-CC demonstrated the stronger effect. Besides, the genotypic combination of these three predictors’ genotypes, CC/CC/TT, increased the rate of SVR. Serum levels of cytokines and gene expression analysis on the genes IFNL3, IFNL4, IFNA1, and some of the IFN-stimulated genes (ISGs) were measured in a subgroup of 24 treated patients and 24 healthy volunteers. An antagonist effect was highlighted between the expression of IFNL3/4 and IFNA1 mRNA among patients. Besides, a prominent production of the proinflammatory chemokines CCL4 and CXCL10 was observed at a 12-week treatment follow-up. Lower serum levels of these chemokines were detected in patients with an rs12979860-CC genotype associated with the better treatment outcome. Also, lower expression levels of the IFI6, IFI16, IRF9 genes were observed among rs12979860-CC individuals. In conclusion, a combination of the genotypes at the IFNL3/4 locus can act as a better marker for the prognosis for virological responses in an admixed Brazilian population presenting the modulating effect over innate immunity and inflammation that are controlling the outcome of the viral infection, but also other infectious diseases

Helicobacter pylori eradication : influence of interleukin-1beta –31 C/T polymorphism

Aim: To analyze the influence of the –31 C/T polymorphism of the interleukin-1 gene on Helicobacter pylori eradication therapy success in patients with functional dyspepsia. Methods: Functional dyspepsia was diagnosed according to the Rome III criteria. All patients underwent upper gastrointestinal endoscopy, and gastric biopsies were obtained at screening and 12 months after randomization (last follow-up visit). Urease test and histological examination were performed to define the H. pylori status. Patients received twice-daily amoxicillin, clarithromycin and omeprazole for 10 days. Genotyping of the interleukin-1beta –31 C/T polymorphism (rs1143627)was performed using polymerase chain reaction-restriction fragment length polymorphism. Results: One hundred forty-nine patients received treatment with triple therapy for H. pylori eradication. Only one patient was lost to follow-up, and adherence to study medication was 94.6%. A total of 148 patients (mean age 46.08±12.24 years; 81.8% women) were evaluated for the influence of the interleukin-1beta –31 C/T polymorphism on the outcome of H. pylori eradication therapy. After treatment, bacteria were eradicated in 87% of patients (129/148). Genotype frequencies of the polymorphism were as follows: CC, 38/148 (25.7%); CT, 71/148 (47.9%); and TT, 39/148 (26.4%). Successful eradication rate was 78.9%, 94.4% and 82.1% for the CC, CT and TT genotypes, respectively. The CT genotype was significantly associated with successful H. pylori eradication (p = 0.039). Conclusion: This study suggests that the CT genotype of the interleukin-1beta –31 C/T polymorphism plays a role in the successful eradication of H. pylori among patients with functional dyspepsia

Estudo do polimorfismo -31C/T do gene da interleucina 1-beta em pacientes dispépticos funcionais

O papel de fatores genéticos na suscetibilidade à dispepsia funcional (DF) ainda não está esclarecido. A interleucina1-beta (IL-1β) é uma citocina que induz e amplifica a resposta inflamatória, sendo que a inflamaçãona mucosa gástrica pode estar envolvida com os sintomas dispépticos. O objetivo do presente estudo foi analisara associação entre o polimorfismo -31C/T do gene da IL-1β e a DF. Foram analisados 73 pacientes dispépticos,positivos para a infecção pelo Helicobacter pylori. Os resultados preliminares indicam que o polimorfismo podeestar associado ao sucesso da terapia de erradicação do H. pylori.Palavras-chave: Dispepsia funcional, interleucina 1-beta, polimorfismo genético, sintomas dispépticos,Helicobacter pylori